To investigate the utility of continuous quantitative end-tidal CO₂ (Etco₂) monitoring for managing assisted ventilation in the delivery room (DR).

This is a prospective randomized controlled trial. Infants who received positive pressure ventilation (PPV) were randomized to a control versus a monitored arm. In the monitored arm, the resuscitating team adjusted PPV based on Etco₂ values. In the control arm, the team provided PPV based on clinical assessment. Etco₂ levels after resuscitation and admission Pco₂ levels were compared between groups.

Fifty infants were enrolled, and 48 subjects had primary outcome data. Of those, 7 infants were intubated in the DR, 41 infants received PPV via mask until respiratory support could be maintained on continuous positive airway pressure alone. The median Etco₂ levels at the end of resuscitation were 44 mm Hg (16-66 mm Hg) in the control arm and 43 mm Hg (29-59 mm Hg) in the monitored arm. The proportion of Etco₂ levels outside of the prespecified range was 52.6% (control) and 33.3% (monitored) (P = .236). The median admission Pco₂ levels were 57 mm Hg (36-110 mm Hg) in the control arm and 55 mm Hg (40-93 mm Hg) in the monitored arm. The proportion of admission Pco₂ levels outside of the prespecified range was 33.3% (control) versus 37.5% (monitored) (P = .763).

Etco₂ monitoring in the DR did not reduce the proportion of admission Pco₂ levels outside of the prespecified range in a population of infants supported mostly with noninvasive ventilation.