Baby-Breathing with non-Invasive Respiratory support During Deferred umbilical cord clamping (A feasibility study).

Infants born very preterm have a high mortality rate and are at increased risk of worse neurodevelopmental outcomes and health-related problems. In recent years, convincing evidence has led to improved care and novel interventions for stabilisation of the newborn in the first 10 minutes of life, which may have a long-lasting impact on neonatal outcome. Non-invasive, continuous positive airway pressure (CPAP) immediately after birth of a very preterm infant (“VPTI,” <32 weeks’ gestational age at birth) is currently recommended as the standard of care during the stabilisation of preterm infants following birth. ) After birth, the infant must rapidly transition from a fluid filled lung, and dependence on the placenta for oxygenation and the elimination of carbon dioxide, to an aerated lung that successfully exchanges gases. CPAP supports the transition from fetal to newborn physiology by providing a distending pressure to the lung, thus maintaining a functional residual capacity (FRC) and enabling oxygenation and ventilation. While the rationale of most cord clamping studies has previously been based on the effects of placental transfusion, more recent studies in preterm lambs have demonstrated that delaying cord clamping until after ventilation onset prevents a rapid decrease in cardiac output. The observed large fluctuations in systemic and cerebral haemodynamics, and concomitant bradycardia and hypoxia frequently observed in preterm infants after ICC, could be avoided by delaying cord clamping until after aeration of the lung When a baby stops breathing or fails to establish normal breathing pattern positive pressure ventilation via a face mask is commenced to provide respiratory support while transitioning. The clinician attempts to create an air-tight seal on the infant’s face, with the nose and mouth inside the internal diameter of the mask. An adequate seal is difficult to achieve and the use of a facemask has the additional adverse effect of high compressive forces being applied to the infant’s face and head during resuscitation regardless of which brand of facemask is used, and even with the use of adjunct respiratory monitoring. Studies have shown that the majority of VPTI born less than 32 weeks completed gestation have a good respiratory drive immediately after birth. Ninety percent of VPTIs will initiate spontaneous breathing by 1 minute after birth. In this feasibility study we will recruit 40 very preterm neonates born from 24+0 weeks to 31+6 weeks completed gestation. We will provide nasal respiratory support to the participants at birth prior to umbilical cord clamping. We will provide CPAP (Continuous positive airway pressure) and if they baby is not spontaneously breathing will provide non-invasive ventilation to the baby. The aim of this study is to enable a longer period of delayed umbilical cord clamping (DCC) and improve cardiopulmonary transition in the neonates.