Last reviewed: September 2018
Last updated: June  2018

Cochrane review shows laryngeal mask airway should be considered before intubation in near-term neonates needing resuscitation

A Cochrane review concludes that in babies >1500 g or >34 weeks’ gestation, a laryngeal mask airway (LMA) reduces resuscitation time and intubation compared with bag and mask ventilation (BMV).

Clinicians should consider using LMA more proactively to provide effective ventilation when a newborn is not responding to BMV and before intubating.

See Management: approach

Original source of update



History and exam

Key diagnostic factors

  • presence of risk factors
  • maternal last menstrual period (LMP)
  • distance from the maternal superior pubis to the uterine fundus
  • infant physical maturity score
  • infant neuromuscular maturity score
  • combined physical/neuromuscular score <10: gestational age <28 weeks
  • combined physical/neuromuscular score 11 to 19: gestational age 29 to 31 weeks
  • combined physical/neuromuscular score 20 to 24: gestational age 32 to 33 weeks
  • combined physical/neuromuscular score 25 to 33: gestational age 34 to 36 weeks

Other diagnostic factors

  • infant birth weight (appropriate for gestational age infants, AGA)

Risk factors

  • spontaneous preterm labour
  • intra-uterine infection
  • preterm premature rupture of membranes (PPROM)
  • pre-eclampsia/pregnancy-induced hypertension
  • abruption/antepartum haemorrhage
  • abnormal amniotic fluid volume
  • severe bacterial vaginosis
  • multiple gestation
  • previous preterm birth
  • fetal abnormality
  • cervical incompetence/uterine abnormality
  • gestational diabetes
  • maternal surgery during pregnancy
  • chronic maternal illness
  • short inter-pregnancy time interval
  • drug use (tobacco, cocaine, heroin)
  • maternal pregnancy BMI <19 or >35
  • stress/depression
  • non-white race

Diagnostic investigations

1st investigations to order

  • fetal biometry during antenatal period
Full details

Treatment algorithm


Authors VIEW ALL

Associate Professor

Section of Neonatology and Department of Pediatrics

Baylor College of Medicine




MP declares that he has no competing interests.

Dr Mohan Pammi would like to gratefully acknowledge Dr Stephen Welty and Dr James L. Wynn, previous contributors to this monograph. SW and JLW declare that they have no competing interests.

Peer reviewers VIEW ALL

Consultant Obstetrician and Gynaecologist

Gloucestershire Royal Hospital




IB declares that he has no competing interests.

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