Improving neonatal resuscitation at birth : technique and devices

The transition after birth represents one of the greatest physiologic challenges that humans encounter. Preterm infants often need respiratory support after birth. Little effort has been made to determine the adequacy and efficacy of ventilation in the delivery room. The general aim of this thesis was to evaluate the adequacy and efficacy of neonatal resuscitation. This thesis comprises manikin studies and observational studies in the delivery room to evaluate and optimise current technique and the use of devices. Mask ventilation is difficult and mostly inefficient. It should be trained regularly with a focus on leak and airway obstruction. A respiratory function monitor is a useful device for feedback on mask technique during training and resuscitation in the delivery room. Spontaneous breathing, which is often missed, contributes to the stabilisation of infants after birth. When using a T-piece resuscitator a fixed gas flow rate is recommended. Caregivers often deviate from the guidelines and more time is needed for clinical evaluation of the infant. Future research and clinical practice should focus on training of optimal mask technique, establishing the efficacy of a respiratory function monitor in the delivery room, and the development of ventilation techniques that focus on the presence of breathing