Does sustained lung inflation at birth improve outcome of preterm infants at risk for respiratory distress syndrome?
BACKGROUND
Sustained lung inflation (SLI) applied at birth has been demonstrated to lead to clearance of lung fluid and achievement of a precocious functional residual capacity in animal studies.


OBJECTIVE
To verify if the application of SLI in preterm infants at birth may reduce the need for mechanical ventilation and improve their respiratory outcome.


METHODS
We prospectively studied 89 infants with respiratory distress (gestational age (GA) 28.1 ± 2.2 weeks) treated at birth with a SLI (25 cm H(2)O, sustained for 15 s) in addition to AAP recommendations versus a historical control group (n = 119; GA 28.1 ± 2.0 weeks) treated without SLI with the same device (controlled positive end-expiratory pressure of 5 cm H(2)O).


RESULTS
The SLI group had less need for (51 vs. 76%, p < 0.0001) and shorter duration of mechanical ventilation (5 ± 11 vs. 11 ± 19 days, p = 0.008), a more frequent occurrence of exclusive nasal continuous airway pressure support (49 vs. 24%, p < 0.0001) and INtubation-SURfactant-Extubation (INSURE) treatment (16 vs. 3%, p = 0.01), less need for surfactant (45 vs. 61%, p = 0.027) and postnatal steroids (10 vs. 25%, p = 0.01), a shorter duration of oxygen therapy (21 ± 27 vs. 31 ± 31 days, p = 0.016), and, finally, a lower occurrence of bronchopulmonary dysplasia in survivors (7 vs. 25%, p = 0.004). Multiple regression analysis showed that 23-27 weeks of GA and birth weight <750 g increased the risk of mechanical ventilation, while a clinical risk index for babies (CRIB) score <3 as well as INSURE strategy and SLI treatment in the delivery room decreased it.


CONCLUSIONS
The application of a SLI at birth in preterm infants with respiratory distress may decrease the need for mechanical ventilation without inducing evident adverse effects.
Lista
Gianluca
G
Division of Neonatology, V Buzzi Children's Hospital of Milan, Milan, Italy. g.lista @ icp.mi.it
Fontana
Paola
P
Castoldi
Francesca
F
Cavigioli
Francesco
F
Dani
Carlo
C
D001997:Bronchopulmonary Dysplasia / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D047928:Premature Birth / Q000503:physiopathology*; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000517:prevention & control*; D012143:Respiratory Physiological Phenomena; D016896:Treatment Outcome
D011663:Pulmonary Surfactants