Sustained lung inflation in the delivery room in preterm infants at high risk of respiratory distress syndrome (SLI STUDY): study protocol for a randomized controlled trial

Dani, Carlo; Lista, Gianluca; Pratesi, Simone; Boni, Luca; Agosti, Massimo; Biban, Paolo; Vecchio, Antonio Del; Gazzolo, Diego; Gizzi, Camilla; Magaldi, Rosario; Messner, Hubert; Mosca, Fabio; Sandri, Fabrizio; Scopesi, F.; Trevisanuto, Daniele; Vento, Giovanni

doi:10.1186/1745-6215-14-67

Cited by 16 publications

(6 citation statements)

References 15 publications

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“…However, the heterogeneous, patchy pattern of lung recruitment and hemorrhage seen in the ACϩVG pigs and the increasing PIP values recorded during the final hours for 30% of the ACϩVG pigs are suggestive of a decrease in lung compliance and derecruitment and coincided with increased FI O 2 to maintain targeted oxygen saturation levels. The APRV protocol is a gentler method than sustained lung inflation protocols that use high pressure or volume for neonatal resuscitation and rapid lung recruitment (6,19,27). Rapid, large-scale lung distension can cause histopathological damage, increase BALF protein concentrations, trigger rapid (Ͻ30 min) inflammatory responses (29), increase the expression of inflammatory cytokines and acute phase proteins (10), and alter expression of genes associated with alveolar development and vascularization of newborn lungs (4,15,28).…”

Section: Discussionmentioning

confidence: 99%

Lung volume recruitment in a preterm pig model of lung immaturity

Arrindell

Krishnan

Merwe

et al. 2015

American Journal of Physiology-Lung Cellular and Molecular Phys

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A translational preterm pig model analogous to infants born at 28 wk of gestation revealed that continuous positive airway pressure results in limited lung recruitment but does not prevent respiratory distress syndrome, whereas assist-control + volume guarantee (AC+VG) ventilation improves recruitment but can cause injury, highlighting the need for improved ventilation strategies. We determined whether airway pressure release ventilation (APRV) can be used to recruit the immature lungs of preterm pigs without injury. Spontaneously breathing pigs delivered at 89% of term (model for 28-wk infants) were randomized to 24 h of APRV (n = 9) vs. AC+VG with a tidal volume of 5 ml/kg (n = 10). Control pigs (n = 36) were provided with supplemental oxygen by an open mask. Nutrition and fluid support was provided throughout the 24-h period. All pigs supported with APRV and AC+VG survived 24 h, compared with 62% of control pigs. APRV resulted in improved lung volume recruitment compared with AC+VG based on radiographs, lower Pco2 levels (44 ± 2.9 vs. 53 ± 2.7 mmHg, P = 0.009) and lower inspired oxygen fraction requirements (36 ± 6 vs. 44 ± 11%, P < 0.001), and higher oxygenation index (5.1 ± 1.5 vs. 2.9 ± 1.1, P = 0.001). There were no differences between APRV and AC+VG pigs for heart rate, ratio of wet to dry lung mass, proinflammatory cytokines, or histopathological markers of lung injury. Lung protective ventilation with APRV improved recruitment of alveoli of preterm lungs, enhanced development and maintenance of functional residual capacity without injury, and improved clinical outcomes relative to AC+VG. Long-term consequences of lung volume recruitment by using APRV should be evaluated.

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Section: Discussionmentioning

confidence: 99%

Lung volume recruitment in a preterm pig model of lung immaturity

Arrindell

Krishnan

Merwe

et al. 2015

American Journal of Physiology-Lung Cellular and Molecular Phys

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“…If respiratory failure persists (that is, apnea and gasping) and/or the heart rate is >60 and <100 bpm despite NCPAP, the SLI maneuver (again 20-30 cmH 2 O for 5-15 seconds) is repeated. If the heart rate remains >60 and <100 bpm after the second SLI maneuver, the infant is resuscitated following the current guidelines of the NRP [ 82 , 83 , 85 , 100 , 101 ]. The European Resuscitation Council Guidelines recommend SI for the initial ventilation of apneic term and preterm infants [ 102 ].…”

Section: Introductionmentioning

confidence: 99%

Golden hour of neonatal life: Need of the hour

Sharma

2017

matern health, neonatol and perinatol

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“Golden Hour” of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates. This concept in neonatology has been adopted from adult trauma where the initial first hour of trauma management is considered as golden hour. The “Golden hour” concept includes practicing all the evidence based intervention for term and preterm neonates, in the initial sixty minutes of postnatal life for better long-term outcome. Although the current evidence supports the concept of golden hour in preterm and still there is no evidence seeking the benefit of golden hour approach in term neonates, but neonatologist around the globe feel the importance of golden hour concept equally in both preterm and term neonates. Initial first hour of neonatal life includes neonatal resuscitation, post-resuscitation care, transportation of sick newborn to neonatal intensive care unit, respiratory and cardiovascular support and initial course in nursery. The studies that evaluated the concept of golden hour in preterm neonates showed marked reduction in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). In this review article, we will discuss various components of neonatal care that are included in “Golden hour” of preterm and term neonatal care.

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“…Published study protocols for 3 included trials were also reviewed. [30][31][32] One trial was excluded because SI was defined as 5 seconds or less. 33 Four trials were excluded on the basis of a trial design that allowed for cointerventions in addition to SI.…”

Section: Resultsmentioning

confidence: 99%

Sustained Inflation vs Standard Resuscitation for Preterm Infants

et al. 2020

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IMPORTANCEMost preterm infants require respiratory support to establish lung aeration after birth. Intermittent positive pressure ventilation and continuous positive airway pressure are standard therapies. An initial sustained inflation (inflation time >5 seconds) is a widely practiced alternative strategy.OBJECTIVE To conduct a systematic review and meta-analysis of sustained inflation vs intermittent positive pressure ventilation and continuous positive airway pressure for the prevention of hospital mortality and morbidity for preterm infants.DATA SOURCES MEDLINE (through PubMed), Embase, the Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials were searched through June 24, 2019.STUDY SELECTION Randomized clinical trials of preterm infants born at less than 37 weeks' gestation that compared sustained inflation (inflation time >5 seconds) vs standard resuscitation with either intermittent positive pressure ventilation or continuous positive airway pressure were included. Studies including other cointerventions were excluded.DATA EXTRACTION AND SYNTHESIS Two reviewers assessed the risk of bias of included studies. Meta-analysis of pooled outcome data used a fixed-effects model specific to rarer events. Subgroups were based on gestational age and study design (rescue vs prophylactic sustained inflation). MAIN OUTCOMES AND MEASURES Death before hospital discharge.RESULTS Nine studies recruiting 1406 infants met inclusion criteria. Death before hospital discharge occurred in 85 of 736 infants (11.5%) treated with sustained inflation and 62 of 670 infants (9.3%) who received standard therapy for a risk difference of 3.6% (95% CI, −0.7% to 7.9%). Although analysis of the primary outcome identified important heterogeneity based on gestational age subgroups, the 95% CI for the risk difference included 0 for each individual gestational age subgroup. There was no difference in the primary outcome between subgroups based on study design. Sustained inflation was associated with increased risk of death in the first 2 days after birth (risk difference, 3.1%; 95% CI, 0.9%-5.3%). No differences in the risk of other secondary outcomes were identified. The quality-of-evidence assessment was low owing to risk of bias and imprecision. CONCLUSIONS AND RELEVANCEThere was no difference in the risk of the primary outcome of death before hospital discharge, and there was no evidence of efficacy for sustained inflation to prevent secondary outcomes. These findings do not support the routine use of sustained inflation for preterm infants after birth.

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Sustained lung inflation in the delivery room in preterm infants at high risk of respiratory distress syndrome (SLI STUDY): study protocol for a randomized controlled trial

Cited by 16 publications

References 15 publications

Lung volume recruitment in a preterm pig model of lung immaturity

Lung volume recruitment in a preterm pig model of lung immaturity

Golden hour of neonatal life: Need of the hour

Sustained Inflation vs Standard Resuscitation for Preterm Infants

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