Rescue nasopharyngeal tube for preterm infants non-responsive to initial ventilation after birth

Background Physiological changes during the insertion of a rescue nasopharyngeal tube (NPT) after birth are unclear. Methods Observational study of very preterm infants in the delivery room. Data were extracted at predefined timepoints starting with first facemask placement after birth until 5 min after insertion of NPT. End-expiratory lung impedance (EELI), heart rate (HR) and SpO 2 /FiO 2 -ratio were analysed over time. Changes during the same time span of NIPPV via facemask and NIPPV via NPT were compared. Results Overall, 1154 inflations in 15 infants were analysed. After NPT insertion, EELI increased significantly [0.33 AU/kg (0.19–0.57), p < 0.001]. Compared with the mask period, changes in EELI were not significantly larger during the NPT period [median difference (IQR) = 0.14 AU/kg (−0.14–0.53); p = 0.12]. Insertion of the NPT was associated with significant improvement in HR [52 (33–96); p = 0.001] and SpO 2 /FiO 2 -ratio [161 (69–169); p < 0.001] not observed during the mask period. Conclusions In very preterm infants non-responsive to initial facemask ventilation after birth, insertion of an NPT resulted in a considerable increase in EELI. This additional gain in lung volume was associated with an immediate improvement in clinical parameters. The use of a NPT may prevent intubation in selected non-responsive infants. Impact After birth, a nasopharyngeal tube may be considered as a rescue airway in newborn infants non-responsive to initial positive pressure ventilation via facemask. Although it is widely used among clinicians, its effect on lung volumes and physiological parameters remains unclear. Insertion of a rescue NPT resulted in a considerable increase in lung volume but this was not significantly larger than during facemask ventilation. However, insertion of a rescue NPT was associated with a significant and clinically important improvement in heart rate and oxygenation. This study highlights the importance of individual strategies in preterm resuscitation and introduces the NPT as a valid option.