BACKGROUND:Bronchopulmonary dysplasia (BPD) is a common outcome of preterm birth. Experimental animal work has shown that initial ventilation strategies injure the immature lung and may lead to BPD. Studies with asphyxiated babies have shown that, if tidal ventilation at birth is preceded by sustained lung inflation, larger inflation volumes can be achieved, which is thought to lead to clearance of lung fluid and formation of the functional residual capacity (FRC). OBJECTIVE: To see if sustained lung inflation at initial resuscitation of preterm babies would facilitate the removal of lung fluid, establish the FRC, and allow an even distribution of alveolar opening, permitting less aggressive ventilation, leading to a reduction in pulmonary inflammation and subsequent BPD. METHOD: The outcomes of 52 babies of less than 31 weeks gestation, resuscitated at birth using either a sustained lung inflation of five seconds or a conventional lung inflation of two seconds for the first assisted breath of resuscitation, were examined. Evidence of pulmonary inflammation was determined by quantification of interleukins 6, 10, and 1beta and tumour necrosis factor alpha in bronchoalveolar lavage fluid by enzyme linked immunosorbent assay. RESULTS: There were no significant differences in any of the cytokines. Death occurred in 3/26 babies in the conventional group and 6/26 babies in the sustained lung inflation group. Survival without BPD occurred in 13/26 and 14/26 respectively. CONCLUSION: The use of sustained lung inflation at resuscitation did not reduce lung injury, as measured by inflammatory markers.
RCT Entities:
BACKGROUND:Bronchopulmonary dysplasia (BPD) is a common outcome of preterm birth. Experimental animal work has shown that initial ventilation strategies injure the immature lung and may lead to BPD. Studies with asphyxiated babies have shown that, if tidal ventilation at birth is preceded by sustained lung inflation, larger inflation volumes can be achieved, which is thought to lead to clearance of lung fluid and formation of the functional residual capacity (FRC). OBJECTIVE: To see if sustained lung inflation at initial resuscitation of preterm babies would facilitate the removal of lung fluid, establish the FRC, and allow an even distribution of alveolar opening, permitting less aggressive ventilation, leading to a reduction in pulmonary inflammation and subsequent BPD. METHOD: The outcomes of 52 babies of less than 31 weeks gestation, resuscitated at birth using either a sustained lung inflation of five seconds or a conventional lung inflation of two seconds for the first assisted breath of resuscitation, were examined. Evidence of pulmonary inflammation was determined by quantification of interleukins 6, 10, and 1beta and tumour necrosis factor alpha in bronchoalveolar lavage fluid by enzyme linked immunosorbent assay. RESULTS: There were no significant differences in any of the cytokines. Death occurred in 3/26 babies in the conventional group and 6/26 babies in the sustained lung inflation group. Survival without BPD occurred in 13/26 and 14/26 respectively. CONCLUSION: The use of sustained lung inflation at resuscitation did not reduce lung injury, as measured by inflammatory markers.
Authors: Karen E McCall; Andreas D Waldmann; Prue Pereira-Fantini; Regina Oakley; Martijn Miedema; Elizabeth J Perkins; Peter G Davis; Peter A Dargaville; Stephan H Böhm; Raffaele Dellacà; Magdy Sourial; Emanuela Zannin; Anushi E Rajapaksa; Andre Tan; Andy Adler; Inéz Frerichs; David G Tingay Journal: Pediatr Res Date: 2017-07-12 Impact factor: 3.756
Authors: Haresh Kirpalani; Sarah J Ratcliffe; Martin Keszler; Peter G Davis; Elizabeth E Foglia; Arjan Te Pas; Melissa Fernando; Aasma Chaudhary; Russell Localio; Anton H van Kaam; Wes Onland; Louise S Owen; Georg M Schmölzer; Anup Katheria; Helmut Hummler; Gianluca Lista; Soraya Abbasi; Daniel Klotz; Burkhard Simma; Vinay Nadkarni; Francis R Poulain; Steven M Donn; Han-Suk Kim; Won Soon Park; Claudia Cadet; Juin Yee Kong; Alexandra Smith; Ursula Guillen; Helen G Liley; Andrew O Hopper; Masanori Tamura Journal: JAMA Date: 2019-03-26 Impact factor: 56.272
Authors: Richard J Martin; G Bradley Bookatz; Steven L Gelfand; Juan Sastre; Alessandro Arduini; Marta Aguar; Raquel Escrig; Máximo Vento Journal: Semin Perinatol Date: 2008-10 Impact factor: 3.300
Authors: Matteo Bruschettini; Colm Pf O'Donnell; Peter G Davis; Colin J Morley; Lorenzo Moja; Maria Grazia Calevo Journal: Cochrane Database Syst Rev Date: 2020-03-18