Quantitative end-tidal carbon dioxide at initiation of resuscitation may help guide the ventilation of infants born at less than 30 weeks gestation.

Aim: Estimation of end-tidal carbon dioxide (EtCO ) with capnography can guide mask ventilation in infants born at less than 30 weeks of gestation. Chemical-sensitive colorimetric devices to detect CO are widely used at resuscitation. We aimed to quantify EtCO in the first breaths following initiation of mask ventilation at birth and correlated need for endotracheal intubation.

Methods: Infants <30 weeks gestation receiving mask ventilation were randomised into two groups of mask-hold technique (one-person vs. two-person). Data on EtCO in the first 30 breaths, time to achieve 5 mmHg, 10 mmHg and 15 mmHg CO using a respiratory function monitor was determined.

Results: Twenty-five infants with a mean gestation of 27.3 (±3 weeks) and mean birth weight 920.4 (±188.3 g) were analysed. The median EtCO was 5.6 mmHg in the first 10 breaths, whereas it was 12.6 mmHg for 11-20 breaths and 18 mmHg for 21-30 breaths. There was no significant difference in maximum median EtCO for the first 20 breaths, although EtCO was significantly lower in infants who were intubated (32.0 vs. 15.0, p = 0.018).

Conclusion: EtCO monitoring in infants <30 weeks gestation at birth is feasible and reflective of alveolar ventilation. EtCO may help guide ventilation of preterm infants at birth.