title: Sustained inflation versus positive pressure ventilation at birth: a systematic review and meta-analysis.
abstract: BACKGROUND
  Sustained inflation (SI) has been advocated as an alternative to intermittent positive pressure ventilation (IPPV) during the resuscitation of neonates at birth, to facilitate the early development of an effective functional residual capacity, reduce atelectotrauma and improve oxygenation after the birth of preterm infants.
  
  
  OBJECTIVE
  The primary aim was to review the available literature on the use of SI compared with IPPV at birth in preterm infants for major neonatal outcomes, including bronchopulmonary dysplasia (BPD) and death.
  
  
  METHODS
  MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials, until 6 October 2014.
  
  
  METHODS
  Randomised clinical trials comparing the effects of SI with IPPV at birth in preterm infants for neonatal outcomes.
  
  
  METHODS
  Descriptive and quantitative information was extracted; data were pooled using a random effects model. Heterogeneity was assessed using the Q statistic and I(2).
  
  
  RESULTS
  Pooled analysis showed significant reduction in the need for mechanical ventilation within 72 h after birth (relative risk (RR) 0.87 (0.77 to 0.97), absolute risk reduction (ARR) -0.10 (-0.17 to -0.03), number needed to treat 10) in preterm infants treated with an initial SI compared with IPPV. However, significantly more infants treated with SI received treatment for patent ductus arteriosus (RR 1.27 (1.05 to 1.54), ARR 0.10 (0.03 to 0.16), number needed to harm 10). There were no differences in BPD, death at the latest follow-up and the combined outcome of death or BPD among survivors between the groups.
  
  
  CONCLUSIONS
  Compared with IPPV, preterm infants initially treated with SI at birth required less mechanical ventilation with no improvement in the rate of BPD and/or death. The use of SI should be restricted to randomised trials until future studies demonstrate the efficacy and safety of this lung aeration manoeuvre.
authors.affiliation: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Department of Paediatrics, Medical University Graz, Graz, Austria.
authors.forename: Georg M
authors.initials: GM
authors.lastname: Schmölzer
authors.affiliation: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Manoj
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Khalid
authors.initials: K
authors.lastname: Aziz
authors.affiliation: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Department of Paediatrics, Medical University Graz, Graz, Austria.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Pichler
authors.affiliation: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Megan
authors.initials: M
authors.lastname: O'Reilly
authors.affiliation: Division of Neonatology, 'V Buzzi' Children's Hospital-ICP, Milan, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lista
authors.affiliation: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Po-Yin
authors.initials: PY
authors.lastname: Cheung
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007327:Insufflation / Q000009:adverse effects / Q000379:methods; D007385:Intermittent Positive-Pressure Ventilation / Q000009:adverse effects / Q000379:methods; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis
keywords: Delivery room; Infant; Neonatal Resuscitation; Newborn; Positive Pressure Respiration; Sustained inflation