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Effect of Sustained Inflations vs Intermittent Positive Pressure Ventilation on Bronchopulmonary Dysplasia or Death

Haresh Kirpalani1, Sarah J Ratcliffe2, Martin Keszler3

  • 1Division of Neonatology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia.

JAMA
|March 27, 2019
PubMed

Insights

Sustained inflations did not reduce bronchopulmonary dysplasia or death in extremely preterm infants. This ventilation strategy is not supported, though trial limitations exist.

Area of Science:

  • Neonatal Resuscitation
  • Respiratory Support for Preterm Infants
  • Clinical Trials in Neonatology

Background:

  • Establishing regular respirations is critical for preterm infants at delivery.
  • Sustained inflations are a potential method to establish lung volume more rapidly than intermittent positive pressure ventilation.

Purpose of the Study:

  • To evaluate if a ventilation strategy using sustained inflations reduces bronchopulmonary dysplasia (BPD) or death at 36 weeks' postmenstrual age in extremely preterm infants.
  • To assess the safety of sustained inflations compared to standard intermittent positive pressure ventilation.

Main Methods:

  • An unmasked, randomized clinical trial involving 426 extremely preterm infants (23-26 weeks' gestational age) across 18 neonatal intensive care units.
  • Infants received either up to 2 sustained inflations (n=215) or standard intermittent positive pressure ventilation (n=211) during resuscitation.
  • The primary outcome was the composite rate of BPD or death at 36 weeks' postmenstrual age, with secondary efficacy and safety outcomes assessed.

Main Results:

  • No significant difference in the composite outcome of BPD or death at 36 weeks' postmenstrual age was observed (63.7% vs 59.2%; P=.29).
  • A significantly higher rate of death at less than 48 hours of age occurred in the sustained inflation group (7.4% vs 1.4%; P=.002).
  • Most secondary efficacy outcomes (26 of 27) showed no significant difference between the groups.

Conclusions:

  • The use of sustained inflations as a resuscitation strategy in extremely preterm infants did not reduce the risk of BPD or death at 36 weeks' postmenstrual age.
  • The findings do not support the use of ventilation with sustained inflations in this population.
  • Early termination of the trial due to adverse outcomes limits definitive conclusions regarding the efficacy and safety of sustained inflations.
Abstract

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