“MR SOPA” – A German Adaption of the Acronym to Optimize Non-Invasive Ventilation in Preterm and Term Neonates

Effective lung aeration through non-invasive positive pressure ventilation is the most important intervention when treating ineffectively or non-breathing neonates during the postnatal transition period (Foglia EE et al. Semin Fetal Neonatal Med 2018; 23: 340–346). However, even for experienced healthcare providers, mask ventilation can be challenging especially in preterm neonates due to high mask leakage, obstructed airways and, thus, low tidal volumes (Schmölzer GM et al. Arch Dis Child Fetal Neonatal Ed 2011; 96: F254 – F257; Schilleman K et al. J Pediatr 2013; 162: 457–463). A video-based analysis showed that manoeuvres aiming at improving non-invasive respiratory support were required in 78% of insufficiently breathing or apnoeic neonates immediately after birth, with a significantly higher incidence of ventilation problems requiring corrective steps in preterm neonates (Mileder LP et al. J Matern Fetal Neonatal Med 2020; doi: 10.1080/14767058.2020.1846176

In the case of ineffective ventilation, the recently published European Resuscitation Council guidelines recommend to check equipment immediately, to recheck head position and airway patency, to recheck mask size, position and seal, and to consider an increase in peak inspiratory pressure. Furthermore, application of two-person ventilation technique, insertion of oro-/nasopharyngeal airways or a laryngeal mask, or even securing the airway via endotracheal intubation is recommended (Madar J et al. Resuscitation 2021; 161: 291–326). Summarizing ventilation correcting measures, the Neonatal Resuscitation Program^® by the American Academy of Pediatrics uses the acronym “MR SOPA” ([Table 1]): Mask adjustment, reposition head, suction mouth and nose, open mouth, pressure increase, and alternative airway (Weiner GM et al. Textbook of neonatal resuscitation. 8^th edition. American Academy of Pediatrics and American Heart Association, Elk Grove Village 2021). One Canadian study with a pre-post study design showed that daily “MR SOPA”-simulation drills were associated with a significantly increased utilization of “MR SOPA” and improved ventilation performance in preterm neonates below 33 weeks of gestation (Nosherwan A. Paediatr Child Health 2017; 22(Suppl 1): e23).

Table 1 Suggestion for a German adaption of the acronym “MR SOPA” (Weiner GM, Zaichkin J, editors. Textbook of neonatal resuscitation. 8^th edition. American Academy of Pediatrics and American Heart Association, Elk Grove Village 2021).

English version	German adaption
Mask adjustment	Maske repositionieren oder wechseln
Reposition head	Repositioniere Kopf/Atemweg
Suction mouth and nose	Sauge ab (Mund/Nase)
Open mouth	Oeffne den Mund/Atemweg, erwäge oropharyngealen Atemweg (Guedel-Tubus)
Pressure increase	PIP* erhöhen
Alternative airway	Alternativer Atemweg (Endotrachealtubus, Larynxmaske)

* PIP: peak inspiratory pressure=maximaler inspiratorischer Atemwegsdruck.

However, the acronym “MR SOPA” is relatively unknown among German-speaking paediatricians and neonatologists and, therefore, rarely taught and practised during neonatal resuscitation training. A language barrier as well as a lack of knowledge about the acronym may be reasons for this situation, as both have been identified as barriers to the implementation and use of evidence-based medicine (Sadeghi-Bazargani H et al. J Eval Clin Pract 2014; 20: 793–802). Hence, we are presenting an easily applicable German translation of “MR SOPA” ([Table 1]). This shall inform ventilation and resuscitation training to provide neonatal health care professionals with a ‘catchy’ yet effective cognitive aid to correct and optimize non-invasive ventilation. Such MR SOPA-based educational interventions would help to implement standardized ventilation correcting steps into actual delivery room resuscitations. It would be of interest to investigate the current knowledge of “MR SOPA” and the potential increase of its utilization following our suggested translation among German-speaking neonatal institutions through a survey. Nevertheless, as the clinical impact of our proposed translation will be difficult to measure, it is reasonable to suppose that a standardized airway approach could have the potential to improve non-invasive ventilation in, and ultimately the outcome of, preterm and term neonates.

Publication History

Article published online:
01 September 2021