Resuscitation 107 (2016) 25–30 Contents lists available at ScienceDirect Resuscitation jou rn al hom ep age : w ww.elsevier.com/locate/resuscitation Clinical paper Ventilation fraction during the first 30 s of neonatal resuscitation ,,⋆ Christiane Skåre a,∗ , Anne-Marthe Boldingh b,c , Britt Nakstad b,c , Tor Einar Calisch d , Dana E. Niles e , Vinay M. Nadkarni f , Jo Kramer-Johansen a , Theresa M. Olasveengen a a Norwegian National Advisory Unit for Prehospital Emergency Care (NAKOS) and Department of Anaesthesiology, Oslo University Hospital and University of Oslo, Oslo, Norway b Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway c Institute of Clinical Medicine Campus Ahus, University of Oslo, Lørenskog, Norway d Neonatal Intensive Care Unit, Oslo University Hospital, Oslo, Norway e Center for Simulation, Advanced Education and Innovation, The Children’s Hospital in Philadelphia, Philadelphia, USA f Department of Anesthesia, Critical Care and Pediatrics, University of Pennsylvania Perelman School of Medicine, The Children’s Hospital of Philadelphia, Philadelphia, USA a r t i c l e i n f o Article history: Received 20 January 2016 Received in revised form 6 July 2016 Accepted 17 July 2016 Keywords: Neonatal resuscitation Positive pressure ventilation Education a b s t r a c t Aim: Approximately 5% of newborns receive positive pressure ventilation (PPV) for successful transition. Guidelines urge providers to ensure effective PPV for 30–60 s before considering chest compressions and intravenous therapy. Pauses in this initial PPV may delay recovery of spontaneous respiration. The aim was to find the ventilation fraction during the first 30 s of PPV in non-breathing babies. Methods: Prospective observational study in two hospitals in Norway. All newborns receiving PPV imme- diately after delivery were included. Cameras with motion detectors were installed at every resuscitation bay capturing both expected and unexpected compromised newborns. We determined the cumulative number of seconds with PPV efforts excluding pauses in infants without spontaneous breathing and reported ventilation fraction during the first minute. Data are presented as median (IQR). Results: 110 of 3508 (3%) newborns received PPV and were filmed in the resuscitation bays. PPV started 42 (18–78) s after arrival at the resuscitation bay and median duration was 100 (35–225) s. Forty-eight infants (44%) were ventilated continuously, or with minimal pause (ventilation fraction >90%) during the first 30 s of PPV. For the remaining 62 infants ventilation fraction was 60% (39–75). PPV was interrupted due to adjustments, checking heart rate, stimulation, administration of CPAP and suctioning. Conclusion: In 56% of the neonatal resuscitations interruptions in ventilation are frequent with 60% ven- tilation fraction during the first 30 s of PPV. Eliminating disruption for improved quality of PPV delivery should be emphasized when training newborn resuscitation providers. © 2016 Elsevier Ireland Ltd. All rights reserved. Introduction Immediately after birth, the newborn child transitions from placenta-based oxygenation to pulmonary-based oxygenation Abbreviations: PPV, positive pressure ventilation; CPAP, continuous positive airways pressure; NICU, newborn intensive care unit; ERC, European Resuscita- tion Council; ILCOR, International Liaison Committee of Resuscitation; OUH, Oslo University Hospital; AUH, Akershus University Hospital.  A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2016.07.231.  The clinical trial registration number: NCT02347241. ⋆ The institutional reference numbers: 2013/12769 (OUH) and 14-032 (AUH). ∗ Corresponding author at: Department of Anaesthesiology, Oslo University Hos- pital, PB 4956 Nydalen, N-0424 Oslo, Norway. Fax: +47 23016799. E-mail address: christiane.skare@medisin.uio.no (C. Skåre). with the onset of lung aeration and spontaneous respiration. 1 This transition is uncomplicated for most infants, however approxi- mately 5% receive ventilatory support to facilitate liquid movement out of the airways. 2 Most depressed neonates respond to applied positive end-expiratory pressure or positive pressure ventila- tion (PPV) to increase functional residual capacity. 3 International guidelines in neonatal resuscitation recommend providers ensure effective PPV for at least 30 s before considering chest compressions and intravenous therapy. 4,5 Video recordings have been suggested to be a valuable tool to evaluate resuscitation performance and outcome during neona- tal resuscitations. 6–9 Difficulties with mask leak, head position, obstructed airways or inappropriate airway pressures have been reported even when highly experienced and skilled neonatolo- gists resuscitate infants. 10–13 These previous studies have mainly http://dx.doi.org/10.1016/j.resuscitation.2016.07.231 0300-9572/© 2016 Elsevier Ireland Ltd. 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