Delivery room resuscitation of near-term infants: role of the laryngeal mask airway

Aim: This observational study aims to describe: (1) the use of positive pressure ventilation (PPV) for resuscitation in the delivery room among newly born near-term infants; (2) the methods used for PPV resuscitation [e.g., bag-facial mask (BFM), laryngeal mask airway (LMA), endotracheal tube (ETT)]; and (3) the association of each device with short-term neonatal outcomes.

Methods: We identified near-term (34 0/7-36 6/7 weeks) infants delivered at the Padua University Hospital (Padua, Italy) during the years 2002-2006. The mode of delivery, gestational age, birth weight, Apgar scores, methods of resuscitation and respiratory outcome after NICU admission were analysed.

Results: During the 5-year study period, 921 (4.9%) near-term infants were identified from a total of 18,641 live births. PPV was provided in the delivery room to 86 (9.3%) of these infants. Among them, 36 (41.8%) were managed by LMA, 34 (39.5%) by BFM and 16 (18.6%) by ETT. Thirty-four (39.5%) resuscitated near-term infants were admitted to the Neonatal Intensive Care Unit (NICU): 15 (44.1%) after BFM, 12 (75%) after ETT and seven (19.4%) after LMA. Resuscitation with an ETT was associated with an increased rate of respiratory distress syndrome when compared with either BFM or LMA. Resuscitation with an LMA was associated with a lower rate of NICU admission and shorter length of stay when compared with either BFM or ETT.

Conclusion: The LMA is an effective device for primary airway management of near-term infants and for secondary airway management among near-term infants failing BFM or ETT resuscitation.