Are airway adjuncts useful or indicated in the management of the newborn?
Yes. CPAP is widely used in infants who are breathing but exhibiting increased respiratory effort. It has been studied in preterm infants and shown to decrease intubation rates, mechanical ventilation duration, and use of surfactant, but increases rates of pneumothorax. Local expertise and comfort should guide the use of CPAP.
Laryngeal mask airways (LMAs) are adjuncts to airway management and are generally used when tracheal intubation is unable to be attained or face mask ventilation is inadequate. The newly born infant over 2000 g or 34 or more weeks of gestation can be ventilated effectively with LMAs. They have not been studied in infants with meconium-stained fluid, during chest compressions, or for the administration of tracheal medications.
Kattwinkel J, Perlman JM, Aziz K, et al: Part 15: Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S909-S919.
Trevisanuto D, Micaglio M, Pitton M, et al: Laryngeal mask airway: Is the management of neonates requiring positive pressure ventilation at birth changing? Resuscitation 2004;62:151-157.