A multicenter cohort study of 132 preterm neonates with bradycardia at birth has identified exhaled tidal volume (VTE), not inspiratory pressure, as the key respiratory parameter linked to successful lung aeration. A threshold of 4 mL/kg VTE emerged as the inflection point associated with a sustained heart rate increase above 100 bpm, a finding robustly validated in an independent cohort of 115 neonates. Importantly, higher VTE beyond this threshold did not confer additional benefit, underscoring the physiologic ceiling of neonatal lung compliance during early resuscitation.
Additional covariates included birth weight and frequency of mask removal, suggesting that both lung mechanics and procedural precision matter. These results may recalibrate how pediatricians conceptualize resuscitation targets, moving from pressure-centric to volume-based strategies. The journal has the full…
