Sustained versus standard inflations during neonatal resuscitation to prevent mortality and improve respiratory outcomes

• Published in: Cochrane database of systematic reviews 2017-07, Vol.7 (7), p.CD004953-CD004953
• Main Authors: Bruschettini, Matteo, O'Donnell, Colm Pf, Davis, Peter G, Morley, Colin J, Moja, Lorenzo, Zappettini, Simona, Calevo, Maria Grazia
• Format: Article
• Language: English
• Subjects: Ductus Arteriosus, Patent - epidemiology; Hospital Mortality; Humans; Infant, Newborn; Intubation, Intratracheal - methods; Intubation, Intratracheal - mortality; Medicine General & Introductory Medical Sciences; Positive-Pressure Respiration - methods; Positive-Pressure Respiration - mortality; Pulmonary Surfactants - administration & dosage; Randomized Controlled Trials as Topic; Respiration, Artificial - statistics & numerical data; Resuscitation - methods; Time Factors
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD004953.pub3

At birth, infants' lungs are fluid-filled. For newborns to have a successful transition, this fluid must be replaced by air to enable effective breathing. Some infants are judged to have inadequate breathing at birth and are resuscitated with positive pressure ventilation (PPV). Giving prolonged (sustained) inflations at the start of PPV may help clear lung fluid and establish gas volume within the lungs. To assess the efficacy of an initial sustained (> 1 second duration) lung inflation versus standard inflations (≤ 1 second) in newly born infants receiving resuscitation with intermittent PPV. We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1), MEDLINE via PubMed (1966 to 17 February 2017), Embase (1980 to 17 February 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 17 February 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles to identify randomised controlled trials and quasi-randomised trials. Randomised controlled trials (RCTs) and quasi-RCTs comparing initial sustained lung inflation (SLI) versus standard inflations given to infants receiving resuscitation with PPV at birth. We assessed the methodological quality of included trials using Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria (assessing randomisation, blinding, loss to follow-up, and handling of outcome data). We evaluated treatment effects using a fixed-effect model with risk ratio (RR) for categorical data and mean, standard deviation (SD), and weighted mean difference (WMD) for continuous data. We assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Eight trials enrolling 941 infants met our inclusion criteria. Investigators in seven trials (932 infants) administered sustained inflation with no chest compressions. Use of sustained inflation had no impact on the primary outcomes of this review - mortality in the delivery room (typical RR 2.66, 95% confidence interval (CI) 0.11 to 63.40; participants = 479; studies = 5; I² not applicable) and mortality during hospitalisation (typical RR 1.01, 95% CI 0.67 to 1.51; participants = 932; studies = 7; I² = 19%); the quality of the evidence was low for death in the delivery room (limitations in study design and imprecision of esti