title: Sustained versus intermittent lung inflation for resuscitation of preterm infants: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate efficacy and safety of delivery room (DR) sustained lung inflation (SLI) in resuscitation of preterm neonates.
  
  
  METHODS
  Randomized Controlled Trial including 112 preterm infants randomized to either SLI (n = 57) using T-piece resuscitator [maximum three inflations with maximum pressure of 30 cmH2O for 15 s followed by continuous positive airway pressure (CPAP) of 5-7 cmH2O] or conventional bag/mask inflation (CBMI) (n = 55) using traditional self-inflating bag (maximum pressure of 40 cmH2O at a rate of 40-60 per min). Failure was defined as the need for DR or first 72 h intubation. Cord and 2-h post-resuscitation blood samples were collected to measure interleukin (IL)-1β and tumor necrosis factor-α levels before and after intervention.
  
  
  RESULTS
  SLI was associated with significantly higher success rate compared to CBMI [75.4 versus 54.5%; p = 0.017], lower need for DR intubation [5.3% versus 23.6%; (X2=7.7; p = 0.005)], higher 5-min-Apgar score (median 8 versus 7; p = 0.018), shorter duration on nasal-CPAP (p = 0.017), and non-significantly different air leak (7% versus 11%; p = 0.3) and bronchopulmonary dysplasia rates among survivors (2% versus 11%; p = 0.09). Post-resuscitation IL-1β plasma levels increased significantly in CBMI (p = 0.009) and not in SLI group.
  
  
  CONCLUSIONS
  Delivery room SLI is more effective than intermittent bag and mask inflation for improving short-term respiratory outcome in preterm infants, without significant adverse effects.
authors.affiliation: a Department of Pediatrics , Neonatology Division, Children's Hospital, Ain Shams University , Cairo , Egypt , and.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: El-Chimi
authors.affiliation: a Department of Pediatrics , Neonatology Division, Children's Hospital, Ain Shams University , Cairo , Egypt , and.
authors.forename: Hisham A
authors.initials: HA
authors.lastname: Awad
authors.affiliation: a Department of Pediatrics , Neonatology Division, Children's Hospital, Ain Shams University , Cairo , Egypt , and.
authors.forename: Tarek M
authors.initials: TM
authors.lastname: El-Gammasy
authors.affiliation: a Department of Pediatrics , Neonatology Division, Children's Hospital, Ain Shams University , Cairo , Egypt , and.
authors.forename: Ola G
authors.initials: OG
authors.lastname: El-Farghali
authors.affiliation: b Department of Clinical Pathology , Ain Shams University , Cairo , Egypt.
authors.forename: Mohamed T
authors.initials: MT
authors.lastname: Sallam
authors.affiliation: a Department of Pediatrics , Neonatology Division, Children's Hospital, Ain Shams University , Cairo , Egypt , and.
authors.forename: Dina M
authors.initials: DM
authors.lastname: Shinkar
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007327:Insufflation; D020382:Interleukin-18 / Q000097:blood; D017214:Laryngeal Masks; D008168:Lung / Q000503:physiopathology; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012307:Risk Factors; D048069:Tumor Necrosis Factors / Q000097:blood
chemical_list: D020382:Interleukin-18; D048069:Tumor Necrosis Factors
keywords: BPD; T-piece resuscitator; delivery room; respiratory outcome