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

摘要

Background: Sustained lung inflation (SLI) would permit lung recruitment immediately after birth, improving lung mechanics and reducing the need for intubation and subsequent respiratory support in the neonatal intensive care unit among preterm infants. Aim of the Study: To assess the efficacy of initial sustained lung inflation compared to standard intermittent positive pressure ventilation (IPPV) in preterm infants who need resuscitation in delivery room. Methods: This was prospective randomized observational study that was conducted in the delivery room and NICU of A in shames University hospital from February 2019 to September 2019. The study included 115 preterm infants between 26 style="font-family:Verdana;">- style="font-family:""> style="font-family:""> style="font-family:Verdana;">32 weeks of gestation who needed resuscitation at delivery room. The infants were randomly allocated into 2 groups;SLI group: included the preterm infants who received the SLI at initial inflation pressure of 25 cm H _{style="font-family:Verdana;">2} style="font-family:Verdana;">O for 15 seconds using the Neopuff/T piece. IPPV group: preterm infants who received standard resuscitation;IPPV using the self-inflating bag. The heart rate (HR), oxygen saturation (SpO _{style="font-family:Verdana;">2} style="font-family:Verdana;">), oxygen requirement, and intubation rate as well as need of surfactant in the delivery room were assessed. style="font-family:Verdana;">All cases were evaluated after admission to the NICU for the need of me style="font-family:Verdana;">chanical ventilation in the style="font-family:Verdana;">fi style="font-family:Verdana;">rst 72 hours of life, death in delivery room or NICU and for bronchopulmonary dysplasia or death at 36 weeks post menstrual age style="font-family:""> style="font-family:Verdana;">(PMA). style="font-family:""> style="font-family:Verdana;">Results: style="font-family:Verdana;"> The percentage of preterm infants who needed resuscitation was 25.5% from the total deliveries during the study period. style="font-family:""> style="font-family:Verdana;">56.5% of them received SLI and 43.4% received conventional IPPV. There were no significant differences between the studied groups regarding gestational age, birth weight. style="font-family:""> style="font-family:Verdana;">Apgar score, heart rate, style="font-family:""> style="font-family:""> style="font-family:Verdana;">oxygen saturation was not significantly in style="font-family:Verdana;">creased in the SLI group at fifth minutes of age. The percentage of infants style="font-family:Verdana;"> who style="font-family:Verdana;">needed further resuscitation was 20% in SLI group and 12% in the IPPV style="font-family:Verdana;">group. There were no significant differences in need for surfactant, CPAP or ventilator among the studied groups. style="font-family:""> style="font-family:Verdana;">There were no style="font-family:""> style="font-family:Verdana;">significant differences in relation to complications as BPD, air leak or retinopathy and death between the two groups. style="font-family:""> style="font-family:Verdana;">Conclusion: style="font-family:Verdana;"> This study showed that there was no advantage from use of SLI in delivery room using T-piece upon the conventional IPPV using self-inflating bag.