Sustained inflations and avoiding mechanical ventilation to prevent bronchopulmonary dysplasia

What is it about?

The resuscitation of very preterm infants immediately after birth is intricate. Delivery room treatment of these delicate patients may impact on long term respiratory complications, such as bronchopulmonary dysplasia (BPD). In the present meta-analysis, we examined the effect that two delivery room interventions had on BPD: Sustained inflations and avoidance of artificial ventilation. Both sustained inflations and avoiding artificial ventilation are regarded as promising measures to reduce BPD and subsequent long-term respiratory impairment: 1.) Sustained inflations at the onset of neonatal resuscitation are provided by a face mask. Sustained inflations may be beneficial because they accelerate uniform aeration of the lungs immediately after birth. 2.) Subsequent artificial ventilation by insertion of a ventilation tube into a patient's windpipe may be inevitable, but can also harm the lungs. Avoidance of artificial ventilation represents a less invasive approach to the respiratory support of preterm infants, and may reduce ventilator-induced lung injury. Our meta-analysis showed that strategies to avoid artificial ventilation reduced BPD, whereas sustained inflations had no effect and may even increase the number of patients who die.

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Why is it important?

The findings of the present meta-analysis are of immediate importance for the delivery room treatment of preterm infants: Strategies to avoid mechanical ventilation in these infants reduced BPD. By contrast, clinical use of sustained inflations cannot be recommended, due to apparent lack of efficacy and possible harm.

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