Sustained Lung Inflation in Preterm Infants with Signs of Respiratory Distress: A Randomized Controlled Trial

The role of sustained lung inflation (SI) in neonatal resuscitation at birth as a substitute for, or an adjuvant to positive pressure ventilation (PPV) has been previously examined. This study was conducted to examine the effect of applying SI in preterm infants, who did not need PPV at birth but showed signs of respiratory distress within the first minutes of life, on their mortality and some common morbidities.

In this double-blind randomized clinical trial, seventy-four preterm infants with gestational age 28-33 6/7 weeks and birth weight more than 1000 g in whom signs of respiratory distress appeared within five to ten minutes after birth were randomly assigned to receive nCPAP alone (nCPAP-only group) or a 10-second sustained inflation with 20 cmH₂O pressure followed by nCPAP (SI group).

The need for surfactant administration was significantly less (P = 0.003) and the length of hospital stay was significantly shorter in the SI group (P = 0.005), but the duration of nCPAP was significantly longer in this group (P = 0.003). There was no statistically significant difference between the two groups in terms of the need for and duration of mechanical ventilation and also, other secondary outcomes.

Applying SI within the first minutes after birth in preterm infants with early signs of respiratory distress can reduce the need for exogenous surfactant and the length of hospital stay. Further studies on the role of this modality in the management of RDS in neonates, especially its effect on long-term cardiopulmonary and neurodevelopment outcomes, are recommended.