Practice Seeing without touching: advances in non-invasive assessment during neonatal resuscitation (Session)

Key Takeaways from the Advanced Monitoring & Point-of-Care Diagnostics Session

We have officially wrapped up the final afternoon session of the day, and it was a fantastic glimpse into the future of neonatal intensive care! The focus was entirely on cutting-edge, non-invasive monitoring and how we can bring real-time physiological data directly to the delivery room and the bedside.

Here is the breakdown of the core messages from our final three speakers:

• Cerebral Oxygenation Monitoring / NIRS (Gerhard Pichler)

  • The SPO2 Disconnect: Routine parameters like arterial oxygen saturation (SPO2) and heart rate do not always reflect what is happening in the brain. Due to immature autoregulation or varying metabolic demands, a neonate can have perfectly on-target SPO2 while their brain remains dangerously hypoxic—a pattern closely associated with subsequent IVH.

  • The COSCA Trials: Using NIRS to guide interventions (adjusting FiO2, respiratory support, or giving fluid boluses) successfully reduced the burden of cerebral hypoxia. While standard frequentist analysis showed a 4.3% increase in survival without brain injury (not statistically significant), Bayesian analysis revealed a 92% probability of improved outcomes, alongside significant reductions in cerebral palsy and sensory impairments in the 28-31 week subgroup.

  • Clinical Protocol: Following the 2024 ILCOR guidelines, NIRS can be a powerful bedside tool: stabilize routine targets first (SPO2 80-85%), and then look at the NIRS monitor. If the brain is still hypoxic, escalate your support.

• Lung Ultrasound in the Delivery Room (Bernhard Schwaberger)

  • Lung ultrasound (LUS) is highly feasible in the delivery room and serves two distinct clinical purposes without delaying essential resuscitation:

  • Emergency Assessment: Rapidly identifying immediately actionable pathologies like pneumothorax (loss of seashore sign/barcode sign), massive pleural effusions (jellyfish sign), or unexpected congenital diaphragmatic hernias.

  • Organ-Based Assessment (Transition Tracking): For infants with persistent respiratory distress, LUS can visualize lung aeration in real-time.

  • Predictive Power: An LUS performed at just 15 minutes of life can accurately distinguish TTN from RDS and predict CPAP requirements at 60 minutes. Even earlier, at 5-10 minutes, LUS predicts the need for subsequent surfactant treatment better than clinical oxygen requirements alone.

• Lung Recruitment & Impedance Measurement / EIT (Vincent Gaertner)

  • Electrical Impedance Tomography (EIT) utilizes a sensory belt to measure bioimpedance, allowing us to visualize breath-by-breath regional lung ventilation and volume changes (FRC) in real-time.

  • Preterm Breathing Patterns: EIT identified three distinct breathing patterns in preterm infants on CPAP. Notably, the "holding maneuver" (where the infant halts exhalation for up to 10 seconds, closing the glottis) was the only pattern associated with a successful gain in end-expiratory lung volume (FRC).

  • Clinical Traps Revealed by EIT:

    • The Face Mask Illusion: EIT showed cases where a Respiratory Function Monitor (RFM) at the T-piece displayed "adequate" tidal volumes, but EIT proved zero air was reaching the lungs. The highly compliant nasopharyngeal space was simply expanding and obstructing flow. Intubation was required to actually ventilate the lung.

    • The Cost of Interventions: EIT visualized massive, immediate drops in end-expiratory lung volume during routine nasopharyngeal suctioning (questioning the routine use of steps like VISTA-SOPA) and during laryngoscopy for LISA surfactant administration.

What an incredible day of science and clinical innovation. Before we head to the evening networking events, let's bring these concepts back to our own units:

1. NIRS at the Bedside: Gerhard's talk bridges the gap between research and practice, highlighting that SPO2 isn't always enough to protect the brain. Is your unit currently using cerebral oxygenation monitoring routinely for clinical decision-making, or is it still primarily used in a research context?

2. LUS in the Delivery Room: Lung ultrasound is rapidly gaining traction as a predictive tool, but the delivery room is a high-stress, fast-paced environment. Do you see point-of-care LUS becoming a standard tool during the "Golden Hour" in your unit, and what are the main training hurdles?

3. Visualizing the Invisible: Vincent's EIT data showing that RFMs can register "good" tidal volumes while the lungs receive nothing is alarming. How rely on T-piece monitors vs. clinical chest rise in your delivery room, and how close do you feel we are to using tools like EIT at the bedside?

Disclosure: This is an AI-assisted summary of the session, generated from a recording made by our team in attendance. We believe it is as accurate as our own notes would be, but please refer to the speakers’ original work before applying anything in clinical practice.