Resuscitation of term and near-term newborns in low-resourced settings: Studies of positive end-expiratory pressure and expired CO2 during bag-mask ventilation at birth


perinatal asphyxia, bag-mask ventilation, newborns, lung aeration, PEEP, airway patency, pulmonary circulation


Background: An estimated 0.7 million newborns die due to perinatal asphyxia each year, most are born at or near term. The major burden of preventable newborn deaths occur in low-resourced settings. A self-inflating bag is the most used and available equipment to save newborn lives globally. To aerate the lungs is key to survival. Expired CO2 (ECO2) may be an indicator for lung aeration, and positive end-expiratory pressure (PEEP) may facilitate aeration of the lungs. Research aiming to improve ventilation in term and near-term newborns using a self-inflating bag is needed.

Aims: To investigate interpretation of ECO2 measured during bag-mask ventilation in the immediate newborn period, and assess whether this can be used as a marker for lung aeration, effective ventilation technique and prognosis. To study the effects of PEEP during bag-mask ventilation at or near term.

Methods: Two observational studies and one randomized clinical trial were performed at Haydom Lutheran Hospital in Tanzania. Data were collected using direct observation, side-stream CO2-monitoring, respiratory function monitoring and dry-electrode ECG. In the randomized trial, newborns in need of ventilation were assigned in blocks based on weeks to receive ventilations by self-inflating bag with or without a PEEP-valve.

Results: ECO2 during bag-mask ventilation at birth was significantly associated with both ventilation factors and clinical factors. Tidal volumes of 10-14 ml/kg and a low ventilation frequency of around 30 inflations/minute were associated with the fastest rise and highest levels of ECO2. ECO2 increased before heart rate, and measured levels of ECO2 during resuscitation could, similar to heart rate, predict 24-hours survival. Adding a PEEP-valve to the self-inflating bag did not improve heart rate, ECO2 or outcomes in term and near-term newborns despite delivery of an adequate PEEP.

Conclusions: ECO2 may be seen as a combined marker for lung aeration, airway patency and pulmonary circulation at birth. Tidal volumes of 10-14 ml/kg and ventilation frequencies of around 30 inflations/minute may be favorable to achieve a fast lung aeration. We found no clinical benefit of adding a PEEP-valve during bag-mask ventilation at birth in term and near-term newborns, and our study does not support routine use.

Author Biography

Kari Holte

PhD Fellow
University of Stavanger
Faculty of Health Sciences


Dawes G, ed Birth asphyxia, resuscitation and brain damage. Foetal and neonatal physiology year book. 1968. p. 141-59. 1968.

Sharrow D HL, Liu Y, You D. Levels and trends in child mortality, United Nations. New York2020. 978-92-806-5147-8.

Wall SN, Lee AC, Niermeyer S, et al. Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up? International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2009;107 Suppl 1:S47-62, S63-44.

Skare C, Kramer-Johansen J, Steen T, et al. Incidence of Newborn Stabilization and Resuscitation Measures and Guideline Compliance during the First Minutes of Life in Norway. Neonatology. 2015;108(2):100-107.

Bjorland PA, Oymar K, Ersdal HL, Rettedal SI. Incidence of newborn resuscitative interventions at birth and short-term outcomes: a regional population-based study. BMJ Paediatr Open. 2019;3(1):e000592.

Aziz K, Chadwick M, Baker M, Andrews W. Ante- and intra- partum factors that predict increased need for neonatal resuscitation. Resuscitation. 2008;79(3):444-452.

Perlman JM, Risser R. Cardiopulmonary resuscitation in the delivery room. Associated clinical events. Arch Pediatr Adolesc Med. 1995;149(1):20-25.

Gill CJ, Phiri-Mazala G, Guerina NG, et al. Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study. BMJ. 2011;342:d346.

Ersdal HL, Mduma E, Svensen E, Perlman JM. Early initiation of basic resuscitation interventions including face mask ventilation may reduce birth asphyxia related mortality in low- income countries: a prospective descriptive observational study. Resuscitation. 2012;83(7):869-873.

Msemo G, Massawe A, Mmbando D, et al. Newborn mortality and fresh stillbirth rates in Tanzania after helping babies breathe training. Pediatrics. 2013;131(2):e353-360.

Wrammert J, Zetterlund C, Kc A, Ewald U, Malqvist M. Resuscitation practices of low and normal birth weight infants in Nepal: an observational study using video camera recordings. Glob Health Action. 2017;10(1):1322372.

Helsedirektoratet. Nasjonale kvalitetsindikatorer. Fødsel- dødelighet i nyfødtperioden. 2020.

Sankar MJ NC, Das RR, Agarwal R, Chandrasekaran R, Paul VK. When do newborns die? A systematic review of timing of overall and cause-specific neonatal deaths in developing countries. Journal of Perinatology. 2016;36(Suppl 1):S1-S11.

Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388(10063):3027-3035.

Lawn JE, Cousens S, Bhutta ZA, et al. Why are 4 million newborn babies dying each year? Lancet. 2004;364(9432):399- 401.

Lawn JE, Blencowe H, Oza S, et al. Every Newborn: progress, priorities, and potential beyond survival. Lancet. 2014;384(9938):189-205.

Ersdal HL, Eilevstjonn J, Linde JE, et al. Fresh stillborn and severely asphyxiated neonates share a common hypoxic- ischemic pathway. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2018;141(2):171-180.

Graham W, Hussein J. The right to count. Lancet. 2004;363(9402):67-68.

Lawn JE, Blencowe H, Pattinson R, et al. Stillbirths: Where? When? Why? How to make the data count? Lancet. 2011;377(9775):1448-1463.

Lawn JE, Blencowe H, Waiswa P, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;387(10018):587-603.

WHO. World Health Report 2005: Make every mother and child count. 2005:10.

Lee AC, Kozuki N, Blencowe H, et al. Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatric research. 2013;74 Suppl 1:50-72.

Nations U. The Millennium Development Goals Report. 2015

WHO. World Health Statistics 2020 monitoring health for the sustainable development goals. 2020.

Ersdal HL, Singhal N. Resuscitation in resource-limited settings. Seminars in fetal & neonatal medicine. 2013;18(6):373-378.

Bhutta ZA, Das JK, Bahl R, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384(9940):347-370.

Bhutta ZA, Yakoob MY, Lawn JE, et al. Stillbirths: what difference can we make and at what cost? Lancet. 2011;377(9776):1523-1538.

Langli Ersdal H, Mduma E, Svensen E, Sundby J, Perlman J. Intermittent detection of fetal heart rate abnormalities identify infants at greatest risk for fresh stillbirths, birth asphyxia, neonatal resuscitation, and early neonatal deaths in a limited- resource setting: a prospective descriptive observational study at Haydom Lutheran Hospital. Neonatology. 2012;102(3):235-242.

Mdoe PF, Ersdal HL, Mduma ER, et al. Intermittent fetal heart rate monitoring using a fetoscope or hand held Doppler in rural Tanzania: a randomized controlled trial. BMC pregnancy and childbirth. 2018;18(1):134.

Stensvold HJ, Klingenberg C, Stoen R, et al. Neonatal Morbidity and 1-Year Survival of Extremely Preterm Infants. Pediatrics. 2017;139(3).

Niermeyer S, Little GA, Singhal N, Keenan WJ. A Short History of Helping Babies Breathe: Why and How, Then and Now. Pediatrics. 2020;146(Suppl 2):S101-S111.

Moshiro R, Mdoe P, Perlman JM. A Global View of Neonatal Asphyxia and Resuscitation. Front Pediatr. 2019;7:489.

Wrammert J, Kc A, Ewald U, Malqvist M. Improved postnatal care is needed to maintain gains in neonatal survival after the implementation of the Helping Babies Breathe initiative. Acta paediatrica. 2017;106(8):1280-1285.

Lawn JE, Kinney M, Lee AC, et al. Reducing intrapartum-related deaths and disability: can the health system deliver? International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2009;107 Suppl 1:S123-140, S140-122.

Yoshida S, Rudan I, Lawn JE, et al. Newborn health research priorities beyond 2015. Lancet. 2014;384(9938):e27-29.

Hooper SB, Harding R. Fetal lung liquid: a major determinant of the growth and functional development of the fetal lung. Clin Exp Pharmacol Physiol. 1995;22(4):235-247.

te Pas AB, Davis PG, Hooper SB, Morley CJ. From liquid to air: breathing after birth. The Journal of pediatrics. 2008;152(5):607- 611.

Harding R, Hooper SB. Regulation of lung expansion and lung growth before birth. Journal of applied physiology. 1996;81(1):209-224.

Milner AD, Vyas H. Lung expansion at birth. The Journal of pediatrics. 1982;101(6):879-886.

Mielke G, Benda N. Cardiac output and central distribution of blood flow in the human fetus. Circulation. 2001;103(12):1662- 1668.

Prsa M, Sun L, van Amerom J, et al. Reference ranges of blood flow in the major vessels of the normal human fetal circulation at term by phase-contrast magnetic resonance imaging. Circ Cardiovasc Imaging. 2014;7(4):663-670.

Soothill PW, Nicolaides KH, Rodeck CH, Gamsu H. Blood gases and acid-base status of the human second-trimester fetus. Obstet Gynecol. 1986;68(2):173-176.

Kiserud T, Ebbing C, Kessler J, Rasmussen S. Fetal cardiac output, distribution to the placenta and impact of placental compromise. Ultrasound Obstet Gynecol. 2006;28(2):126-136.

Barker PM, Olver RE. Invited review: Clearance of lung liquid during the perinatal period. Journal of applied physiology. 2002;93(4):1542-1548.

Olver RE, Ramsden CA, Strang LB, Walters DV. The role of amiloride-blockable sodium transport in adrenaline-induced lung liquid reabsorption in the fetal lamb. J Physiol. 1986;376:321- 340.

Jain L, Eaton DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol. 2006;30(1):34-43.

Bland RD. Lung epithelial ion transport and fluid movement during the perinatal period. Am J Physiol. 1990;259(2 Pt 1):L30- 37.

Saunders RA, Milner AD. Pulmonary pressure/volume relationships during the last phase of delivery and the first postnatal breaths in human subjects. The Journal of pediatrics. 1978;93(4):667-673.

Vyas H, Field D, Milner AD, Hopkin IE. Determinants of the first inspiratory volume and functional residual capacity at birth. Pediatr Pulmonol. 1986;2(4):189-193.

Vyas H, Milner AD, Hopkins IE. Intrathoracic pressure and volume changes during the spontaneous onset of respiration in babies born by cesarean section and by vaginal delivery. The Journal of pediatrics. 1981;99(5):787-791.

Hooper SB, Siew ML, Kitchen MJ, te Pas AB. Establishing functional residual capacity in the non-breathing infant. Seminars in fetal & neonatal medicine. 2013;18(6):336-343.

Siew ML, Wallace MJ, Kitchen MJ, et al. Inspiration regulates the rate and temporal pattern of lung liquid clearance and lung aeration at birth. Journal of applied physiology. 2009;106(6):1888-1895.

Hooper SB, Kitchen MJ, Siew ML, et al. Imaging lung aeration and lung liquid clearance at birth using phase contrast X-ray imaging. Clin Exp Pharmacol Physiol. 2009;36(1):117-125.

Hooper SB, Kitchen MJ, Wallace MJ, et al. Imaging lung aeration and lung liquid clearance at birth. FASEB J. 2007;21(12):3329-3337.

Bland RD, McMillan DD, Bressack MA, Dong L. Clearance of liquid from lungs of newborn rabbits. J Appl Physiol Respir Environ Exerc Physiol. 1980;49(2):171-177.

Miserocchi G, Poskurica BH, Del Fabbro M. Pulmonary interstitial pressure in anesthetized paralyzed newborn rabbits. Journal of applied physiology. 1994;77(5):2260-2268.

Kosch PC, Stark AR. Dynamic maintenance of end-expiratory lung volume in full-term infants. J Appl Physiol Respir Environ Exerc Physiol. 1984;57(4):1126-1133.

Kosch PC, Davenport PW, Wozniak JA, Stark AR. Reflex control of expiratory duration in newborn infants. Journal of applied physiology. 1985;58(2):575-581.

Henderson-Smart DJ, Johnson P, McClelland ME. Asynchronous respiratory activity of the diaphragm during spontaneous breathing in the lamb. J Physiol. 1982;327:377-391.

Frappell PB, MacFarlane PM. Development of mechanics and pulmonary reflexes. Respir Physiol Neurobiol. 2005;149(1- 3):143-154.

te Pas AB, Wong C, Kamlin CO, Dawson JA, Morley CJ, Davis PG. Breathing patterns in preterm and term infants immediately after birth. Pediatric research. 2009;65(3):352-356.

Stocks J. The functional growth and development of the lung during the first year of life. Early Hum Dev. 1977;1(3):285-309.

Stocks J. Respiratory physiology during early life. Monaldi Arch Chest Dis. 1999;54(4):358-364.

Enhorning G, Robertson B. Lung expansion in the premature rabbit fetus after tracheal deposition of surfactant. Pediatrics. 1972;50(1):58-66.

Enhorning G, Hill D, Sherwood G, Cutz E, Robertson B, Bryan C. Improved ventilation of prematurely delivered primates following tracheal deposition of surfactant. Am J Obstet Gynecol. 1978;132(5):529-536.

Hooper SB, Te Pas AB, Lang J, et al. Cardiovascular transition at birth: a physiological sequence. Pediatric research. 2015;77(5):608-614.

Gao Y, Raj JU. Regulation of the pulmonary circulation in the fetus and newborn. Physiol Rev. 2010;90(4):1291-1335.

Bhatt S, Polglase GR, Wallace EM, Te Pas AB, Hooper SB. Ventilation before Umbilical Cord Clamping Improves the Physiological Transition at Birth. Front Pediatr. 2014;2:113.

Niermeyer S, Velaphi S. Promoting physiologic transition at birth: re-examining resuscitation and the timing of cord clamping. Seminars in fetal & neonatal medicine. 2013;18(6):385-392.

Blank D, Niermeyer S. Going "the Last Mile" With Guidelines for Deferred Umbilical Cord Clamping. Pediatrics. 2020;146(5).

Dildy GA, van den Berg PP, Katz M, et al. Intrapartum fetal pulse oximetry: fetal oxygen saturation trends during labor and relation to delivery outcome. Am J Obstet Gynecol. 1994;171(3):679- 684.

Dawson JA, Kamlin CO, Vento M, et al. Defining the reference range for oxygen saturation for infants after birth. Pediatrics. 2010;125(6):e1340-1347.

Bjorland PA, Ersdal HL, Eilevstjonn J, Oymar K, Davis PG, Rettedal SI. Changes in heart rate from 5 s to 5 min after birth in vaginally delivered term newborns with delayed cord clamping. Archives of disease in childhood Fetal and neonatal edition. 2020.

Linde JE, Schulz J, Perlman JM, et al. Normal Newborn Heart Rate in the First Five Minutes of Life Assessed by Dry-Electrode Electrocardiography. Neonatology. 2016;110(3):231-237.

Dawson JA, Kamlin CO, Wong C, et al. Changes in heart rate in the first minutes after birth. Archives of disease in childhood Fetal and neonatal edition. 2010;95(3):F177-181.

Padilla-Sanchez C, Baixauli-Alacreu S, Canada-Martinez AJ, Solaz-Garcia A, Alemany-Anchel MJ, Vento M. Delayed vs Immediate Cord Clamping Changes Oxygen Saturation and Heart Rate Patterns in the First Minutes after Birth. The Journal of pediatrics. 2020;227:149-156 e141.

Rainaldi MA, Perlman JM. Pathophysiology of Birth Asphyxia. Clin Perinatol. 2016;43(3):409-422.

Sehdev HM, Stamilio DM, Macones GA, Graham E, Morgan MA. Predictive factors for neonatal morbidity in neonates with an umbilical arterial cord pH less than 7.00. Am J Obstet Gynecol. 1997;177(5):1030-1034.

Goldaber KG, Gilstrap LC, 3rd, Leveno KJ, Dax JS, McIntire DD. Pathologic fetal acidemia. Obstet Gynecol. 1991;78(6):1103-1107.

WHO. Guidelines on basic newborn resuscitation. 2012.

Lawn JE, Lee AC, Kinney M, et al. Two million intrapartum- related stillbirths and neonatal deaths: where, why, and what can be done? International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2009;107 Suppl 1:S5-18, S19.

King TA, Jackson GL, Josey AS, et al. The effect of profound umbilical artery acidemia in term neonates admitted to a newborn nursery. The Journal of pediatrics. 1998;132(4):624-629.

Perlman JM, Risser R. Severe fetal acidemia: neonatal neurologic features and short-term outcome. Pediatr Neurol. 1993;9(4):277-282.

Goodwin TM, Belai I, Hernandez P, Durand M, Paul RH. Asphyxial complications in the term newborn with severe umbilical acidemia. Am J Obstet Gynecol. 1992;167(6):1506- 1512.

Fee SC, Malee K, Deddish R, Minogue JP, Socol ML. Severe acidosis and subsequent neurologic status. Am J Obstet Gynecol. 1990;162(3):802-806.

Kro GA, Yli BM, Rasmussen S, et al. Association between umbilical cord artery pCO(2) and the Apgar score; elevated levels of pCO(2) may be beneficial for neonatal vitality after moderate acidemia. Acta obstetricia et gynecologica Scandinavica. 2013;92(6):662-670.

Practice ACoO. ACOG Committee Opinion No. 348, November 2006: Umbilical cord blood gas and acid-base analysis. Obstet Gynecol. 2006;108(5):1319-1322.

Zaichkin J, Wiswell TE. The history of neonatal resuscitation. Neonatal Netw. 2002;21(5):21-28.

Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260-267.

ILCOR. Webpage for the International Liaison Committee on Resuscitation. Published 2021. Accessed April 19th, 2021.

International Liaison Committee on R. 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 7: Neonatal resuscitation. Resuscitation. 2005;67(2-3):293-303.

Perlman JM, Wyllie J, Kattwinkel J, et al. Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122(16 Suppl 2):S516-538.

Perlman JM, Wyllie J, Kattwinkel J, et al. Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2015;132(16 Suppl 1):S204-241.

Wyckoff MH, Wyllie J, Aziz K, et al. Neonatal Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(16_suppl_1):S185- S221.

Aziz K, Lee HC, Escobedo MB, et al. Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S524-S550.

Madar J, Roehr CC, Ainsworth S, et al. European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation. 2021;161:291-326.

Liley HG, Mildenhall L, Morley P, Australian New Zealand Committee on R. Australian and New Zealand Committee on Resuscitation Neonatal Resuscitation guidelines 2016. Journal of paediatrics and child health. 2017;53(7):621-627.

American Academy of Pediatrics. Helping Babies Breathe. Accessed March 23th 2021.

Engle WA. A recommendation for the definition of "late preterm" (near-term) and the birth weight-gestational age classification system. Semin Perinatol. 2006;30(1):2-7.

WHO. Preterm birth. sheets/detail/preterm-birth. Published 2018. Accessed March 17th 2021.

Schmolzer GM, Te Pas AB, Davis PG, Morley CJ. Reducing lung injury during neonatal resuscitation of preterm infants. The Journal of pediatrics. 2008;153(6):741-745.

Bjorklund LJ, Ingimarsson J, Curstedt T, et al. Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs. Pediatric research. 1997;42(3):348-355.

Hillman NH, Moss TJ, Kallapur SG, et al. Brief, large tidal volume ventilation initiates lung injury and a systemic response in fetal sheep. Am J Respir Crit Care Med. 2007;176(6):575-581.

Vilstrup CT, Bjorklund LJ, Werner O, Larsson A. Lung volumes and pressure-volume relations of the respiratory system in small ventilated neonates with severe respiratory distress syndrome. Pediatric research. 1996;39(1):127-133.

Narayanan J, Vivio D. Basic Neonatal Resuscitation: A Global Landscape (2016). PATH, Save the Children. Published 2016. Accessed.106. Wyckoff MH, Weiner GM, Neonatal Life Support C. 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Pediatrics. 2020.

Murthy V, Rao N, Fox GF, Milner AD, Campbell M, Greenough A. Survey of UK newborn resuscitation practices. Archives of disease in childhood Fetal and neonatal edition. 2012;97(2):F154-155.

El-Naggar W, McNamara PJ. Delivery room resuscitation of preterm infants in Canada: current practice and views of neonatologists at level III centers. Journal of perinatology : official journal of the California Perinatal Association. 2012;32(7):491-497.

Trevisanuto D, Satariano I, Doglioni N, et al. Changes over time in delivery room management of extremely low birth weight infants in Italy. Resuscitation. 2014;85(8):1072-1076.

O'Donnell CP, Davis PG, Morley CJ. Positive pressure ventilation at neonatal resuscitation: review of equipment and international survey of practice. Acta paediatrica. 2004;93(5):583-588.

O'Donnell CP, Davis PG, Morley CJ. Neonatal resuscitation: review of ventilation equipment and survey of practice in Australia and New Zealand. Journal of paediatrics and child health. 2004;40(4):208-212.

Finer NN, Rich W, Craft A, Henderson C. Comparison of methods of bag and mask ventilation for neonatal resuscitation. Resuscitation. 2001;49(3):299-305.

Berkelhamer SK, Kamath-Rayne BD, Niermeyer S. Neonatal Resuscitation in Low-Resource Settings. Clin Perinatol. 2016;43(3):573-591.

Bennett S, Finer NN, Rich W, Vaucher Y. A comparison of three neonatal resuscitation devices. Resuscitation. 2005;67(1):113- 118.

Hartung JC, Dold SK, Thio M, tePas A, Schmalisch G, Roehr CC. Time to adjust to changes in ventilation settings varies significantly between different T-piece resuscitators, self- inflating bags, and manometer equipped self-inflating bags. Am J Perinatol. 2014;31(6):505-512.

Kattwinkel J, Stewart C, Walsh B, Gurka M, Paget-Brown A. Responding to compliance changes in a lung model during manual ventilation: perhaps volume, rather than pressure, should be displayed. Pediatrics. 2009;123(3):e465-470.

Hawkes CP, Ryan CA, Dempsey EM. Comparison of the T-piece resuscitator with other neonatal manual ventilation devices: a qualitative review. Resuscitation. 2012;83(7):797-802.

Hussey SG, Ryan CA, Murphy BP. Comparison of three manual ventilation devices using an intubated mannequin. Archives of disease in childhood Fetal and neonatal edition. 2004;89(6):F490-493.

Szyld E, Aguilar A, Musante GA, et al. Comparison of devices for newborn ventilation in the delivery room. The Journal of pediatrics. 2014;165(2):234-239 e233.

Morley CJ, Dawson JA, Stewart MJ, Hussain F, Davis PG. The effect of a PEEP valve on a Laerdal neonatal self-inflating resuscitation bag. Journal of paediatrics and child health. 2010;46(1-2):51-56.

Hartung JC, Wilitzki S, Thio-Lluch M, te Pas AB, Schmalisch G, Roehr CC. Reliability of Single-Use PEEP-Valves Attached to Self-Inflating Bags during Manual Ventilation of Neonates--An In Vitro Study. PloS one. 2016;11(2):e0150224.

Thio M, Dawson JA, Crossley KJ, et al. Delivery of positive end- expiratory pressure to preterm lambs using common resuscitation devices. Archives of disease in childhood Fetal and neonatal edition. 2019;104(1):F83-F88.

Hinder M, McEwan A, Drevhammer T, Donaldson S, Tracy MB. T-piece resuscitators: how do they compare? Archives of disease in childhood Fetal and neonatal edition. 2019;104(2):F122- F127.

Hooper SB, Polglase GR, Roehr CC. Cardiopulmonary changes with aeration of the newborn lung. Paediatr Respir Rev. 2015;16(3):147-150.

Dunn MS, Kaempf J, de Klerk A, et al. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics. 2011;128(5):e1069-1076.

Roehr CC, Davis PG, Weiner GM, Jonathan Wyllie J, Wyckoff MH, Trevisanuto D. T-piece resuscitator or self-inflating bag during neonatal resuscitation: a scoping review. Pediatric research. 2020.

Kookna S, Singh AK, Pandit S, Dhawan N. T-Piece Resuscitator or Self Inflating Bag for Positive Pressure Ventilation during Neonatal Resuscitation: A Randomized Controlled Trial. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS).18(5):66- 74.

Guinsburg R, de Almeida MFB, de Castro JS, et al. T-piece versus self-inflating bag ventilation in preterm neonates at birth. Archives of disease in childhood Fetal and neonatal edition. 2018;103(1):F49-F55.

Hawkes CP, Oni OA, Dempsey EM, Ryan CA. Should the Neopuff T-piece resuscitator be restricted to frequent users? Acta paediatrica. 2010;99(3):452-453.

Hawkes CP, Oni OA, Dempsey EM, Ryan CA. Potential hazard of the Neopuff T-piece resuscitator in the absence of flow limitation. Archives of disease in childhood Fetal and neonatal edition. 2009;94(6):F461-463.

Smithhart W, Wyckoff MH, Kapadia V, et al. Delivery Room Continuous Positive Airway Pressure and Pneumothorax. Pediatrics. 2019;144(3).

Clevenger L, Britton JR. Delivery room continuous positive airway pressure and early pneumothorax in term newborn infants. J Neonatal Perinatal Med. 2017;10(2):157-161.

Hishikawa K, Goishi K, Fujiwara T, Kaneshige M, Ito Y, Sago H. Pulmonary air leak associated with CPAP at term birth resuscitation. Archives of disease in childhood Fetal and neonatal edition. 2015;100(5):F382-387.

Linde JE, Schulz J, Perlman JM, et al. The relation between given volume and heart rate during newborn resuscitation. Resuscitation. 2017;117:80-86.

Chua C, Schmolzer GM, Davis PG. Airway manoeuvres to achieve upper airway patency during mask ventilation in newborn infants - An historical perspective. Resuscitation. 2012;83(4):411-416.

Schmolzer GM, Dawson JA, Kamlin CO, O'Donnell CP, Morley CJ, Davis PG. Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room. Archives of disease in childhood Fetal and neonatal edition. 2011;96(4):F254-257.

O'Donnell CP, Kamlin CO, Davis PG, Morley CJ. Neonatal resuscitation 1: a model to measure inspired and expired tidal volumes and assess leakage at the face mask. Archives of disease in childhood Fetal and neonatal edition. 2005;90(5):F388-391.

Ersdal HL, Eilevstjonn J, Perlman J, et al. Establishment of functional residual capacity at birth: Observational study of 821 neonatal resuscitations. Resuscitation. 2020;153:71-78.

Slutsky AS. History of Mechanical Ventilation. From Vesalius to Ventilator-induced Lung Injury. Am J Respir Crit Care Med. 2015;191(10):1106-1115.

Tremblay LN, Slutsky AS. Ventilator-induced injury: from barotrauma to biotrauma. Proc Assoc Am Physicians. 1998;110(6):482-488.

dos Santos CC, Slutsky AS. The contribution of biophysical lung injury to the development of biotrauma. Annu Rev Physiol. 2006;68:585-618.

Jobe AH. Mechanisms of Lung Injury and Bronchopulmonary Dysplasia. Am J Perinatol. 2016;33(11):1076-1078.

Trevisanuto D, Roehr C, Davis P, et al. Devices for administering positive pressure ventilation at birth (NLS#879): Systematic review. ILCOR. administering-positive-pressure-ventilation-ppv-at-birth-nls- 870-systematic-review. Published 2021. Accessed April 20th, 2021.

Clark RH, Slutsky AS, Gerstmann DR. Lung protective strategies of ventilation in the neonate: what are they? Pediatrics. 2000;105(1 Pt 1):112-114.

van Kaam AH, Rimensberger PC. Lung-protective ventilation strategies in neonatology: what do we know--what do we need to know? Crit Care Med. 2007;35(3):925-931.

Hartung JC, te Pas AB, Fischer H, Schmalisch G, Roehr CC. Leak during manual neonatal ventilation and its effect on the delivered pressures and volumes: an in vitro study. Neonatology. 2012;102(3):190-195.

Wood FE, Morley CJ, Dawson JA, et al. Improved techniques reduce face mask leak during simulated neonatal resuscitation: study 2. Archives of disease in childhood Fetal and neonatal edition. 2008;93(3):F230-234.

Schilleman K, Witlox RS, Lopriore E, Morley CJ, Walther FJ, te Pas AB. Leak and obstruction with mask ventilation during simulated neonatal resuscitation. Archives of disease in childhood Fetal and neonatal edition. 2010;95(6):F398-402.

O'Donnell CP, Davis PG, Lau R, Dargaville PA, Doyle LW, Morley CJ. Neonatal resuscitation 2: an evaluation of manual ventilation devices and face masks. Archives of disease in childhood Fetal and neonatal edition. 2005;90(5):F392-396.

Schmolzer GM, Kamlin OC, O'Donnell CP, Dawson JA, Morley CJ, Davis PG. Assessment of tidal volume and gas leak during mask ventilation of preterm infants in the delivery room. Archives of disease in childhood Fetal and neonatal edition. 2010;95(6):F393-397.

Kaufman J, Schmolzer GM, Kamlin CO, Davis PG. Mask ventilation of preterm infants in the delivery room. Archives of disease in childhood Fetal and neonatal edition. 2013;98(5):F405-410.

Finer NN, Rich W, Wang C, Leone T. Airway obstruction during mask ventilation of very low birth weight infants during neonatal resuscitation. Pediatrics. 2009;123(3):865-869.

Kuypers K, Lamberska T, Martherus T, et al. The effect of a face mask for respiratory support on breathing in preterm infants at birth. Resuscitation. 2019.

Deindl P, Schwindt J, Berger A, Schmolzer GM. An instructional video enhanced bag-mask ventilation quality during simulated newborn resuscitation. Acta paediatrica. 2015;104(1):e20-26.

Poulton DA, Schmolzer GM, Morley CJ, Davis PG. Assessment of chest rise during mask ventilation of preterm infants in the delivery room. Resuscitation. 2011;82(2):175-179.

Binder C, Schmolzer GM, O'Reilly M, Schwaberger B, Urlesberger B, Pichler G. Human or monitor feedback to improve mask ventilation during simulated neonatal cardiopulmonary resuscitation. Archives of disease in childhood Fetal and neonatal edition. 2014;99(2):F120-123.

Schmolzer GM, Kamlin OC, Dawson JA, te Pas AB, Morley CJ, Davis PG. Respiratory monitoring of neonatal resuscitation. Archives of disease in childhood Fetal and neonatal edition. 2010;95(4):F295-303.

Schmolzer GM, Morley CJ, Davis PG. Respiratory function monitoring to reduce mortality and morbidity in newborn infants receiving resuscitation. The Cochrane database of systematic reviews. 2010(9):CD008437.

Wood FE, Morley CJ, Dawson JA, Davis PG. A respiratory function monitor improves mask ventilation. Archives of disease in childhood Fetal and neonatal edition. 2008;93(5):F380-381.

Milner AD, Sauders RA. Pressure and volume changes during the first breath of human neonates. Archives of disease in childhood. 1977;52(12):918-924.

Mortola JP, Fisher JT, Smith JB, Fox GS, Weeks S, Willis D. Onset of respiration in infants delivered by cesarean section. J Appl Physiol Respir Environ Exerc Physiol. 1982;52(3):716-724.

Karlberg P, Cherry RB, Escardo FE, Koch G. Respiratory studies in neborn infants II: Pulmonary ventilation and mechanics of breathing in the first minutes of life, including onset of ventilation. Acta paediatrica. 1962;51:121-136.

Resende JG, Menezes CG, Paula AM, et al. Evaluation of peak inspiratory pressure and respiratory rate during ventilation of an infant lung model with a self-inflating bag. J Pediatr (Rio J). 2006;82(5):359-364.

Stenson BJ, Boyle DW, Szyld EG. Initial ventilation strategies during newborn resuscitation. Clin Perinatol. 2006;33(1):65-82, vi-vii.

Boon AW, Milner AD, Hopkin IE. Lung expansion, tidal exchange, and formation of the functional residual capacity during resuscitation of asphyxiated neonates. The Journal of pediatrics. 1979;95(6):1031-1036.

Murthy V, Dattani N, Peacock JL, et al. The first five inflations during resuscitation of prematurely born infants. Archives of disease in childhood Fetal and neonatal edition. 2012;97(4):F249-253.

Karlberg P, Koch G. Respiratory studies in newborn infants. III. Development of mechanics of breathing during the first week of life. A longitudinal study. Acta Paediatr Suppl. 1962;135:121- 129.

Cook CD, Cherry RB, O'Brien D, Karlberg P, Smith CA. Studies of respiratory physiology in the newborn infant. I. Observations on normal premature and full-term infants. J Clin Invest. 1955;34(7, Part 1):975-982.

Vyas H, Milner AD, Hopkin IE, Boon AW. Physiologic responses to prolonged and slow-rise inflation in the resuscitation of the asphyxiated newborn infant. The Journal of pediatrics. 1981;99(4):635-639.

Klingenberg C, Sobotka KS, Ong T, et al. Effect of sustained inflation duration; resuscitation of near-term asphyxiated lambs. Archives of disease in childhood Fetal and neonatal edition. 2013;98(3):F222-227.

Sobotka KS, Hooper SB, Allison BJ, et al. An initial sustained inflation improves the respiratory and cardiovascular transition at birth in preterm lambs. Pediatric research. 2011;70(1):56-60.

te Pas AB, Siew M, Wallace MJ, et al. Establishing functional residual capacity at birth: the effect of sustained inflation and positive end-expiratory pressure in a preterm rabbit model. Pediatric research. 2009;65(5):537-541.

Kirpalani H, Ratcliffe SJ, Keszler M, et al. Effect of Sustained Inflations vs Intermittent Positive Pressure Ventilation on Bronchopulmonary Dysplasia or Death Among Extremely Preterm Infants: The SAIL Randomized Clinical Trial. JAMA. 2019;321(12):1165-1175.

Hull D. Lung expansion and ventilation during resuscitation of asphyxiated newborn infants. The Journal of pediatrics. 1969;75(1):47-58.

Hoskyns EW, Milner AD, Boon AW, Vyas H, Hopkin IE. Endotracheal resuscitation of preterm infants at birth. Archives of disease in childhood. 1987;62(7):663-666.

Siew ML, Te Pas AB, Wallace MJ, et al. Positive end-expiratory pressure enhances development of a functional residual capacity in preterm rabbits ventilated from birth. Journal of applied physiology. 2009;106(5):1487-1493.

Wheeler K, Wallace M, Kitchen M, et al. Establishing lung gas volumes at birth: interaction between positive end-expiratory pressures and tidal volumes in preterm rabbits. Pediatric research. 2013;73(6):734-741.

Kattwinkel J, Fleming D, Cha CC, Fanaroff AA, Klaus MH. A device for administration of continuous positive airway pressure by the nasal route. Pediatrics. 1973;52(1):131-134.

Kattwinkel J, Nearman HS, Fanaroff AA, Katona PG, Klaus MH. Apnea of prematurity. Comparative therapeutic effects of cutaneous stimulation and nasal continuous positive airway pressure. The Journal of pediatrics. 1975;86(4):588-592.

Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK. Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N Engl J Med. 1971;284(24):1333-1340.

Diblasi RM. Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant. Respiratory care. 2009;54(9):1209-1235.

Sweet DG, Carnielli V, Greisen G, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology. 2019;115(4):432-450.

Gie AG, Hubble TR, Regin Y, et al. A Systematic Review of the Influence of Continuous Positive Airway Pressure on Fetal and Newborn Animal Models: Suggestions to Improve Neonatal Respiratory Care. Neonatology. 2021;118(1):5-14.

Schmolzer GM, Kumar M, Pichler G, Aziz K, O'Reilly M, Cheung PY. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ. 2013;347:f5980.

Dawson JA, Schmolzer GM, Kamlin CO, et al. Oxygenation with T-piece versus self-inflating bag for ventilation of extremely preterm infants at birth: a randomized controlled trial. The Journal of pediatrics. 2011;158(6):912-918 e911-912.

Thakur A, Saluja S, Modi M, et al. T-piece or self inflating bag for positive pressure ventilation during delivery room resuscitation: an RCT. Resuscitation. 2015;90:21-24.

Kelm M, Proquitte H, Schmalisch G, Roehr CC. Reliability of two common PEEP-generating devices used in neonatal resuscitation. Klin Padiatr. 2009;221(7):415-418.

Morley CJ. Monitoring Neonatal Resuscitation: Why Is It Needed? Neonatology. 2018;113(4):387-392.

Ehrenstein V. Association of Apgar scores with death and neurologic disability. Clin Epidemiol. 2009;1:45-53.

Vik T, Stoen R, Lydersen S. There is a linear association between decreasing Apgar scores at 5 and 10 min and adverse neurodevelopmental outcomes. BMJ Evid Based Med. 2018;23(5):193-194.

Gynecology ACoOa. ACOG committee opinion 644: The Apgar score. Publications/Committee-Opinions/Committee-on-Obstetric- Practice/The-Apgar-Score. Published 2015. Accessed.

Ersdal HL, Mduma E, Svensen E, Perlman J. Birth asphyxia: a major cause of early neonatal mortality in a Tanzanian rural hospital. Pediatrics. 2012;129(5):e1238-1243.

O'Donnell CP, Kamlin CO, Davis PG, Carlin JB, Morley CJ. Interobserver variability of the 5-minute Apgar score. The Journal of pediatrics. 2006;149(4):486-489.

Frey HA. Apgar scores: Is anything less than perfect a cause for concern? Paediatr Perinat Epidemiol. 2020;34(5):581-582.

Kamlin CO, O'Donnell CP, Everest NJ, Davis PG, Morley CJ. Accuracy of clinical assessment of infant heart rate in the delivery room. Resuscitation. 2006;71(3):319-321.

Haug I, Holte K, Chang C, et al. Video Analysis of Newborn Resuscitations After Simulation-Based Helping Babies Breathe Training. Clinical Simulation in Nursing. 2020;44:68-78.

Skare C, Boldingh AM, Nakstad B, et al. Ventilation fraction during the first 30s of neonatal resuscitation. Resuscitation. 2016;107:25-30.

Katheria A, Rich W, Finer N. Electrocardiogram provides a continuous heart rate faster than oximetry during neonatal resuscitation. Pediatrics. 2012;130(5):e1177-1181.

Mizumoto H, Tomotaki S, Shibata H, et al. Electrocardiogram shows reliable heart rates much earlier than pulse oximetry during neonatal resuscitation. Pediatr Int. 2012;54(2):205-207.

Bjorland PA, Ersdal HL, Oymar K, Rettedal SI. Compliance with Guidelines and Efficacy of Heart Rate Monitoring during Newborn Resuscitation: A Prospective Video Study. Neonatology. 2020;117(2):175-181.

van Vonderen JJ, Hooper SB, Kroese JK, et al. Pulse oximetry measures a lower heart rate at birth compared with electrocardiography. The Journal of pediatrics. 2015;166(1):49- 53.

van Vonderen JJ, van Zanten HA, Schilleman K, et al. Cardiorespiratory Monitoring during Neonatal Resuscitation for Direct Feedback and Audit. Front Pediatr. 2016;4:38.

Koizumi M, Mizumoto H, Araki R, Kan H, Akashi R, Hata D. The utility of electrocardiogram for evaluation of clinical cardiac arrest in neonatal resuscitation. Resuscitation. 2016;104:e3-4.

Baik N, Urlesberger B, Schwaberger B, Freidl T, Schmolzer GM, Pichler G. Cardiocirculatory monitoring during immediate fetal- to-neonatal transition: a systematic qualitative review of the literature. Neonatology. 2015;107(2):100-107.

Niermeyer S. Ventilation Remains the Key to Neonatal Resuscitation. The Journal of pediatrics. 2016;171:8-10.

Chu JS, Dawson P, Klaus M, Sweet AY. Lung Compliance and Lung Volume Measured Concurrently in Normal Full-Term and Premature Infants. Pediatrics. 1964;34:525-532.

Bowman TA, Paget-Brown A, Carroll J, Gurka MJ, Kattwinkel J. Sensing and responding to compliance changes during manual ventilation using a lung model: can we teach healthcare providers to improve? The Journal of pediatrics. 2012;160(3):372-376 e371.

Hunt KA, Murthy V, Bhat P, et al. Tidal volume monitoring during initial resuscitation of extremely prematurely born infants. J Perinat Med. 2019;47(6):665-670.

Hernandez LA, Peevy KJ, Moise AA, Parker JC. Chest wall restriction limits high airway pressure-induced lung injury in young rabbits. Journal of applied physiology. 1989;66(5):2364- 2368.

Probyn ME, Hooper SB, Dargaville PA, McCallion N, Harding R, Morley CJ. Effects of tidal volume and positive end-expiratory pressure during resuscitation of very premature lambs. Acta paediatrica. 2005;94(12):1764-1770.

van Vonderen JJ, Kamar R, Schilleman K, Walther FJ, Hooper SB, Te Pas AB. Influence of the hand squeeze and mask distensibility on tidal volume measurements during neonatal mask ventilation. Neonatology. 2013;104(3):216-221.

van Vonderen JJ, Hooper SB, Krabbe VB, Siew ML, Te Pas AB. Monitoring tidal volumes in preterm infants at birth: mask versus endotracheal ventilation. Archives of disease in childhood Fetal and neonatal edition. 2015;100(1):F43-46.

Milner A, Murthy V, Bhat P, et al. Evaluation of respiratory function monitoring at the resuscitation of prematurely born infants. Eur J Pediatr. 2015;174(2):205-208.

Hooper SB, Fouras A, Siew ML, et al. Expired CO2 levels indicate degree of lung aeration at birth. PloS one. 2013;8(8):e70895.

Schmolzer GM, Hooper SB, Wong C, Kamlin CO, Davis PG. Exhaled carbon dioxide in healthy term infants immediately after birth. The Journal of pediatrics. 2015;166(4):844-849 e841-843.

Blank DA, Gaertner VD, Kamlin COF, et al. Respiratory changes in term infants immediately after birth. Resuscitation. 2018;130:105-110.

Mizumoto H, Iki Y, Yamashita S, Hata D. Expiratory CO2 as the first sign of successful ventilation during neonatal resuscitation. Pediatr Int. 2015;57(1):186-188.

Blank D, Rich W, Leone T, Garey D, Finer N. Pedi-cap color change precedes a significant increase in heart rate during neonatal resuscitation. Resuscitation. 2014;85(11):1568-1572.

Leone TA, Lange A, Rich W, Finer NN. Disposable colorimetric carbon dioxide detector use as an indicator of a patent airway during noninvasive mask ventilation. Pediatrics. 2006;118(1):e202-204.

Murthy V, O'Rourke-Potocki A, Dattani N, et al. End tidal carbon dioxide levels during the resuscitation of prematurely born infants. Early Hum Dev. 2012;88(10):783-787.

Linde JE, Perlman JM, Oymar K, et al. Predictors of 24-h outcome in newborns in need of positive pressure ventilation at birth. Resuscitation. 2018;129:1-5.

Lee AC, Cousens S, Wall SN, et al. Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effect. BMC Public Health. 2011;11 Suppl 3:S12.

Ersdal H, Nuwass E. SAFER BIRTHS - a research and development project to save lives at birth, 2019 update. 4a257a/globalassets/lgh/partnerships--programs/safer-births/safer-births-report-screens-07.08.29.pdf. Published 2019. Accessed 24. May, 2021.

Ersdal H. Appropriate interventions to reduce perinatal mortality and morbidity in low-resourced settings. Oslo: Faculty of Medicine, University of Oslo; 2012.

Stordal K, Eilevstjonn J, Mduma E, et al. Increased perinatal survival and improved ventilation skills over a five-year period: An observational study. PloS one. 2020;15(10):e0240520.

Vossius C, Lotto E, Lyanga S, et al. Cost-effectiveness of the "helping babies breathe" program in a missionary hospital in rural Tanzania. PloS one. 2014;9(7):e102080.

Vossius C, Mduma E, Moshiro R, et al. The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania. BMC Health Serv Res. 2021;21(1):99.

Mduma ER, Ersdal H, Kvaloy JT, et al. Using statistical process control methods to trace small changes in perinatal mortality after a training program in a low-resource setting. Int J Qual Health Care. 2018.

Moshiro R, Perlman J, Kidanto H, Kvaløy J, Mdoe P, Ersdal H. Predictors of death including quality of positive pressure ventilation during newborn resuscitation and the relationship to outcome at seven days in a rural Tanzanian hospital. PloS one. 2018.

Urdal J, Engan K, Eftestol T, et al. Fetal heart rate development during labour. Biomed Eng Online. 2021;20(1):26.

Vu H, Eftestol T, Engan K, et al. Automatic Detection and Parameterization of Manual Bag-Mask Ventilation on Newborns. IEEE journal of biomedical and health informatics. 2016.

Meinich-Bache O, Austnes SL, Engan K, et al. Activity Recognition From Newborn Resuscitation Videos. IEEE journal of biomedical and health informatics. 2020;24(11):3258-3267.

Ersdal HL, Singhal N, Msemo G, et al. Successful implementation of Helping Babies Survive and Helping Mothers Survive programs-An Utstein formula for newborn and maternal survival. PloS one. 2017;12(6):e0178073.

Ersdal HL, Vossius C, Bayo E, et al. A one-day "Helping Babies Breathe" course improves simulated performance but not clinical management of neonates. Resuscitation. 2013;84(10):1422- 1427.

Mduma E, Ersdal H, Svensen E, Kidanto H, Auestad B, Perlman J. Frequent brief on-site simulation training and reduction in 24- h neonatal mortality--an educational intervention study. Resuscitation. 2015;93:1-7.

Mduma E, Kvaloy JT, Soreide E, et al. Frequent refresher training on newborn resuscitation and potential impact on perinatal outcome over time in a rural Tanzanian hospital: an observational study. BMJ Open. 2019;9(9):e030572.

Gomo OH, Eilevstjonn J, Holte K, Yeconia A, Kidanto H, Ersdal HL. Delivery of Positive End-Expiratory Pressure Using Self- Inflating Bags during Newborn Resuscitation Is Possible Despite Mask Leak. Neonatology. 2020:1-8.

Mdoe PF, Ersdal HL, Mduma E, et al. Randomized controlled trial of continuous Doppler versus intermittent fetoscope fetal heart rate monitoring in a low-resource setting. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2018;143(3):344-350.

Thallinger M, Ersdal HL, Francis F, et al. Born not breathing: A randomised trial comparing two self-inflating bag-masks during newborn resuscitation in Tanzania. Resuscitation. 2017;116:66- 72.

Website for Haydom Lutheran Hospital. Accessed February, 2021.

Tanzania Demographic and Health Surveys 2015-2016. Accessed 10 February, 2021.

Linde JE, Eilevstjonn J, Oymar K, Ersdal HL. Feasibility of a prototype newborn resuscitation monitor to study transition at birth, measuring heart rate and ventilator parameters, an animal experimental study. BMC Res Notes. 2017;10(1):235.

Zou KH, O'Malley AJ, Mauri L. Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation. 2007;115(5):654-657.

Thallinger M, Ersdal HL, Morley C, et al. Neonatal ventilation with a manikin model and two novel PEEP valves without an external gas source. Archives of disease in childhood Fetal and neonatal edition. 2016.

Sloss S, Dawson JA, McGrory L, Rafferty AR, Davis PG, Owen LS. Observational study of parental opinion of deferred consent for neonatal research. Archives of disease in childhood Fetal and neonatal edition. 2021;106(3):258-264.

Songstad NT, Roberts CT, Manley BJ, Owen LS, Davis PG, investigators Ht. Retrospective Consent in a Neonatal Randomized Controlled Trial. Pediatrics. 2018;141(1).

van Os S, Cheung PY, Pichler G, Aziz K, O'Reilly M, Schmolzer GM. Exhaled carbon dioxide can be used to guide respiratory support in the delivery room. Acta paediatrica. 2014;103(8):796- 806.

Chalak LF. End-tidal CO2 detection of an Audible Heart Rate During Neonatal Cardiopulmonary Resusctiation After Asystole in Asphyxiated Piglets. Pediatric research. 2011;69(5):401-405.

Stine CN, Koch J, Brown LS, Chalak L, Kapadia V, Wyckoff MH. Quantitative end-tidal CO2 can predict increase in heart rate during infant cardiopulmonary resuscitation. Heliyon. 2019;5(6):e01871.

Trillo G, von Planta M, Kette F. ETCO2 monitoring during low flow states: clinical aims and limits. Resuscitation. 1994;27(1):1- 8.

Soar J, Berg KM, Andersen LW, et al. Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation. 2020;156:A80- A119.

Maconochie IK, Aickin R, Hazinski MF, et al. Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2020;156:A120- A155.

Kitsommart R, Nakornchai K, Yangthara B, Jiraprasertwong R, Paes B. Positive end-expiratory pressure during resuscitation at birth in very-low birth weight infants: A randomized-controlled pilot trial. Pediatr Neonatol. 2018;59(5):448-454.

van Vonderen JJ, Hooper SB, Hummler HD, Lopriore E, te Pas AB. Effects of a sustained inflation in preterm infants at birth. The Journal of pediatrics. 2014;165(5):903-908 e901.

Gaertner VD, Ruegger CM, O'Currain E, et al. Physiological responses to facemask application in newborns immediately after birth. Archives of disease in childhood Fetal and neonatal edition. 2020.

Polglase GR, Hooper SB, Gill AW, et al. Cardiovascular and pulmonary consequences of airway recruitment in preterm lambs. Journal of applied physiology. 2009;106(4):1347-1355.

Schmolzer GM, Morley CJ, Kamlin O. Enhanced monitoring during neonatal resuscitation. Semin Perinatol. 2019;43(8):151177.

Hughes SM, Blake BL, Woods SL, Lehmann CU. False-positive results on colorimetric carbon dioxide analysis in neonatal resuscitation: potential for serious patient harm. Journal of perinatology : official journal of the California Perinatal Association. 2007;27(12):800-801.

Brown MK, Lazarus DV, Gonzales SR, et al. Resistance of Colorimetric Carbon Dioxide Detectors Commonly Utilized in Neonates. Respiratory care. 2016;61(8):1003-1007.

Schmolzer GM, Roehr CC. Use of respiratory function monitors during simulated neonatal resuscitation. Klin Padiatr. 2011;223(5):261-266.

Zeballos Sarrato G, Sanchez Luna M, Zeballos Sarrato S, Perez Perez A, Pescador Chamorro I, Bellon Cano JM. New Strategies of Pulmonary Protection of Preterm Infants in the Delivery Room with the Respiratory Function Monitoring. Am J Perinatol. 2019;36(13):1368-1376.

Schmolzer GM, Morley CJ, Wong C, et al. Respiratory function monitor guidance of mask ventilation in the delivery room: a feasibility study. The Journal of pediatrics. 2012;160(3):377-381 e372.

van Vonderen JJ, Roest AA, Siew ML, Walther FJ, Hooper SB, te Pas AB. Measuring physiological changes during the transition to life after birth. Neonatology. 2014;105(3):230-242.

Bohrer B, Silveira RC, Neto EC, Procianoy RS. Mechanical ventilation of newborns infant changes in plasma pro- and anti- inflammatory cytokines. The Journal of pediatrics. 2010;156(1):16-19.

Klingenberg C, Dawson JA, Gerber A, Kamlin CO, Davis PG, Morley CJ. Sustained inflations: comparing three neonatal resuscitation devices. Neonatology. 2011;100(1):78-84.

WMA. Helsinki declaration. post/wma-declaration-of-helsinki-ethical-principles-for- medical-research-involving-human-subjects/. Published 2018. Updated July 9th 2018. Accessed June 6th, 2021.

Bhutta ZA. Ethics in international health research: a perspective from the developing world. Bull World Health Organ. 2002;80(2):114-120.

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