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remain inadequate or the HR <100 bpm, assisted ventilation must be continued
and placement of advanced airway must be considered.
Continuous Positive Airway Pressure
For centers skilled in the respiratory management of neonates, CPAPs may be an
alternative to PPV in a spontaneously breathing preterm newly born infant with
respiratory distress. Current evidence shows that CPAP for these infants is
associated with decreased rate of intubation at birth, decreased duration of
mechanical ventilation, reduced subsequent BPD, and decrease in mortality.
Unlike flow-inflating bags, self-inflating bags cannot deliver CPAP and may
not be able to achieve PEEP reliably during PPV.
Endotracheal Intubation
ET intubation is indicated in the event of a prolonged need for PPV, if mask
ventilation is ineffective or prolonged, if chest compressions are being initiated,
or in the presence of congenital diaphragmatic hernia (CDH). Exhaled CO2
detection is the most reliable method of confirmation of placement, supported by
chest wall movement, auscultation of breath sounds, and condensation in the tube.
The best indicator of successful PPV through the ET tube is increase in HR.
TABLE 9.9
SELECTION OF AIRWAY EQUIPMENT BY WEIGHT

Chapter 8 Airway reviews advanced airway management in depth and this
generally applies to the newly born with a few differences. Sizes of airway
equipment can be determined by birth weight ( Table 9.9 ). ET tube size can be
estimated by gestational age: ET tube size in mm = gestational age in weeks
divided by 10. Thus, a 35-week premature infant would require a 3.5-mm ET
tube. Proper ET tube insertion depth is estimated as follows: total cm at gumline
= 6 + weight of the infant in kg.
Laryngeal Mask Airways
Laryngeal mask airways (LMAs) can be successfully used for ventilating full- or
near-term newborns (>34 weeks’ gestational age, >2,000 g), particularly in cases