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Arch Dis Child. 2018 Mar;103(3):255-260. doi: 10.1136/archdischild-2017-312934. Epub 2017 Sep 14.

Neonatal resuscitation using a laryngeal mask airway: a randomised trial in Uganda.

Author information

1
Centre for International Health, Universitetet i Bergen, Bergen, Norway.
2
Neonatal Unit, Sachs' Children and Youth Hospital, Stockholm, Sweden.
3
Department of Public Health Science, Karolinska Institute, Stockholm, Sweden.
4
Department of Pediatrics, Padua University, Padua, Italy.
5
Mulago National Referral Hospital, Kampala, Uganda.
6
Independent statistician, Padua, Italy.
7
Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda.
8
Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Abstract

OBJECTIVE:

Mortality rates from birth asphyxia in low-income countries remain high. Face mask ventilation (FMV) performed by midwives is the usual method of resuscitating neonates in such settings but may not always be effective. The i-gel is a cuffless laryngeal mask airway (LMA) that could enhance neonatal resuscitation performance. We aimed to compare LMA and face mask (FM) during neonatal resuscitation in a low-resource setting.

SETTING:

Mulago National Referral Hospital, Kampala, Uganda.

DESIGN:

This prospective randomised clinical trial was conducted at the labour ward operating theatre. After a brief training on LMA and FM use, infants with a birth weight >2000 g and requiring positive pressure ventilation at birth were randomised to resuscitation by LMA or FM. Resuscitations were video recorded.

MAIN OUTCOME MEASURES:

Time to spontaneous breathing.

RESULTS:

Forty-nine (24 in the LMA and 25 in the FM arm) out of 50 enrolled patients were analysed. Baseline characteristics were comparable between the two arms. Time to spontaneous breathing was shorter in LMA arm than in FM arm (mean 153 s (SD±59) vs 216 s (SD±92)). All resuscitations were effective in LMA arm, whereas 11 patients receiving FM were converted to LMA because response to FMV was unsatisfactory. There were no adverse effects.

CONCLUSION:

A cuffless LMA was more effective than FM in reducing time to spontaneous breathing. LMA seems to be safe and effective in clinical practice after a short training programme. Its potential benefits on long-term outcomes need to be assessed in a larger trial.

CLINICAL TRIAL REGISTRY:

This trial was registered in https://clinicaltrials.gov, with registration number NCT02042118.

KEYWORDS:

Asphyxia Neonatorum; Global Health; Laryngeal Masks; Newborn Infant; Resuscitation

PMID:
28912163
PMCID:
PMC5865513
DOI:
10.1136/archdischild-2017-312934
[Indexed for MEDLINE]
Free PMC Article

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