Study of the effects of the use of sustained lung inflation in treatment of preterm infants with respiratory distress in the delivery room

Abstract

Objective To assess the effect of sustained lung inflation (SLI) on the need for invasive mechanical ventilation (MV) within the first 72 h of age in preterm infants with respiratory distress. Study design In this controlled trial, we randomly assigned preterm infants 33 weeks of gestation or less to receive SLI (25 cmH2O) at birth, to be repeated if needed for a second time (30 cmH2O) followed by continuous positive airway pressure (CPAP), or assistance according to the recommendations of the American Academy of Pediatrics. The primary outcome was the need for invasive MV within the first 72 h of life. The secondary outcomes included development of bronchopulmonary dysplasia or death. The risk ratios (RRs) and 95% confidence intervals of the outcomes were calculated for the SLI group and compared with the control group. Results A total of 145 infants were enrolled: 71 in the SLI group and 74 in the control group. Less preterm infants needed invasive MV in the SLI of preterm group compared with the control group (19.72 vs. 29.73%; RR, 0.6633; 95% confidence interval, 0.2693–1.2517), with a number needed to treat of 10 patients; the difference was statistically significant by multivariate logistic regression (P=0.032). No statistically significant difference was detected between the studied groups regarding the occurrence of bronchopulmonary dysplasia, and also the median cumulative survival for the SLI of preterms group showed no statistically significant difference when compared with the median of the standard group. Conclusion A sustained inflation followed by early nasal CPAP, delivered through a nasopharyngeal tube, is a more efficient strategy than repeated manual inflations with a self-inflating bag and mask followed by nasal CPAP on admission to the neonatal intensive care unit.