From the Guidelines
Proper Use of a Farrell Bag on a Neonate with Low Birth Weight
The proper use of a Farrell bag, also known as a resuscitation bag, on a neonate with low birth weight involves using a T-piece resuscitator instead of a self-inflating bag for administering positive-pressure ventilation, particularly for preterm infants 1.
Key Considerations
- Device Selection: A T-piece resuscitator is beneficial for preterm infants due to its ability to provide more consistent and controlled ventilation 1.
- Positive End-Expiratory Pressure (PEEP): Approximately 5 cm H2O PEEP is suggested when administering positive-pressure ventilation to preterm newborns 1.
- Oxygen Administration: Initiating resuscitation of preterm newborns with high oxygen (65% or greater) is not recommended; instead, start with low inspired oxygen and increase as necessary, guided by pulse oximetry 1.
- Ventilation Technique: Effective ventilation can be achieved with a flow-inflating bag, self-inflating bag, or T-piece resuscitator, but the T-piece resuscitator is preferred for preterm infants 1.
Clinical Application
In clinical practice, the use of a Farrell bag or any resuscitation device on a neonate with low birth weight should prioritize gentle and controlled ventilation to avoid lung injury and ensure effective gas exchange. The choice of device and ventilation strategy should be guided by the neonate's specific needs and the clinician's expertise, with consideration of the latest guidelines and evidence-based practices 1.
From the Research
Proper Use of a Farrell Bag on a Neonate with Low Birth Weight
- The proper use of a Farrell bag (resuscitation bag) on a neonate with low birth weight requires careful consideration of the device's performance characteristics and the neonate's respiratory needs 2.
- Manual inflation resuscitation devices, such as self-inflating bags (SIB) and flow-inflating bags (FIB), can be used to provide positive pressure lung inflation at birth, but their effectiveness and safety may vary depending on the device and the neonate's weight and lung state 2, 3.
- The American Heart Association recommends bag-and-mask ventilation as the initial method of resuscitation for newborns, but notes that the use of a pressure-monitoring device can help ensure consistent ventilation 3.
- For very low birth weight infants, airway obstruction is a common occurrence during mask ventilation, and the use of a colorimetric carbon dioxide detector can help recognize and manage this issue 4.
- The choice of device and ventilation strategy should be based on the individual neonate's needs and the availability of skilled personnel and equipment 5, 6.
- It is essential to monitor the neonate's heart rate, skin color, and respiratory effort during resuscitation and adjust the ventilation strategy as needed to ensure effective and safe ventilation 3, 5, 6.