Sustained lung inflation at birth for preterm infants: a randomized clinical trial.

Abstract:

BACKGROUND:Studies suggest that giving newly born preterm infants sustained lung inflation (SLI) may decrease their need for mechanical ventilation (MV) and improve their respiratory outcomes. METHODS:We randomly assigned infants born at 25 weeks 0 days to 28 weeks 6 days of gestation to receive SLI (25 cm H2O for 15 seconds) followed by nasal continuous positive airway pressure (nCPAP) or nCPAP alone in the delivery room. SLI and nCPAP were delivered by using a neonatal mask and a T-piece ventilator. The primary end point was the need for MV in the first 72 hours of life. The secondary end points included the need for respiratory supports and survival without bronchopulmonary dysplasia (BPD). RESULTS:A total of 148 infants were enrolled in the SLI group and 143 in the control group. Significantly fewer infants were ventilated in the first 72 hours of life in the SLI group (79 of 148 [53%]) than in the control group (93 of 143 [65%]); unadjusted odds ratio: 0.62 [95% confidence interval: 0.38-0.99]; P = .04). The need for respiratory support and survival without BPD did not differ between the groups. Pneumothorax occurred in 1% (n = 2) of infants in the control group compared with 6% (n = 9) in the SLI group, with an unadjusted odds ratio of 4.57 (95% confidence interval: 0.97-21.50; P = .06). CONCLUSIONS:SLI followed by nCPAP in the delivery room decreased the need for MV in the first 72 hours of life in preterm infants at high risk of respiratory distress syndrome compared with nCPAP alone but did not decrease the need for respiratory support and the occurrence of BPD.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Lista G,Boni L,Scopesi F,Mosca F,Trevisanuto D,Messner H,Vento G,Magaldi R,Del Vecchio A,Agosti M,Gizzi C,Sandri F,Biban P,Bellettato M,Gazzolo D,Boldrini A,Dani C,SLI Trial Investigators.

doi

10.1542/peds.2014-1692

subject

Has Abstract

pub_date

2015-02-01 00:00:00

pages

e457-64

issue

2

eissn

0031-4005

issn

1098-4275

pii

peds.2014-1692

journal_volume

135

pub_type

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