Respiratory function monitoring for neonatal resuscitation: a narrative review

Newborn infants must undergo complex physiological changes when transitioning from fetal to extrauterine life, including rapid lung aeration, fluid clearance and major haemodynamic shifts. Although the majority breathe spontaneously, a significant minority may require respiratory support. Resuscitation guidelines recommend face-mask positive pressure ventilation with a T-piece resuscitator, but effectiveness in the delivery room (DR) is typically assessed by subjective measures such as chest wall movement. This narrative review summarises the evidence regarding the use of respiratory function monitors (RFMs) to provide real-time objective feedback on tidal volumes, pressures and mask leak during DR resuscitation. We examine the potential for RFMs to reduce the risk of both underventilation and overventilation and whether their employment in the first few hours of life could mitigate long-term complications such as bronchopulmonary dysplasia and intraventricular haemorrhage. We also explore practical considerations such as sensor technology, dead space, staff training, usability and cost-effectiveness. While systematic reviews and major international guidelines have not yet endorsed their routine implementation, citing limited randomised controlled trial data, multiple observational studies demonstrate that RFMs can improve DR ventilation. Ultimately, RFMs may facilitate individualised, lung-protective approaches to DR ventilation, particularly in vulnerable preterm infants. Future directions include high-quality trials with comprehensive clinical outcomes, cost-effectiveness evaluations and clarifications of training requirements for effective RFM use.