Related Experiment Video
Updated: Apr 26, 2026
Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
Effects of a sustained inflation in preterm infants at birth
Jeroen J van Vonderen1, Stuart B Hooper2, Helmut D Hummler3
1Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Insights
A sustained inflation of 10 seconds and 25 cmH2O was not effective in preterm infants unless they actively breathed. Mask leaks and potential glottic adduction limited the functional residual capacity gain, highlighting the importance of infant respiratory effort.
Area of Science:
- Neonatal Physiology
- Respiratory Medicine
- Pediatric Critical Care
Background:
- Effective respiratory support at birth is crucial for preterm infants.
- Initial respiratory management strategies aim to establish adequate lung volumes.
- Sustained inflation is a technique used to improve lung aeration.
Purpose of the Study:
- To evaluate the clinical effectiveness of an initial sustained inflation (SI) of 10 seconds and 25 cmH2O in preterm infants.
- To determine the impact of SI on functional residual capacity (FRC) gain.
- To identify factors influencing the success of SI in this population.
Main Methods:
- Observational study involving preterm infants (<32 weeks' gestation).
- Respiratory function monitoring to record inflation pressures and tidal volumes during SI.
- Measurement of heart rate and oxygen saturation before and after SI.
Main Results:
- Seventy preterm infants were included; mean SI duration was 10.5 seconds at 24.2 cmH2O.
- Mask leak occurred in 20 infants, preventing volume delivery.
- In infants who breathed during SI (n=36), FRC gain was 7.1 mL/kg; no significant FRC gain occurred in non-breathing infants.
Conclusions:
- Sustained inflation at 10 seconds and 25 cmH2O was ineffective in preterm infants if they did not breathe.
- Mask leak was a significant issue, but breathing effort appeared critical for FRC gain.
- Active glottic adduction may contribute to SI failure in non-breathing infants.
Objective:
To assess the clinical effect of an initial sustained inflation of 10 seconds and 25 cmH2O in preterm infants at birth.
Study Design:
In this observational study inflation pressures and tidal volumes were recorded with the use of respiratory function monitoring of preterm infants <32 weeks' gestation receiving a sustained inflation. Inspiratory tidal volume (Vti) and expiratory tidal volume (Vte) of sustained inflation and cumulative Vti and Vte of breaths during sustained inflation were determined. Heart rate and oxygen saturation were measured before and after the sustained inflation.
Results:
Seventy infants were included (median [IQR]: gestational age 29 [27-30] weeks). Mean (SD) sustained inflation duration was 10.5 seconds (2.9 seconds) with positive inflation pressure 24.2 cmH2O (2.3 cmH2O) and positive end-expiratory pressure 6.0 cmH2O (1.8 cmH2O). In 20 of 70 infants, no volumes were delivered during the sustained inflation because of mask leak. No leak occurred in 50 of 70 infants, of whom 36 of 50 breathed during the sustained inflation. In 14 of the infants who did not breathe, Vti and Vte were 0.9 mL/kg (0.4-2.7 mL/kg) and 0.6 mL/kg (0.1-2.0 mL/kg) with a functional residual capacity (FRC) gain of 0.0 (-0.5 to 0.6) mL/kg. In 36 of 50 infants who breathed during the sustained inflation, Vti was 2.9 mL/kg (0.9-9.2 mL/kg) and Vte 3.8 mL/kg (1.0-5.9 mL/kg), whereas cumulative Vti of breaths was 16.4 mL/kg (6.8-23.3 mL/kg) and cumulative Vte of breaths was 5.8 mL/kg (1.2-16.8 mL/kg) with an FRC gain of 7.1 mL/kg (1.7-15.9 mL/kg). Heart rate and oxygen saturation did not increase immediately after the sustained inflation.
Conclusions:
A sustained inflation of 10 seconds and 25 cmH2O in preterm infants at birth was not effective unless infants breathed. Although large mask leak accounted for approximately one-third of failures, as FRC gain was only associated with breathing, we speculate that active glottic adduction may be responsible for most failures.
