Author:
Kong Juin Yee,Quek Bin Huey,Lim Charis S.E.,Sultana Rehena,Ng Yvonne Y.V.,Rajadurai Victor Samuel,Yeo Kee Thai
Abstract
<b><i>Introduction:</i></b> End-tidal CO<sub>2</sub> (ETCO<sub>2</sub>) detector is currently recommended for confirmation of endotracheal tube placement during neonatal resuscitation. Whether it is feasible to use ETCO<sub>2</sub> detectors during mask ventilation to reduce risk of bradycardia and desaturations, which are associated with increased risk of death in preterm babies, is unknown. <b><i>Methods:</i></b> This is a pilot randomized controlled trial (NCT04287907) involving newborns 24 + 0/7 to 32 + 0/7 weeks gestation who required mask ventilation at birth. Infants were randomized into groups with or without colorimetric ETCO<sub>2</sub> detectors. Combined duration of any bradycardia (<100 bpm) and time below prespecified target oxygen saturation (SpO<sub>2</sub>) as measured by pulse oximetry were compared. <b><i>Results:</i></b> Fifty participants were randomized, 47 with outcomes analysed (2 incomplete data, 1 postnatal diagnosis of trachea-oesophageal fistula). Mean gestational age and birthweight were 28.5 ± 1.9 versus 29.4 ± 1.6 weeks (<i>p</i> = 0.1) and 1,252.7 ± 409.7 g versus 1,334.6 ± 369.1 g (<i>p</i> = 0.5) in the intervention and control arm, respectively. Mean combined duration of bradycardia and desaturation was 276.7 ± 197.7 s (intervention) and 322.7 ± 277.7 s (control) (<i>p</i> = 0.6). Proportion of participants with any bradycardia or desaturation at 5 min were 38.1% (intervention) and 56.5% (control) (<i>p</i> = 0.2). No chest compressions, epinephrine administration, or death occurred in the delivery room. <b><i>Conclusion:</i></b> This pilot study demonstrates the feasibility of a trial to evaluate colorimetric ETCO<sub>2</sub> detectors during mask ventilation of very preterm infants to reduce bradycardia and low SpO<sub>2</sub>. Further assessment with a larger population will be required to determine if ETCO<sub>2</sub> detector usage at resuscitation reduces risk of adverse outcomes, including death and disability, in very preterm infants.