Establishing breathing and oxygenation after birth is vital for survival and long-term health of premature infants. However, approximately 10% of premature infants require breathing support at birth. An international consensus and various national resuscitation guidelines suggest techniques and equipment for neonatal resuscitation. They all agree positive pressure ventilation is the cornerstone of breathing support in the delivery room.
A lung-protective strategy should start immediately after birth. To facilitate the early development of functional residual capacity, and improve oxygenation during the transition of preterm infants, sustained inflations, positive end expiratory pressure and continuous positive airway pressure (CPAP) should be applied at the initiation of respiratory support. Although sustained inflations (SI) are advocated as lung recruitment maneuvers and positive end expiratory pressure helps to maintain end expiratory lung volume, neither of these has been mandated in neonatal resuscitation guidelines. This presentation will provide an update on current literature about techniques and devices used during neonatal resuscitation. Initial respiratory support provided with either CPAP, SI, and positive pressure ventilation along with available devices (e.g. face mask, nasal prong, Guedel airway, Laryngeal airway mask) will be discussed. In addition, new insights about intubation and chest compressions will be presented.