Innovating Neonatal Resuscitation Bags for Ease of Use in Diverse Locations.

The Chinese emperor Huang-Ti (2698–2599 BCE) noted that newborn death from ventilatory failure was common in premature infants.1 Galen (129–199 CE) inflated the lungs of deceased animals with a bellows and concluded that the air movement causes the chest to rise.1,2 Between 1850 and 1950, many techniques were used to resuscitate newborns, including swinging the infant upside down,1-3 rhythmic traction of the tongue, tickling, shaking, and yelling,2 and various other methods. In 1950, the first positivepressure device was created to inflate infant lungs.4 Since that time, flowand self-inflating manual resuscitation bagvalve devices have been developed to manually support infants requiring ventilation. In more recent years, flowcontrolled pressure-limited T-piece devices, such as the Neopuff resuscitator (Fisher & Paykel Healthcare, Auckland New Zealand), have also been designed for manual ventilation of infants. Current neonatal resuscitation guidelines specify that ventilation can be achieved with a flowinflating bag,5 self-inflating bag,5,6 or T-piece device.5 Statistics in 2010 on global child mortality show that over 700,000 neonates die annually from birth asphyxia, and this is the second largest cause of neonatal death in Africa, the Eastern Mediterranean, Western Pacific, and Southeast Asia.7 There may be an opportunity in this population to reduce mortalities especially in low-resource settings with an affordable and easy-to-use manual neonatal resuscitation bag. There are limited data comparing neonatal resuscitation equipment. Several studies have compared self-inflating neonatal resuscitation bags8,9 and flow-inflating neonatal resuscitation bags and T-piece devices.8-10 These studies have generally examined the effectiveness of maintaining a desired peak inspiratory pressure, breathing frequency, and PEEP and have found no significant differences between devices. There is a dearth of evidence examining resuscitation equipment that may be well suited for under-resourced locations or places where training may not be optimal. In this issue of RESPIRATORY CARE, Coffey et al11 examine the performance and acceptability of two self-inflating resuscitation bags for neonates. One of the bags is a commonly used device, and the other is a new design intended to be less expensive and easier to both use and clean, with