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What is the proper technique for assisting ventilations in the newly born infant?
The mask should fit around the nose and mouth but not cover the eyes or go below the chin. Assisted ventilations should be at a rate of 40 to 60 breaths per minute (30 breaths per minute when chest compressions are being performed). The initial breaths may require higher inflation pressures and longer inflation times. Monitor inflation pressure. An inflation pressure of 20 cm H 2 O may be sufficient. Regardless, the effectiveness of the assisted ventilation is judged by the movement of the chest, adequacy of breath sounds, and the heart rate. Poor face mask technique, airway obstruction, movement of the infant, interventions such as removing wet blankets, and distraction of the resuscitator contribute to ineffective mask ventilation. Mask leak and airway obstruction, being the most common reasons, may go undetected unless CO 2 detectors of residual function monitors are used.
If the condition of the neonate does not improve, then reposition the head, check for patency of the airway, improve the seal of the mask on the face, and increase the inflating pressure of the bag.
Sources
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.
O’Donnell C, Schmolzer GM: Resuscitation of the fetus and newborn resuscitation of preterm infants. Clin Perinatol 2012;39:857-869.
