Difficult mask ventilation in the neonate. A structured approach to optimize noninvasive ventilation

During neonatal resuscitation effective ventilation of the lungs is decisive and most frequently the only required measure for successful stabilization after birth [1]. In an initially not spontaneously breathing or not adequately breathing newborn, in most cases, brief mask ventilation leads to the onset of effective spontaneous breathing and thus to a rapid clinical stabilization. In most cases, mask ventilation is successful without any problems but also can cause difficulties. In neonatal resuscitation courses, including the Newborn Life Support Courses of the Austrian Resuscitation Council (ARC), the German Resuscitation Council (GRC) and the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) [2], a focus of the training is therefore on the optimization of noninvasive ventilation during neonatal resuscitation, especially because awareness of optimization measures seems limited. Therefore, this article is devoted to strategies for optimizing noninvasive ventilation in neonates and proposes with the German acronym RALPH a possibility for overcoming difficulties in noninvasive ventilation in a structured and targeted manner.