Neaha Patel, Lee Prior Collier, Arameh Aghababaie, Burak Salgin
{"title":"Respiratory function monitoring for neonatal resuscitation: a narrative review.","authors":"Neaha Patel, Lee Prior Collier, Arameh Aghababaie, Burak Salgin","doi":"10.1136/archdischild-2025-328586","DOIUrl":null,"url":null,"abstract":"<p><p>Newborn infants must undergo complex physiological changes when transitioning from fetal to extrauterine life, including rapid lung aeration, fluid clearance and major haemodynamic shifts. Although the majority breathe spontaneously, a significant minority may require respiratory support. Resuscitation guidelines recommend face-mask positive pressure ventilation with a T-piece resuscitator, but effectiveness in the delivery room (DR) is typically assessed by subjective measures such as chest wall movement.This narrative review summarises the evidence regarding the use of respiratory function monitors (RFMs) to provide real-time objective feedback on tidal volumes, pressures and mask leak during DR resuscitation. We examine the potential for RFMs to reduce the risk of both underventilation and overventilation and whether their employment in the first few hours of life could mitigate long-term complications such as bronchopulmonary dysplasia and intraventricular haemorrhage. We also explore practical considerations such as sensor technology, dead space, staff training, usability and cost-effectiveness. While systematic reviews and major international guidelines have not yet endorsed their routine implementation, citing limited randomised controlled trial data, multiple observational studies demonstrate that RFMs can improve DR ventilation. Ultimately, RFMs may facilitate individualised, lung-protective approaches to DR ventilation, particularly in vulnerable preterm infants. Future directions include high-quality trials with comprehensive clinical outcomes, cost-effectiveness evaluations and clarifications of training requirements for effective RFM use.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Disease in Childhood - Fetal and Neonatal Edition","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/archdischild-2025-328586","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Newborn infants must undergo complex physiological changes when transitioning from fetal to extrauterine life, including rapid lung aeration, fluid clearance and major haemodynamic shifts. Although the majority breathe spontaneously, a significant minority may require respiratory support. Resuscitation guidelines recommend face-mask positive pressure ventilation with a T-piece resuscitator, but effectiveness in the delivery room (DR) is typically assessed by subjective measures such as chest wall movement.This narrative review summarises the evidence regarding the use of respiratory function monitors (RFMs) to provide real-time objective feedback on tidal volumes, pressures and mask leak during DR resuscitation. We examine the potential for RFMs to reduce the risk of both underventilation and overventilation and whether their employment in the first few hours of life could mitigate long-term complications such as bronchopulmonary dysplasia and intraventricular haemorrhage. We also explore practical considerations such as sensor technology, dead space, staff training, usability and cost-effectiveness. While systematic reviews and major international guidelines have not yet endorsed their routine implementation, citing limited randomised controlled trial data, multiple observational studies demonstrate that RFMs can improve DR ventilation. Ultimately, RFMs may facilitate individualised, lung-protective approaches to DR ventilation, particularly in vulnerable preterm infants. Future directions include high-quality trials with comprehensive clinical outcomes, cost-effectiveness evaluations and clarifications of training requirements for effective RFM use.
期刊介绍:
Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.