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Sustained inflation versus positive pressure ventilation at birth: a systematic review and meta-analysis

Georg M Schmölzer1, Manoj Kumar2, Khalid Aziz2

  • 1Centre 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.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|January 1, 2015
PubMed

Insights

Sustained inflation (SI) reduced the need for mechanical ventilation in preterm infants but did not improve rates of bronchopulmonary dysplasia (BPD) or death. Further research is needed to confirm the safety and efficacy of SI for neonatal resuscitation.

Area of Science:

  • Neonatal Medicine
  • Respiratory Physiology
  • Clinical Trials

Background:

  • Sustained inflation (SI) is proposed as an alternative to intermittent positive pressure ventilation (IPPV) for neonatal resuscitation.
  • SI aims to improve functional residual capacity, reduce lung injury, and enhance oxygenation in preterm infants.

Purpose of the Study:

  • To review existing literature comparing SI and IPPV in preterm infants at birth.
  • To evaluate the impact of SI versus IPPV on major neonatal outcomes, including bronchopulmonary dysplasia (BPD) and mortality.

Main Methods:

  • Systematic review of randomized clinical trials sourced from MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials.
  • Data extraction and pooled analysis using a random effects model, with heterogeneity assessed by Q statistic and I(2).

Main Results:

  • SI significantly reduced the need for mechanical ventilation within 72 hours (RR 0.87; NNT 10).
  • However, SI was associated with increased treatment for patent ductus arteriosus (RR 1.27; NNH 10).
  • No significant differences were observed in BPD, death, or combined BPD/death outcomes.

Conclusions:

  • Initial SI use in preterm infants reduces mechanical ventilation needs compared to IPPV.
  • SI did not improve rates of BPD or death and requires further investigation for efficacy and safety.
  • Current use of SI should be limited to randomized trials.
Abstract

Keywords:
Delivery roomInfantNeonatal ResuscitationNewbornPositive Pressure RespirationSustained inflation

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