Positive-pressure ventilation (PPV) in Neonatal Resuscitation Program (NRP) is discontinued when the infant demonstrates good spontaneous breathing effort, a heart rate of 140 bpm, and an oxygen saturation of 85% at 4 minutes of age. Following discontinuation, continuous monitoring of the baby's oxygen saturation is essential.
Understanding Discontinuation Criteria
Discontinuing PPV in a newborn is a critical decision based on specific physiological improvements, indicating the baby is transitioning well and can maintain vital functions independently. The primary goal of PPV is to help the baby establish effective breathing and improve heart rate and oxygenation.
Key Indicators for Discontinuation
For instance, if a baby is 4 minutes of age and presents with the following criteria, positive-pressure ventilation can be safely discontinued:
- Good Spontaneous Breathing Effort: The baby is initiating and maintaining their own breaths effectively, indicating active respiratory drive and lung function. This signifies that the baby no longer requires external ventilatory support to inflate their lungs.
- Heart Rate (HR) of 140 bpm: A heart rate above 100 bpm, and specifically a robust 140 bpm, indicates good cardiac output and oxygen delivery to the tissues. A stable and strong heart rate is a primary sign of successful resuscitation.
- Oxygen Saturation (SpO2) of 85%: While 100% saturation is not the immediate target, an SpO2 of 85% at 4 minutes of age aligns with the expected physiological transition to extrauterine life. This target range allows for a gradual increase in oxygen saturation, mimicking the natural progression of a healthy newborn.
These parameters collectively indicate that the newborn has successfully responded to initial resuscitation efforts and is now capable of independent cardiopulmonary function.
Discontinuation Criteria at a Glance
| Parameter | Discontinuation Criterion |
|---|---|
| Age of Baby | 4 minutes of age |
| Breathing Effort | Good spontaneous breathing effort |
| Heart Rate (HR) | 140 beats per minute (bpm) |
| Oxygen Saturation | 85% |
Post-Discontinuation Monitoring
Even after discontinuing PPV, the baby's condition must be closely monitored. Continuous assessment of oxygen saturation is crucial to ensure they maintain adequate oxygenation without assistance. If the baby's condition deteriorates (e.g., decreased breathing effort, dropping heart rate, or falling oxygen saturation), PPV may need to be reinitiated.
This careful approach ensures that the baby receives the necessary support only for as long as required, minimizing potential risks associated with prolonged ventilation while ensuring a stable transition to independent physiological function.
