Comparison of Respiratory Outcome between Sustained Lung Inflation and Intermittent Positive Ventilation in Preterm Infants Requiring Resuscitation at Birth

Abstract

Background: Sustained lung inflation (SLI) would permit lung recruitment immediately after \nbirth, improving lung mechanics and reducing the need for intubation and subsequent \nrespiratory support in the neonatal intensive care unit among preterm infants. Aim of the Study: To assess \nthe efficacy of initial sustained lung inflation compared to standard intermittent positive pressure \nventilation (IPPV) in \npreterm infants who need resuscitation in delivery room. Methods: This was prospective randomized observational study that \nwas conducted in the delivery room and NICU of A in shames University hospital from February 2019 to September \n2019. The study included 115 preterm infants between 26 - 32 weeks of \ngestation who needed resuscitation at delivery room. The infants were randomly allocated \ninto 2 groups; SLI group: included the preterm infants who received the SLI at initial \ninflation pressure of 25 cm H2O for 15 seconds using the Neopuff/T piece. \nIPPV group: preterm infants who received standard resuscitation; IPPV using the \nself-inflating bag. The heart rate (HR), oxygen saturation (SpO2), oxygen \nrequirement, and intubation rate as well as need of surfactant in the delivery room \nwere assessed. All cases were evaluated after \nadmission to the NICU for the need of mechanical ventilation in the first 72 hours of life, death in \ndelivery room or NICU and for bronchopulmonary dysplasia or death at 36 weeks post \nmenstrual age (PMA). Results: The percentage of preterm infants \nwho needed resuscitation was 25.5% from the total deliveries during the study period. 56.5% of them received SLI and \n43.4% received conventional IPPV. There were no significant differences between \nthe studied groups regarding gestational age, birth weight. Apgar score, heart rate, oxygen saturation was not significantly \nincreased in the SLI group at fifth minutes of \nage. The percentage of infants who needed \nfurther resuscitation was 20% in SLI group and 12% in the IPPV group. There \nwere no significant differences in need for surfactant, CPAP or ventilator among \nthe studied groups. There were \nno significant \ndifferences in relation to complications as BPD, air leak or retinopathy and death \nbetween the two groups. Conclusion: This study showed that there was no advantage from use of SLI in delivery \nroom using T-piece upon the conventional IPPV using self-inflating bag.