Sustained Lung Inflation in Pre-term Infants at Birth: A Randomized Controlled Trial

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Respiratory Physiology

Background:

• Invasive mechanical ventilation (IMV) poses risks for preterm infants in low- and middle-income countries.
• Sustained lung inflation (SLI) is a potential method to decrease IMV reliance.

Purpose of the Study:

• To evaluate the efficacy of SLI in reducing the need for IMV in preterm infants.
• To assess the impact of SLI on mortality and iatrogenic complications.

Main Methods:

• A randomized controlled trial involving 160 preterm infants (gestational age 27-32 weeks).
• Infants were randomized to receive either SLI followed by nasal CPAP or nasal CPAP alone.
• The primary outcome was the need for IMV within the first 72 hours of life.

Main Results:

• No significant difference in IMV rates between the SLI and control groups overall (55% vs. 65%).
• SLI significantly reduced IMV need in infants meeting clinical eligibility criteria (CEC) (OR: 0.224, P=0.005).
• SLI also significantly reduced IMV need in infants with gestational age <30 weeks (OR: 0.183, P=0.005).

Conclusions:

• SLI is not associated with harm in preterm infants.
• While not reducing IMV overall, SLI demonstrated significant benefits in specific subgroups: sicker infants and those born earlier.
• Further research is warranted to explore SLI's targeted application in these subgroups.