AIM: To evaluate efficacy and safety of delivery room (DR) sustained lung inflation (SLI) in resuscitation of preterm neonates. METHODS: Randomized Controlled Trial including 112 preterm infants randomized to eitherSLI (n = 57) using T-piece resuscitator [maximum three inflations with maximum pressure of 30 cmH2O for 15 s followed by continuous positive airway pressure (CPAP) of 5-7 cmH2O] or conventional bag/mask inflation (CBMI) (n = 55) using traditional self-inflating bag (maximum pressure of 40 cmH2O at a rate of 40-60 per min). Failure was defined as the need for DR or first 72 h intubation. Cord and 2-h post-resuscitation blood samples were collected to measure interleukin (IL)-1β and tumor necrosis factor-α levels before and after intervention. RESULTS: SLI was associated with significantly higher success rate compared to CBMI [75.4 versus 54.5%; p = 0.017], lower need for DR intubation [5.3% versus 23.6%; (X2 = 7.7; p = 0.005)], higher 5-min-Apgar score (median 8 versus 7; p = 0.018), shorter duration on nasal-CPAP (p = 0.017), and non-significantly different air leak (7% versus 11%; p = 0.3) and bronchopulmonary dysplasia rates among survivors (2% versus 11%; p = 0.09). Post-resuscitation IL-1β plasma levels increased significantly in CBMI (p = 0.009) and not in SLI group. CONCLUSION: Delivery room SLI is more effective than intermittent bag and mask inflation for improving short-term respiratory outcome in preterm infants, without significant adverse effects.
RCT Entities:
AIM: To evaluate efficacy and safety of delivery room (DR) sustained lung inflation (SLI) in resuscitation of preterm neonates. METHODS: Randomized Controlled Trial including 112 preterm infants randomized to either SLI (n = 57) using T-piece resuscitator [maximum three inflations with maximum pressure of 30 cmH2O for 15 s followed by continuous positive airway pressure (CPAP) of 5-7 cmH2O] or conventional bag/mask inflation (CBMI) (n = 55) using traditional self-inflating bag (maximum pressure of 40 cmH2O at a rate of 40-60 per min). Failure was defined as the need for DR or first 72 h intubation. Cord and 2-h post-resuscitation blood samples were collected to measure interleukin (IL)-1β and tumor necrosis factor-α levels before and after intervention. RESULTS: SLI was associated with significantly higher success rate compared to CBMI [75.4 versus 54.5%; p = 0.017], lower need for DR intubation [5.3% versus 23.6%; (X2 = 7.7; p = 0.005)], higher 5-min-Apgar score (median 8 versus 7; p = 0.018), shorter duration on nasal-CPAP (p = 0.017), and non-significantly different air leak (7% versus 11%; p = 0.3) and bronchopulmonary dysplasia rates among survivors (2% versus 11%; p = 0.09). Post-resuscitation IL-1β plasma levels increased significantly in CBMI (p = 0.009) and not in SLI group. CONCLUSION: Delivery room SLI is more effective than intermittent bag and mask inflation for improving short-term respiratory outcome in preterm infants, without significant adverse effects.
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: 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
Authors: Jerry P Nolan; Ian Maconochie; Jasmeet Soar; Theresa M Olasveengen; Robert Greif; Myra H Wyckoff; Eunice M Singletary; Richard Aickin; Katherine M Berg; Mary E Mancini; Farhan Bhanji; Jonathan Wyllie; David Zideman; Robert W Neumar; Gavin D Perkins; Maaret Castrén; Peter T Morley; William H Montgomery; Vinay M Nadkarni; John E Billi; Raina M Merchant; Allan de Caen; Raffo Escalante-Kanashiro; David Kloeck; Tzong-Luen Wang; Mary Fran Hazinski Journal: Resuscitation Date: 2020-10-21 Impact factor: 6.251