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ObjectivesWe investigated the inflating pressures (Pinfl, the difference between peak inspiratory pressure and positive end-expiratory pressure) in infants receiving volume targeted ventilation.MethodsData were collected and analysed from 195 infants. Median Pinfl was determined before each blood gas (n = 3425). Ventilator parameters and blood gases were compared between periods when Pinfl was <5 mbar and periods when it was higher.Results1-hour periods when median Pinfl was <5 mbar occurred in 30% of the babies and were associated with similar tidal volumes and minutes ventilation as periods with higher Pinfl. Babies triggered more ventilator inflations, had more spontaneous breaths and lower oxygen requirement when Pinfl was low. There was no difference in blood gases when Pinfl was <5 mbar or when it was higher.ConclusionsEpisodes of low inflating pressure occur frequently in babies receiving volume targeted ventilation, but they do not lead to changes in blood gases.

Objectives To analyse deviation of ventilator parameters from their set targets during high-frequency oscillatory ventilation (HFOV) with or without volume guarantee (VG) and compare the two modes during emergency neonatal transport. Study design Retrospective observational study using the fabian™ HFOi ventilator. Results Median deviation of mean airway pressure from the set value was <1 cmH 2 O. During HFOV the pressure amplitude differed from the set value by <1 cmH 2 O. During HFOV-VG median deviation of the oscillation volume (VThf) from the targeted value was −0.07 mL/kg, but in some cases VThf was by >0.38 mL/kg below target. Setting maximum allowed amplitude 10 cmH 2 O above the usually required amplitude improved maintenance of VThf. HFOV and HFOV-VG parameters were similar, except the lower amplitude during HFOV without VG. VThf <2.5 mL/kg avoided hypercapnia in most cases. Conclusions HFOV and HFOV-VG maintain ventilator parameters close to their targets and are promising modalities during neonatal transport.

Objective To assess stabilization, respiratory care and survival of extremely low birth weight (ELBW, <1000 g at birth) infants requiring emergency transfer to tertiary NICUs on the first day of life. Study design Retrospective cohort study of 55 ELBW infants transported by a dedicated neonatal transport service over a 65-month period. Ventilator data were downloaded computationally. Results 95% of infants were intubated and received surfactant prior to transfer. Median expired tidal volume was 5.0 mL/kg (interquartile range: 4.6–6.2 mL/kg). Infants ventilated with SIPPV had significantly higher mean airway pressure and minute ventilation, but similar FiO 2 compared to babies on SIMV. Blood gases showed significant improvement during transport. 55% of infants survived to discharge from NICU. Conclusion Most ELBW infants transferred on the first day of life require mechanical ventilation and can be ventilated with 5 mL/kg tidal volume.

Background Retinopathy of prematurity is treated with laser photocoagulation under general anaesthesia with intubation using endotracheal tube (ETT), which carries a risk for postoperative mechanical ventilation (MV). Laryngeal mask airway (LMA) may provide a safe alternative. We assessed the need for postoperative MV in preterm infants who received LMA versus ETT. Methods In this single-centre, retrospective cohort study, preterm infants who underwent laser photocoagulation between 2014–2021 were enroled. For airway management, patients received either LMA ( n  = 224) or ETT ( n  = 47). The outcome was the rate of postoperative MV. Results Patients’ age were 37 [35;39] weeks of postmenstrual age, median bodyweight of Group LMA was higher than Group ETT’s (2110 [1800;2780] g versus 1350 [1230;1610] g, respectively, p  < 0.0001). After laser photocoagulation, 8% of Group LMA and 74% of Group ETT left the operating theatre requiring MV. Multiple logistic regression revealed that the use of LMA and every 100 g increase in bodyweight significantly decreased the odds of mechanical ventilation (OR 0.21 [95% CI 0.07–0.60], and 0.73 [95% CI 0.63–0.84], respectively). Propensity score matching confirmed that LMA decreased the odds of postoperative MV (OR 0.30 [95% CI 0.11–0.70]). Conclusion The use of LMA is associated with a reduced need for postoperative MV. Impact Using laryngeal mask airway instead of endotracheal tube for airway management in preterm infants undergoing general anaesthesia for laser photocoagulation for treating retinopathy of prematurity could significantly decrease the postoperative need for mechanical ventilation. According to our current understanding, this has been the largest study investigating the effect of laryngeal mask airway during general anaesthesia in preterm infants. Our study suggests that the use of laryngeal mask airway is a viable alternative to intubation in the vulnerable population of preterm infants in need of laser treatment.