Background and aims Sustained inflations (SI) have been advocated as an alternative to intermittent positive pressure ventilation (IPPV) during the resuscitation of preterm infants at birth to facilitate the early development of an effective functional residual capacity, reduce atelectotrauma, improve speed of circulatory rate and oxygenation after birth. The role of SI on major neonatal outcomes remains controversial.
Methods We conducted a systematic review and meta-analysis of randomised clinical trials that evaluated the effects of SI and IPPV on mortality and bronchopulmonary dysplasia (BPD). Descriptive and quantitative information was extracted; relative risk (RR) and risk difference (RD) estimates were synthesised under a random-effects model. Heterogeneity was assessed using the Q statistic and I2.
Results Pooled analysis of 4 trials (n = 611) showed significant reduction in the need of mechanical ventilation within 72 h after birth (RR=0.87 [0.77–0.99], RD=-0.10 [-0.17, -0.03]. number-needed-to-treat=10) in preterm infants treated with an initial SI compared to IPPV. However, significantly more infants treated with SI received treatment for patent ductus arteriosus (RR=1.27 [1.05–1.54], RD=0.09 [0.02, 0.16], number-needed-to-harm=11). There were no differences in BPD, death at latest follow-up, the combined outcome for BPD or death, and other major neonatal outcomes between the two approaches.
Conclusions Compared to IPPV, preterm infants initially treated with SI at birth required less mechanical ventilation within 72 h after birth with no improvement in the rate of BPD and/or death. SI should currently only be used in randomised trials until future studies demonstrate the efficacy and safety of this lung aeration manoeuvre.
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