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Background: Ventilation is the key intervention to resuscitate non-breathing newborns. Positive end-expiratory pressure (PEEP) may facilitate lung-liquid clearance and help establish functional residual capacity. Objectives: The aim of this study was to describe how mask leak and ventilation rates affect delivered PEEP and tidal volumes during newborn resuscitations using a self-inflating bag with an integrated PEEP valve. Methods: This was an observational study including near-term/term newborns who received bag-mask ventilation (BMV) with a new self-inflating bag with a novel 6 mbar PEEP valve, without external gas flow, between October 1, 2016 and June 30, 2018 in rural Tanzania. Helping Babies Breathe-trained midwives performed most of the resuscitations. Pressures and flow were continuously measured and recorded by resuscitation monitors. Results: In total, 198 newborns with a median gestation of 39 weeks (25th, 75th percentiles 37, 40) and birth weight of 3,100 g (2,580, 3,500) were included. The median delivered PEEP and expired (tidal) volume at different levels of mask leak were 6.0 mbar and 11.3 mL/kg at 0–20% mask leak, 5.5 mbar and 9.3 mL/kg at 20–40%, 5.2 mbar and 7.8 mL/kg at 40–60%, 4.6 mbar and 5.0 mL/kg at 60–80%, and 1.0 mbar and 0.6 mL/kg at 80–100% mask leak. A high ventilation rate (>60/min) nearly halved expired volumes compared to <60/min for 0–60% leak. The BMV rate had a negligible effect on peak inflation pressure (PIP) and PEEP. Conclusions: Mask leak up to 80% did not impair the provision of recommended PEEP or tidal volumes during BMV with a self-inflating bag. High or low ventilation rates did not significantly affect PIP or PEEP. Expired volumes were reduced at ventilation rates >60/min. [ABSTRACT FROM AUTHOR]

Objective: Positive end expiratory pressure (PEEP) is beneficial when ventilating preterm newborns. The aim was to study whether inexperienced providers were able to generate PEEP during simulated neonatal ventilation, using two novel prototype PEEP valves, on a self-inflating bag without an external gas source.Design: Forty-six nursing students in Tanzania were trained in ventilation with a new Laerdal Upright resuscitator and mask on a NeoNatalie manikin with a newborn resuscitation monitor. Ventilation was studied with and without PEEP valve 1 (anticipated level 4-5 cm H2O) and with and without PEEP valve 2 (anticipated level 9-10 cm H2O) in random order for normal and low 'lung' compliance. The PEEP valves were concave silicone valves with a small slit that would open to let expiratory air out.Results: Mean PEEP with PEEP1 was 4.4 cm H2O (SD 2.2) and with PEEP2 was 4.9 cm H2O (SD 3.1). PEEP ≥4 cm H2O was generated with 70% of inflations with PEEP1 and 65% with PEEP2. Mean airway pressure was 16.3 cm H2O with both PEEP valves compared with 14.2 without PEEP (p<0.001). Mean mask leak was similar with and without PEEP (48% with PEEP1, 58% with PEEP2, 55% without PEEP). Mask leak and PEEP were inversely correlated. Findings with normal and low 'lung' compliance were similar.Conclusions: PEEP between 4 cm H2O and 5 cm H2O was achieved when ventilating a neonatal manikin using a self-inflating bag and novel PEEP valves. Valves that can generate PEEP without external gas sources may aid resuscitation in resource-limited settings. [ABSTRACT FROM AUTHOR]