title: 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.
authors.affiliation: Division of Neonatology, "V. Buzzi" Children's Hospital, ICP, Milan, Italy;
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lista
authors.affiliation: Clinical Trials Coordinating Center, Istituto Toscano Tumori, Florence, Department of Human Pathology and Oncology, University of Florence, Florence, Italy;
authors.forename: Luca
authors.initials: L
authors.lastname: Boni
authors.affiliation: Neonatal ICU (NICU), Istituto G. Gaslini, Genoa, Italy;
authors.forename: Fabio
authors.initials: F
authors.lastname: Scopesi
authors.affiliation: Neonatal ICU, Department of Mother and Infant Science, Fondazione IRCCS ''Ca' Granda'' Ospedale Maggiore Policlinico, University of Milan, Milan, Italy;
authors.forename: Fabio
authors.initials: F
authors.lastname: Mosca
authors.affiliation: Department of Pediatrics, Padua, Italy;
authors.forename: Daniele
authors.initials: D
authors.lastname: Trevisanuto
authors.affiliation: Neonatal ICU of Ospedale Regionale, Bolzano, Italy;
authors.forename: Hubert
authors.initials: H
authors.lastname: Messner
authors.affiliation: Division of Neonatology, Catholic University of Rome, Italy;
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vento
authors.affiliation: Division of Neonatology, Neonatal ICU, Ospedali Riuniti, Azienda Ospedaliero-Universitaria, Foggia, Italy;
authors.forename: Rosario
authors.initials: R
authors.lastname: Magaldi
authors.affiliation: Division of Neonatology, Neonatal ICU, Di Venere Hospital, Bari, Italy;
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Vecchio
authors.affiliation: Maternal and Child Health Department, Del Ponte Hospital, A.O. Di Circolo Fondazione Macchi, Varese, Italy;
authors.forename: Massimo
authors.initials: M
authors.lastname: Agosti
authors.affiliation: Division of Neonatology, S. Giovanni Calibita Hospital Fatebenefratelli, Isola Tiberina, Rome, Italy;
authors.forename: Camilla
authors.initials: C
authors.lastname: Gizzi
authors.affiliation: Maternal and Pediatrics Department, Maggiore Hospital, Bologna, Italy;
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sandri
authors.affiliation: Department of Pediatrics, Pediatric and Neonatal ICU, Azienda Ospedaliera Universitaria Integrata, Verona, Italy;
authors.forename: Paolo
authors.initials: P
authors.lastname: Biban
authors.affiliation: Division of Neonatology, Ospedale San Bortolo, Vicenza, Italy;
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellettato
authors.affiliation: Department of Maternal Fetal and Neonatal Medicine, C. Arrigo Children's Hospital, Alessandria, Italy;
authors.forename: Diego
authors.initials: D
authors.lastname: Gazzolo
authors.affiliation: Division of Neonatology and Neonatal ICU, S. Chiara Hospital, University of Pisa, Pisa, Italy; and.
authors.forename: Antonio
authors.initials: A
authors.lastname: Boldrini
authors.affiliation: Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy cdani@unifi.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Dani
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000628:therapy*; D045422:Continuous Positive Airway Pressure; D003696:Delivery Rooms; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood / Q000628:therapy*
chemical_list: D010100:Oxygen
keywords: delivery room; infant; mechanical ventilation; newborn; preterm infants; resuscitation; sustained lung inflation