Close to one million newborns will die in 2020 because they do not start breathing at birth. In addition, breathing problems at birth will result in much more developing brain damage. Getting air immediately into the lungs of any non-breathing newborn can help prevent brain damage.
In most countries, midwives – not doctors – care for non-breathing newborns after delivery and ventilate the newborns. The standard-of-care is to use a self-inflating balloon or bag and a face mask. This is a difficult skill. There is a high risk of air leaks, meaning less oxygen will reach the brain.
The laryngeal face mask is a short tube that acts as an airway. It is placed directly into the throat. It fits snugly minimizing the risk of air leakage and thereby ensuring that the air reaches the lungs. Laryngeal face masks are currently used by anesthesiologists during surgical procedures but have not previously been available for use by midwives resuscitating newborns.
The maternity service at Mulago National Referral Hospital in Kampala, Uganda, presented a unique opportunity for being able to carry out a large randomized trial. There are around 25000 births at Mulago every year – much more than at any Norwegian hospital and, indeed, most European and North American ones.
Around 200 midwives were trained in the new technique. After a single day’s training, the midwives stated that they felt comfortable with the new technique, and found it easier to use than the standard face mask and bag. Over 1000 babies were resuscitated during the 2018-2019 study period. The babies were randomly assigned to one or other resuscitation technique.
The results showed that the laryngeal mask airway is a valuable new tool to use in neonatal resuscitation. The technique can be easily taught and safely be used by midwives. While newborn survival was not improved with the laryngeal mask airway compared to the standard-of-care, face mask, and bag, a larger number of newborns first resuscitated with face masks were then rescued with the laryngeal masks than the other way around.
Pejovic, N. J., et al. (2020) A Randomized Trial of Laryngeal Mask Airway in Neonatal Resuscitation. New England Journal of Medicine. doi.org/10.1056/NEJMoa2005333.