LMA not superior to face-mask ventilation for lowering death risk in neonatal asphyxia: NEJM

Written By : MD Bureau

Medically Reviewed By : Dr. Kamal Kant Kohli

Published On 2020-11-27 09:30 GMT | Update On 2020-11-27 09:30 GMT

Researchers have found in a new study that laryngeal Mask Airway is not as effective as face-mask ventilation in lowering early neonatal death and moderate-to-severe hypoxic–ischemic encephalopathy. The study has been published in The New England journal of Medicine on 26, November 2020.

Face-mask ventilation is the most common resuscitation method for birth asphyxia. Ventilation with a cuffless laryngeal mask airway (LMA) has potential advantages over face-mask ventilation during neonatal resuscitation in low-income countries, but whether the use of an LMA reduces mortality and morbidity among neonates with asphyxia is unknown.

Birth asphyxia is the third leading cause of neonatal death, accounting for approximately 700,000 deaths each year. Effective positive-pressure ventilation is the most vital step in neonatal resuscitation. However, delivering proper tidal volumes with a face mask is difficult due to Mask leakage, airway blockage, and poor chest expansion. International guidelines have suggested the use of the laryngeal mask airway (LMA) in cases of failure of positive-pressure ventilation with the use of a face mask during resuscitation of neonates or if intubation is unsuccessful or not feasible. The effectiveness and safety of the LMA as compared with the face mask have been identified as important knowledge gaps. So the researchers conducted a Neonatal Supraglottic Airway (NeoSupra) trial to compare the use of uncuffed LMA (Laryngeal Mask Airway) vs. FMV ( Face MAsk Ventilation) during neonatal resuscitation.

It was a randomised controlled, open label, phase 3 superiority trial in Mulago Hospital, Kampala, Uganda. A total of 1154 neonates had an estimated gestational age of at least 34 weeks, an estimated birth weight of at least 2000g or both were included. They were randomly assigned to either LMA group (n=563) or FMV group (n=591). Researchers determined the primary outcome as a composite of death within 7 days or admission to the neonatal intensive care unit (NICU) with moderate-to-severe hypoxic–ischemic encephalopathy at day 1 to 5 during hospitalization.

Key findings of the study were:

♦ Researchers found, about 27.4% neonates in LMA group and 24.4% neonates in FMV group reached the primary outcome.

♦ They also found 21.7% of the neonates in the LMA group and 18.4% of those in the face-mask group were dead within 7 days of resuscitation.

♦ Admission to the NICU with moderate-to-severe hypoxic–ischemic encephalopathy at day 1 to 5 during hospitalization occurred in 11.2% in LMA group and 10.1% in FMV group.

♦ The frequency of predefined intervention-related adverse events was similar in both groups.

"In our trial, the LMA was safe in the hands of midwives but did not result in a lower incidence of early neonatal death or moderate-to-severe hypoxic–ischemic encephalopathy than face-mask ventilation among neonates with asphyxia" the Authors concluded.

For further information:

https://www.nejm.org/doi/full/10.1056/NEJMoa2005333

Article Source : The New England journal of Medicine

Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.

NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.

MD Bureau

Medical Dialogues Bureau consists of a team of passionate medical/scientific writers, led by doctors and healthcare researchers. Our team efforts to bring you updated and timely news about the important happenings of the medical and healthcare sector. Our editorial team can be reached at editorial@medicaldialogues.in.

Comments Policy

Our comments section is governed by our Comments Policy . By posting comments at Medical Dialogues you automatically agree with our Comments Policy , Terms And Conditions and Privacy Policy .

LMA not superior to face-mask ventilation for lowering death risk in neonatal asphyxia: NEJM

Similar News

Handheld Ultrasound Proves Effective for VExUS Assessment in Critically Ill Patients: Study

Keeping It Warm: A Comprehensive Study on Postoperative Hypothermia in Non-Cardiac Surgery

Pediatric Pain Relief: The Role of Regional Anesthesia in Renal Disease Management, study finds

Pediatric Pain Relief in Laparoscopic Surgery: Study Unravels Anesthetic Dilemma

Cochrane Review Raises Concerns Over Off-Label Use of Ketamine for Chronic Pain

Double Relief: Study evaluates Synergistic Effects of Hydromorphone and Ropivacaine in Thoracoscopic Surgery

Doxycycline monotherapy first line treatment for Chronic Endometritis: Study

Shaking Off the Shakes: Study evaluates Ondansetron's Role in Mitigating Etomidate-Induced Myoclonus