Efficacy of Upright vs. Standard Resuscitation Bags in Elevating Heart Rate in Late Preterm Newborns: A Randomized Clinical Trial

Abstract

Background: In the transitional cycle from intrauterine to extrauterine life, with aeration of the lungs, gas exchange shifts from the placenta to the lungs. This is the most fundamental process that the vast majority of term and near-term infants undergo to adapt to extrauterine life (approximately 85), leaving the rest of the infants unable to perform it without PPV, making birth the most challenging phase of their existence. For neonates depressed by any cause who are unable to establish functional residual capacity (FRC) by replacing the liquid in the alveoli with atmospheric gas through spontaneous breathing and forming a tidal volume (TV) at birth, healthcare providers must intervene with manual ventilation and alveolar ventilation to replace alveolar fluid with atmospheric gas and establish functional residual capacity (FRC). Given that currently self-inflating bags (SIBs) are a central component in any setup related to the neonatal resuscitation program (NRP) and the recent availability of the upright-bag design of SIB, this study investigates the number of ventilations of neonates requiring positive pressure ventilation (PPV) after birth using two approaches: the upright bag and the classic design of SIB, known as the standard bag. Methods: This is a randomized clinical study. Neonates with a gestational age of 35+0/7 to 36+6/7 weeks who required PPV due to a heart rate of less than 100 bpm after the initial steps of newborn care after birth were divided into two groups, each including 30 neonates (60 in total). Both groups received PPV using SIB, with one group experiencing ventilation using standard bags and the other receiving ventilation using upright bags. Shahid Beheshti Hospital in Isfahan conducted this study from September 2020 to February 2024. Results: The study showed that the average number of ventilations needed to achieve a heart rate of 100 bpm or higher was significantly lower (P value = 0.029) using the upright bag. The average gas leakage around the mask during ventilation was significantly less (P value = 0.018) using the upright bag. The need for oral and nasal suction with an open mouth was significantly lower (P-value = 0.020) with the upright bag. The requirement for intubation during ventilation was significantly lower (P value = 0.010) using the upright bag. Pneumothorax was also significantly less common (P value = 0.030) in neonates ventilated using the upright bag. Conclusion: This study suggests that, considering the two available designs of selfinflating resuscitation bags, upright resuscitation bags are more effective in rapidly increasing an infant’s heart rate compared to standard resuscitation bags, offering a superior alternative for neonatal resuscitation. Copyright © 2025 Tehran University of Medical Sciences.