Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 Apr;112(4):652-658.
doi: 10.1111/apa.16639. Epub 2022 Dec 28.

Quantitative end-tidal carbon dioxide at initiation of resuscitation may help guide the ventilation of infants born at less than 30 weeks gestation

Dharmesh Shah  1   2 , Mark Tracy  1   2 , Murray Hinder  1   2 , Nadia Badawi  2   3   4
Affiliations
Randomized Controlled Trial

Quantitative end-tidal carbon dioxide at initiation of resuscitation may help guide the ventilation of infants born at less than 30 weeks gestation

Dharmesh Shah et al. Acta Paediatr. 2023 Apr.

Abstract

Aim: Estimation of end-tidal carbon dioxide (EtCO2 ) with capnography can guide mask ventilation in infants born at less than 30 weeks of gestation. Chemical-sensitive colorimetric devices to detect CO2 are widely used at resuscitation. We aimed to quantify EtCO2 in the first breaths following initiation of mask ventilation at birth and correlated need for endotracheal intubation.

Methods: Infants <30 weeks gestation receiving mask ventilation were randomised into two groups of mask-hold technique (one-person vs. two-person). Data on EtCO2 in the first 30 breaths, time to achieve 5 mmHg, 10 mmHg and 15 mmHg CO2 using a respiratory function monitor was determined.

Results: Twenty-five infants with a mean gestation of 27.3 (±3 weeks) and mean birth weight 920.4 (±188.3 g) were analysed. The median EtCO2 was 5.6 mmHg in the first 10 breaths, whereas it was 12.6 mmHg for 11-20 breaths and 18 mmHg for 21-30 breaths. There was no significant difference in maximum median EtCO2 for the first 20 breaths, although EtCO2 was significantly lower in infants who were intubated (32.0 vs. 15.0, p = 0.018).

Conclusion: EtCO2 monitoring in infants <30 weeks gestation at birth is feasible and reflective of alveolar ventilation. EtCO2 may help guide ventilation of preterm infants at birth.

Keywords: end-tidal carbon dioxide; endotracheal intubation; mask ventilation; preterm infants; resuscitation.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Schmolzer GM, Te Pas AB, Davis PG, Morley CJ. Reducing lung injury during resuscitation of preterm infants. J Pediatr. 2008;153:741-745.
    1. Kamlin CO, Dawson JA, O'Donnell CP, et al. Accuracy of pulse oximetry measurement of heart rate of newborn infants in the delivery room. J Pediatr. 2008;152(6):756-760.
    1. Schmolzer GM, Morley CJ, Wong C, et al. Respiratory function monitor guidance of mask ventilation in the delivery room: a feasibility study. J Pediatr. 2012;160:377-381.
    1. Pahuja A, Hunt K, Murthy V, et al. Relationship of resuscitation, respiratory function monitoring data and outcomes in preterm infants. Eur J Pediatr. 2018;177:1617-1624.
    1. Blank D, Rich W, Leone T, Garey D, Finer N. Pedi-cap color change precedes a significant increase in heart rate during neonatal resuscitation. Resuscitation. 2014;85:1568-1572.

Publication types

LinkOut - more resources