ASSESSMENT OF MOUTH-TO-MASK VENTILATION IN RESUSCITATION OF ASPHYXIC NEWBORN BABIES - A PILOT-STUDY

The aim of the study was to compare the effectiveness of mouth-to-mask ventilation (MM) in neonatal asphyxia with bag-and-mask ventilation ( BM). A new mouth-to-mask infant resuscitation system was constructed. The study was performed in two university clinics with different resou rces. The KEM Hospital in Bombay was well equipped and neonatologists took part in all resuscitations; Muhimbili Medical Centre in Dar es Sa laam was understaffed and had no physicians available at resuscitation . Therefore, different protocols had to be used. In Bombay, the study period was limited to 5 minutes. If needed, mask ventilation was then replaced by intubation. In Dar es Salaam, MM ventilation was continued for up to 10 minutes, the inspiratory pressure was adjusted to 30 cmH (2)O and the ventilation was slow (8-10 breaths/min). In Bombay, 30 ba bies were allocated to the BM and 24 to the MM groups. In Dar es Salaa m 56 were in the BM and 64 in the MM groups. The results for term babi es in Bombay and both term and pre-term babies in Dar es Salaam showed no significant differences between the two groups of treatment, as de termined by Apgar score greater than or equal to 4 at 5 and 10 minutes , number of babies with their first gasp, heart rate >130 beats/min or pulse oximeter values above 75%, all at 5 minutes. An Apgar score gre ater than or equal to 4 at 5 minutes was achieved in more than 75% of all infants, irrespective of treatment. The rates of early neonatal mo rtality and neonatal convulsions did not differ between the two method s of resuscitation. In Dar es Salaam, the low respiratory frequency us ed in both groups was associated with a slow increase in heart rate ab ove 130 beats per min. This result indicates that further studies wilt be needed before such slow respiratory frequencies are used. We concl ude that, if adequate training is provided and the respiratory frequen cy is kept within the normal range, MM ventilation is an alternative t o assisted ventilation when no bag and mask is available. However, fur ther studies are necessary, since this method has proved to be tiring and uncomfortable for the resuscitating health personnel.