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Relationship of resuscitation, respiratory function monitoring data and outcomes in preterm infants


Intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD) are major complications of premature birth. We tested the hypotheses that prematurely born infants who developed an IVH or BPD would have high expiratory tidal volumes (VTE) (VTE > 6 ml/kg) and/or low-end tidal carbon dioxide (ETCO2) levels (ETCO2 levels < 4.5 kPa) as recorded by respiratory function monitoring or hyperoxia (oxygen saturation (SaO2) > 95%) during resuscitation in the delivery suite. Seventy infants, median gestational age 27 weeks (range 23–33), were assessed; 31 developed an IVH and 43 developed BPD. Analysis was undertaken of 31,548 inflations. The duration of resuscitation did not differ significantly between the groups. Those who developed an IVH compared to those who did not had a greater number of inflations with a high VTE and a low ETCO2, which remained significant after correcting for differences in gestational age and birth weight between groups (p = 0.019). Differences between infants who did and did not develop BPD were not significant after correcting for differences in gestational age and birth weight. There were no significant differences in the duration of hyperoxia between the groups.

Conclusions: Avoidance of high tidal volumes and hypocarbia in the delivery suite might reduce IVH development.

What is known
Hypocarbia on the neonatal unit is associated with the development of intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD).
What is new
Infants who developed an IVH compared to those who did not had significantly more inflations with high expiratory tidal volumes and low ETCO2s.

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Fig. 1



Bronchopulmonary dysplasia

CO2 :

Carbon dioxide


End tidal carbon dioxide

FiO2 :

Inspired oxygen fraction


Intraventricular haemorrhage


Positive end expiratory pressure

VT :

Tidal volumes


Expiratory tidal volumes


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Dr. Murthy was supported by a grant from the Guy’s and St Thomas’ Charity. Dr. Bhat and Dr. Hunt were supported by a grant from the Charles Wolfson Charitable Trust. Additionally, Dr. Hunt was supported by SLE. The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Author information

AP collected and analysed the data.

KH collected and analysed the data.

VM collected the data.

PB collected the data.

AG designed the study and analysed the data.

AM designed the study and analysed the data.

All the authors were involved in writing the manuscript and approved the final version.

Correspondence to Anne Greenough.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Infants whose parents gave informed, written consent were recruited.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Anoop Pahuja and Katie Hunt are joint first authors.

Communicated by Patrick Van Reempts

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Pahuja, A., Hunt, K., Murthy, V. et al. Relationship of resuscitation, respiratory function monitoring data and outcomes in preterm infants. Eur J Pediatr 177, 1617–1624 (2018). https://doi.org/10.1007/s00431-018-3222-y

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  • Bronchopulmonary dysplasia
  • Intraventricular haemorrhage
  • Prematurity
  • Resuscitation