Abstract：Objective To systematically review the effect of sustained lung inflation (SLI) in preterm infants with a gestational age of < 34 weeks. Methods PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, China Biology Medicine disc, Chinese Journal Full-text Database, and Weipu Database were searched for randomized controlled trials (RCTs) on the application of SLI versus noninvasive positive pressure ventilation alone in preterm infants. Revman 5.3 was used to perform a Meta analysis for the RCTs which met the inclusion criteria. Results A total of 9 RCTs were included, with 1 432 preterm infants in total (with a gestational age of 23-33.7 weeks). The Meta analysis showed that compared with the control group, the SLI group had a significantly lower proportion of the infants who needed mechanical ventilation within 72 hours (51.9% vs 56.9%, RR=0.91, P=0.04, 95%CI:0.83-0.99). There were no significant differences between the two groups in the mortality rate, rate of use of pulmonary surfactant, and incidence rates of related complications (bronchopulmonary dysplasia, pneumothorax, and grade III-IV intracranial hemorrhage) (P > 0.05). Conclusions SLI can reduce the use of mechanical ventilation in preterm infants with a gestational age of < 34 weeks and does not increase the risk of other complications.
LI Min-Xu,DENG Hao-Hui,SU Jin-Zhen et al. Application of sustained lung inflation in preterm infants with a gestational age of < 34 weeks: a Meta analysis[J]. CJCP, 2020, 22(3): 245-250.
te Pas AB, Siew M, Wallace MJ, et al. Establishing functional residual capacity at birth:the effect of sustained inflation and positive end-expiratory pressure in a preterm rabbit model[J]. Pediatr Res, 2009, 65(5):537-541.
[2]
te Pas AB, Siew M, Wallace MJ, et al. Effect of sustained inflation length on establishing functional residual capacity at birth in ventilated premature rabbits[J]. Pediatr Res, 2009, 66(3):295-300.
Lindner W, Högel J, Pohlandt F. Sustained pressure-controlled inflation or intermittent mandatory ventilation in preterm infants in the delivery room? A randomized, controlled trial on initial respiratory support via nasopharyngeal tube[J]. Acta Paediatr, 2005, 94(3):303-309.
[5]
Harling AE, Beresford MW, Vince GS, et al. Does sustained lung inflation at resuscitation reduce lung injury in the preterm infant?[J]. Arch Dis Child Fetal Neonatal Ed, 2005, 90(5):F406-F410.
[6]
te Pas AB, Walther FJ. A randomized, controlled trial of delivery-room respiratory management in very preterm infants[J]. Pediatrics, 2007, 120(2):322-329.
[7]
Lista G, Boni L, Scopesi F, et al. Sustained lung inflation at birth for preterm infants:a randomized clinical trial[J]. Pediatrics, 2015, 135(2):e457-e464.
[8]
Schwaberger B, Pichler G, Avian A, et al. Do sustained lung inflations during neonatal resuscitation affect cerebral blood volume in preterm infants? A randomized controlled pilot study[J]. PLoS One, 2015, 10(9):e0138964.
[9]
El-Chimi MS, Awad HA, El-Gammasy TM, et al. Sustained versus intermittent lung inflation for resuscitation of preterm infants:a randomized controlled trial[J]. J Matern Fetal Neonatal Med, 2017, 30(11):1273-1278.
[10]
Jiravisitkul P, Rattanasiri S, Nuntnarumit P. Randomised controlled trial of sustained lung inflation for resuscitation of preterm infants in the delivery room[J]. Resuscitation, 2017, 111:68-73.
[11]
Ngan AY, Cheung PY, Hudson-Mason A, et al. Using exhaled CO 2 to guide initial respiratory support at birth:a randomised controlled trial[J]. Arch Dis Child Fetal Neonatal Ed, 2017, 102(6):F525-F531.
[12]
Kirpalani H, Ratcliffe SJ, Keszler M, et al. Effect of sustained inflations vs intermittent positive pressure ventilation on bronchopulmonary dysplasia or death among extremely preterm infants:the SAIL randomized clinical trial[J]. JAMA, 2019, 321(12):1165-1175.
[13]
Schmölzer GM, Kumar M, Aziz K, et al. Sustained inflation versus positive pressure ventilation at birth:a systematic review and meta-analysis[J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100(4):F361-F368.
[14]
Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome-2019 update[J]. Neonatology, 2019, 115(4):432-450.
[15]
Oremus M, Wolfson C, Perrault A, et al. Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer's disease drug trials[J]. Dement Geriatr Cogn Disord, 2001, 12(3):232-236.
[16]
te Pas AB, Walther FJ. Ventilation of very preterm infants in the delivery room[J]. Curr Pediatr Rev, 2006, 2(3):187-197.
[17]
Lista G, Fontana P, Castoldi F. Does sustained lung inflation at birth improve outcome of preterm infants at risk for respiratory distress syndrome?[J]. Neonatology, 2011, 99(1):45-50.
[18]
Fischer HS, Schmölzer GM, Cheung PY, et al. Sustained inflations and avoiding mechanical ventilation to prevent death or bronchopulmonary dysplasia:a meta-analysis[J]. Eur Respir Rev, 2018, 27(150). pii:180083.
[19]
Fuchs H, Lindner W, Buschko A, et al. Cerebral oxygenation in very low birth weight infants supported with sustained lung inflations after birth[J]. Pediatr Res, 2011, 70(2):176-180.
[20]
Sobotka KS, Hooper SB, Allison BJ, et al. An initial sustained inflation improves the respiratory and cardiovascular transition at birth in preterm lambs[J]. Pediatr Res, 2011, 70(1):56-60.
