Early Human Development 91 (2015) 71–75

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Early Human Development

journal homepage: www.elsevier.com/locate/earlhumdev

Effects of Sustained Lung Inflation, a lung recruitment maneuver in

primary acute respiratory distress syndrome, in respiratory and cerebral
outcomes in preterm infants
Chiara Grasso, Pietro Sciacca, Valentina Giacchi, Caterina Carpinato, Carmine Mattia,
Grazia Maria Palano, Pasqua Betta ⁎
Department of Pediatrics, Neonatology, NICU, University of Catania, “Policlinico of Catania”, Italy

a r t i c l e i n f o a b s t r a c t

Article history: Background: Sustained Lung Inflation (SLI) is a maneuver of lung recruitment in preterm newborns at birth that
Received 27 August 2014 can facilitate the achieving of larger inflation volumes, leading to the clearance of lung fluid and formation of
Received in revised form 22 November 2014 functional residual capacity (FRC).
Accepted 2 December 2014 Aim: To investigate if Sustained Lung Inflation (SLI) reduces the need of invasive procedures and iatrogenic risks.
Available online xxxx
Study design: 78 newborns (gestational age ≤ 34 weeks, weighing ≤ 2000 g) who didn't breathe adequately at
birth and needed to receive SLI in addition to other resuscitation maneuvers (2010 guidelines).
Keywords:
Sustained
Subjects: 78 preterm infants born one after the other in our department of Neonatology of Catania University
Neonatal resuscitation from 2010 to 2012.
Surfactant Outcome measures: The need of intubation and surfactant, the ventilation required, radiological signs, the
Pulmonary recruitment maneuvers incidence of intraventricular hemorrhage (IVH), periventricular leukomalacia, retinopathy in prematurity from
Iatrogenic risks III to IV plus grades, bronchopulmonary dysplasia, patent ductus arteriosus, pneumothorax and necrotizing
enterocolitis.
Results: In the SLI group infants needed less intubation in the delivery room (6% vs 21%; p b 0.01), less invasive
mechanical ventilation (14% vs 55%; p ≤ 0.001) and shorter duration of ventilation (9.1 days vs 13.8 days; p ≤
0.001). There wasn't any difference for nasal continuous positive airway pressure (82% vs 77%; p = 0.43); but
there was less surfactant administration (54% vs 85%; p ≤ 0.001) and more infants received INSURE (40% vs
29%; p = 0.17). We didn't found any differences in the outcomes, except for more mild intraventricular hemor-
rhage in the SLI group (23% vs 14%; p = 0.15; OR = 1.83).
Conclusion: SLI is easier to perform even with a single operator, it reduces the necessity of more complicated ma-
neuvers and surfactant without statistically evident adverse effects.
© 2014 Published by Elsevier Ireland Ltd.

1. Introduction for 10–20 s in preterm newborns at birth. Vyas et al. [1] in 1981, studied
the effects of SLI applied for a time of 5 s in preterm newborn resuscita-
Sustained Lung Inflation (SLI) is a maneuver of lung recruitment tion and proved that this method increased the tidal volume, facilitating
characterized by the application of a peak pressure of 25–30 cm H2O the achieving of larger inflation volumes, leading to the clearance of
lung fluid and formation of functional residual capacity (FRC) [1]. Lista
et al. increased at 10–20 s the time of application of SLI and they
Abbreviations:AHA,American HeartAssociation;BPD,bronchopulmonarydysplasia; CI, asserted that the application of SLI at birth in preterm infants with respi-
confidence interval; FiO2, fraction of inspired oxygen; FRC, functional residual capacity; ratory distress might decrease the need for mechanical ventilation with-
INSURE, INtubation, a dose of SURfactant and Extubation; IUGR, intrauterine growth restric- out inducing evident adverse effects [2]. Harling et al. conversely
tion; IVH, intraventricular hemorrhage; MAP, mean airway pressure; n-CPAP, nasal contin-
showed no improvement in the outcome after sustained inflations of
uous positive airway pressure; NICU, neonatal intensive care unit; OR, odds ratio; pCO2,
pressure of carbon dioxide; PDA, patent ductus arteriosus; PMA, postmenstrual age; PEEP, 5 s and suggested that immature lungs may be unable to respond to
positive end-expiratory pressure; PROM, premature rupture of membrane; RDS, respiratory this inflation maneuver [3]. te Pas and Walther showed an increase of
distress syndrome; SaO2, arterial oxygenation saturation; SD, standard deviation; SLI, complications in the infants treated with SLI, such as severe intraven-
Sustained Lung Inflation. tricular hemorrhage, although they did not reach a statistical signifi-
⁎ Corresponding author at: Department of Pediatrics, Neonatology, NICU, University of
Catania, “Policlinico of Catania”, Via Santa Sofia 78, 95123 Catania, Italy. Tel.: + 39
cance [4]. In this retrospective cohort study, we analyze the outcome
0953781197; fax: +39 0953781123. and the onset of complications in infants receiving (SLI group) and in-
E-mail address: [email protected] (P. Betta). fants not receiving it (conventional group).

http://dx.doi.org/10.1016/j.earlhumdev.2014.12.002
0378-3782/© 2014 Published by Elsevier Ireland Ltd.
72 C. Grasso et al. / Early Human Development 91 (2015) 71–75

2. Patients and methods observation period, were transferred to the NICU. Newborns who did
not need intubation were transferred with nasal CPAP and their oxygen
We conducted an observational analytical cross-sectional case– saturation was monitored [6].
control study on 78 infants born one after the other in our depart-
ment of Neonatology of Catania University from 2010 to 2012. 2.3. Maneuvers at the NICU
The study was conducted in accordance with the Helsinki Declara-
tion, and the study protocol was approved by the (local) Ethics Commit- Soon as the infant arrived in NICU pulse oximetry values, objective
tee of the Medical University of Catania. data and chest radiographs were collected. Infants were intubated and
Inclusion criteria comprised gestational age ≤ 34 weeks, weight mechanically ventilated if they had oxygen saturation values ≤ 88%
≤2000 grams (g), absence or inadequate breathing at birth and perfor- while receiving FiO2 ≥ 40%, or pCO2 N 60 mm Hg with a pH b 7.20, or
mance of SLI [5] in addition to the other resuscitation maneuvers ac- if they had more than 4 apneic episodes in 1 h.
cording to the guidelines of 2010 [6] (SLI group). Exclusion criteria Therapy with caffeine was started as soon as possible in infants
comprised major congenital anomalies. younger than 30 weeks and in older infants who had apnea. All
We have analyzed the need of intubation and surfactant administra- intubated newborns received, immediately, a dose of surfactant
tion, the type and duration of ventilation required, radiological signs of se- (Curosurf, Chiesi, Italy) while for newborns who required ventilatory
vere respiratory distress, the timing of hospitalization and the growth of assistance with MAP N 7 cm H2O and FiO2 N 40% a second dose of surfac-
the infants. We have also studied the outcome focusing on the incidence tant was performed at a distance of at least 6 h after the first dose [10].
of intraventricular hemorrhage (IVH), periventricular leukomalacia, reti- No intubated preterm infants who showed clinical features of respirato-
nopathy in prematurity from III to IV plus grades, bronchopulmonary ry distress syndrome (RDS) such us sternal, intercostal or subcostal re-
dysplasia, patent ductus arteriosus, pneumothorax and necrotizing en- traction, grunting, tachypnea and the need of oxygen supplementation,
terocolitis. According to NIH Consensus Development Conference we de- received INtubation, a dose of SURfactant and shortly after Extubation
fined intraventricular hemorrhage (IVH) as a spectrum of hemorrhagic (INSURE) [10–12].
brain injury most typically occurring in the first week of life in very pre- We proceeded to the extubation as soon as FiO2 needed was lowered
mature infant and periventricular leukomalacia as focal cystic damage b30% and the mean airway pressure b7 cm H2O. We continued with
of white matter tracts (made of nerve axons that connect different nasal continuous positive airway pressure (n-CPAP) ventilation until in-
brain regions covered by the insulating substance, myelin) [7]. According fants had no sign of distress and were stable with pCO2 b 60 mm Hg and
to the National Institutes of Child Health and Human Development Neo- SaO2 N 92% without supplementary O2. All infants received a cerebral ul-
natal Research Network we distinguished bronchopulmonary dysplasia trasound study and a retinal examination from the 21st day of life and
(BPD) in mild BPD defined as a need for supplemental oxygen (O2) for subsequent checks if necessary.
≥28 days but not at 36 weeks' postmenstrual age (PMA) or discharge, The management at the NICU was the same in both the SLI and con-
moderate BPD as O2 for ≥28 days plus treatment with b 30% O2 at 36 ventional groups.
weeks' PMA, and severe BPD as O2 for ≥28 days plus ≥30% O2 and/or
positive pressure at 36 weeks' PMA [8]. 3. Results
We compared the data of patients with those of a control group of 78
infants with the same gestational age and weight, born one after the The SLI group presented a mean gestational age of 30.4 weeks (range
other in our department of Neonatology of Catania University from 23 to 33.5 weeks) and a mean weight of 1.335 g ± 376 (range 335 to
2008 to 2010, requiring resuscitation maneuvers at birth (conventional 1975 g). The control group did not present a significant difference in
group) according to the guidelines of 2010 [9]. both gestational age (mean 30.5 weeks; range 22 to 34 weeks) and
weight (mean 1371 g ± 411; 400 to 2000 g).
2.1. Statistical analysis The demographic characteristics of both groups are shown in
Table 1. Six newborns in the SLI group (8%) and five newborns in the
Statistical data were derived using Student's t test for parametric and control group (6%) died during their first two weeks of life, while one
the Mann–Whitney U test for non-parametric continuous variables and newborn in the SLI group (1%) and four in the control group (5%) died
χ2 test for categorical variables. p values were considered statistically subsequently.
significant if p b 0.05. For the categorical variables we analyzed the In the SLI group fewer infants than in the control group required in-
odds ratio (OR) with the 95% confidence interval. tubation in the delivery room (5 of 78 [6%] vs 16 of 78 [21%]; p = 0.009;
odds ratio (OR) = 0.27; confidence interval (CI) = 0.09–0.77). Infants
2.2. Resuscitation maneuvers in the delivery room

Newborns in the SLI group received only one 25 cm H2O pressure Table 1
Demographic characteristics.
controlled inflation for 15 s using a face mask of appropriate size for
each of them and a T-piece ventilator [5,6,10]. If required, after SLI, in- Sustained (N = 78) Conventional (N = 78)
fants were resuscitated according to the maneuvers required by the Gestational age, mean (SD), wk 30.4 (±2,6) 30.5 (±3.1)
American Heart Association (AHA) 2010 neonatal resuscitation guide- Birth weight, mean (SD), g 1335 (±376) 1371 (±411)
lines [6] or received a 4 cm H2O continuous positive airway pressure Male gender, n (%) 39 (50) 38 (49)
(CPAP) [4]. Newborns in the control group received conventional resus- Twin, n (%) 40 (51) 24 (31)
Cesarean birth, n (%) 65 (83) 66 (85)
citation maneuvers which consist in a first initial inflation of 30–
PROM, n (%) 12 (15) 15 (19)
40 cm H2O, followed by insufflations not exceeding 20 cm H2O, with a Chorionamionite, n (%) 9 (12) 8 (10)
rate of 60 per minute and a PEEP of 5 cm H2O using a face mask of appro- Prenatal steroids, n (%) 65 (83) 63 (81)
priate size and a T-piece ventilator (Neopuff). Positive pressure ventila- IUGR, n (%) 4 (5) 5 (6)
Cordonal pH, mean (SD) 7.25 (±0,20) 7.23 (±0.22)
tion was started with FiO2 at 21% [7,10]. FiO2 was subsequently
5′ Apgar score b 6, n (%) 5 (6) 16 (21)
incremented if necessary [7]. 5′ Apgar score, median 8 8
In both groups newborns were intubated and mechanically ventilat- Growth, median 22 21
ed if, despite the correct resuscitation maneuvers, the heart rate did not Died b2 weeks old, n (%) 6 (8) 5 (6)
increase above 100 beats per minute, if breathing was absent, if cyanosis IUGR, intrauterine growth restriction; n, number; PROM, premature rupture of mem-
persisted or dyspnea occurred [6]. All infants, after stabilization and an brane; SD, standard deviation; wk, weeks.
 C. Grasso et al. / Early Human Development 91 (2015) 71–75 73

who received SLI had less need of intubation and invasive mechanical
ventilation than infants in the conventional group (11 of 78 [14%] vs
43 of 78 [55%]; p ≤ 0.001; OR = 0.13; CI = 0.06–0.29). Regarding
non-invasive ventilation, there was no statistically significant difference
in the number of children that received ventilation with n-CPAP be-
tween the sustained group 65 [82%] and conventional group 60 [77%]
(p = 1.43; OR = 1.37; CI = 0.63–3.00) (Fig. 1A). The mean duration
of ventilation was shorter in the SLI group than in the control group
(9.1 days vs 13.8 days; p ≤ 0.001) (Fig. 1B).
Thirty-one of 78 [40%] infants in the SLI group received INtubation, a
dose of SURfactant and shortly after Extubation (INSURE) versus 23 of
78 [29%] infants in the control group (p = 0.17; OR = 1.58; CI =
0.81–3.07). Between the two groups there was a significant difference
in the number of newborns who received a first dose of surfactant (42
of 78 [54%] vs 66 of 78 [85%], p ≤ 0.001; OR = 0.21; CI = 0.10–0.45),
and in those patients who needed subsequent doses (24 of 78 [31%] vs
39 of 78 [50%], p = 0.01; OR = 0.44; CI = 0.23–0.86) (Fig. 1C). There
were no differences in signs of severe respiratory distress as seen at
the X-ray (15 of 78 [19%] vs 16 of 78 [21%]; p = 0.84; OR = 0.92;
CI = 0.42–2.03); bronchopulmonary dysplasia (9 of 78 [12%] vs 12 of
78 [15%]; p = 0.48; OR = 0.72; CI = 0.28–1.81); periventricular
leukomalacia (2 of 78 [3%] vs 5 of 78 [6%]; p = 0.25; OR = 0.38; CI =
0.07–2.04); severe retinopathy of prematurity (5 of 78 [6%] vs 6 of 78
[8%]; p = 0.75; OR = 0.82; CI = 0.24–2.81); pneumothorax (1 of 78
[1%] vs 2 of 78 [3%]; p = 0.56; OR = 0.49; CI = 0.04–5.56); and necro-
tizing enterocolitis (1 of 78 [1%] vs 1 of 78 [1%]; p = 1; OR = 1; CI =
0.06–16.28). There was no statistically significant difference in the num-
ber of patients with patent ductus arteriosus requiring surgical or phar-
macological intervention (PDA) (14 of 78 [18%] vs 10 of 78 [13%], p =
0.37; OR = 1.49; CI = 0.62–3.59) (Table 2).
With regard to the intraventricular hemorrhage (IVH), even if there
were no statistically significant differences between the two groups
(p = 0.46), there were more children with IVH in the group treated
with SLI than in the control group (22 of 78 [28%] vs 18 of 78 [23%];
OR = 1.31; CI = 0.64–2.69); this concerned more mild IVH (grades I–
II) (18 of 78 [23%] vs 11 of 78 [14%]; p = 0.15; OR = 1.83; CI = 0.80–
4.18) than severe ones (grades III–IV) (4 of 78 [5%] vs 6 of 78 [8%];
p = 0.51; OR = 0.65; CI = 0.18–2.39) (Fig. 2).
There was no statistically significant difference in average growth
between the two groups (22 g per day (median 22) vs 21 g per day (me-
dian 20); p ≤ 0.0548, z = −1.59).

4. Discussion

The effects of Sustained Lung Inflation in preterm babies are still under
discussion. The beneficial effects of SLI were not confirmed by Lindner's
randomized work of 2005, any differences between newborns who re-
ceived SLI and newborns who received intermittent mandatory ventila-
tion with a nasopharyngeal tube were not found [13]. The same for
Harling's work that did not prove any benefits from the use of Sustained
Lung Inflation in very preterm newborns [3]. But Harling did not study a
true SLI: as demonstrated, recruitment takes a minimum of 10 s and con-
tinues beyond 30 s while in his study he applied inflation just for 5 s. Sev- Fig. 1. A. Need for invasive and not invasive ventilation in infants resuscitated with
eral more recent studies as te Pas' randomized trial of 2007 [4] and Lista's Sustained Lung Inflation (SLI) or with conventional maneuvers. B. Duration of invasive
work of 2011 [2] proved that the application of a peak pressure of 25– ventilation in infants resuscitated with Sustained Lung Inflation (SLI) or with conventional
30 cm H2O for 10–20 s in preterm newborns at birth, followed by the ap- maneuvers. C. Need for surfactant administration divided in first, subsequent doses or In-
tubation, surfactant and Extubation (INSURE), in infants resuscitated with Sustained Lung
plication of continuous PEEP of 5 cm H2O improves the achievement of an Inflation (SLI) or with conventional maneuvers.
adequate functional residual capacity (FRC) and correlates to a reduction
of the need and duration of mechanical ventilation [2–5,14,15]. A trial of
Dani et al. is currently ongoing to compare the need for MV in the first reduction in the necessity of intubation is very significant because it al-
72 h of life in infants born at 25 + 0 to 28 + 6 weeks' gestation who re- lows the use of nasal CPAP as the first-line respiratory support [17]. It
ceived the SLI maneuver in the delivery room or not [16]. may also contribute to the reduction of the risk of volutrauma, barotrau-
Data obtained in our study are consistent with the most recent data ma and of the bronchopulmonary dysplasia (BPD) without increasing
reported in literature: infants who received SLI followed by CPAP the mortality [18,19].
showed less need of intubation in the delivery room, of mechanical in- According to te Pas' and Lista's studies, as in our study, SLI is related
vasive ventilation and needed a shorter duration of ventilation. The with a reduced demand of surfactant but not of the INSURE treatment
74 C. Grasso et al. / Early Human Development 91 (2015) 71–75

Table 2
Outcomes.

Sustained (N = 78) Conventional (N = 78) p value OR value (CI)

Intubation delivery room, n (%) 5 (6) 16 (21) b0.009 0.27 (0.09–0.77)

Radiological severe chest, n (%) 15 (19) 16 (21) 0.84 0.92 (0.42–2.03)
INSURE, n (%) 31 (40) 23 (29) 0.17 1.58 (0.81–3.07)
Surfactant N1 dose, n (%) 24 (31) 39 (50) 0.01 0.44 (0.23–0.86)
Duration of ventilation, mean (SD) 9.1 (±15.8) 13.8 (±29.8) b0.001 –
Bronchopulmonary dysplasia, n (%) 9 (12) 12 (15) 0.48 0.72 (0.28–1.81)
Patent ductus arteriosus (treated), n (%) 14 (18) 10 (13) 0.37 1.49 (0.62–3.59)
Retinopathy of prematurity (III–IV plus), n (%) 5 (6) 6 (8) 0.75 0.82 (0.24–2.81)
Pneumothorax, n (%) 1 (1) 2 (3) 0.56 0.49 (0.04–5.56)
Necrotizing enterocolitis, n (%) 1 (1) 1 (1) 1 1 (0.06–16.28)
Mild intraventricular hemorrhage, n (%) 18 (23) 11 (14) 0.15 1.83 (0.80–4.18)
Severe intraventricular hemorrhage, n (%) 4 (5) 6 (8) 0.51 0.65 (0.18–2.39)
Periventricular leukomalacia, n (%) 2 (3) 5 (6) 0.25 0.38 (0.07–2.04)
Died N2 weeks old, n (%) 1 (1) 4 (5) 0.17 0.24 (0.03–2.20)

INSURE, INtubation, a dose of SURfactant and Extubation; n, number; OR, odds ratio; CI, 95% confidence interval.

[2–4]. We found a statistically significant reduction in the number of hemodynamic effects of SLI are still uncertain and should be better stud-
children who needed both the first and the second dose of surfactant ied by clinical large trials [23].
in the SLI group compared to the control group. The limit given by the
need of prophylactic surfactant treatment [20] has been exceeded by
5. Conclusions
the most recent studies: they affirm that the use of prophylactic surfac-
tant was not superior to the nCPAP and to the early selective surfactant
The execution of Sustained Lung Inflation (SLI) in the delivery room
in decreasing the need of mechanical ventilation and in improving of
is an easier maneuver to perform, it requires only one operator and re-
the outcomes of preterm infants [12]. te Pas and Walther showed an in-
duces the percentage of children who necessitate of more complicated
crease of severe intraventricular hemorrhage, although without a statis-
maneuvers such as intubation and invasive ventilation. Thereby the in-
tically significant difference, in infants who were treated with SLI at
cidence of volotrauma and barotrauma and risk of infection are reduced.
birth [4]. These data were not confirmed by the most recent study
Infants who received SLI followed by CPAP showed less need of intuba-
which stated that sustained ventilation did not induce evident adverse
tion in the delivery room, mechanical invasive ventilation and a shorter
effects [2]. In our study we didn't find any differences in the outcome ex-
duration of ventilation without statistically evident adverse effects.
cept for a slight not significant increase of the mild form of IVH (I–II
In the SLI group there was also less requirement of surfactant which
grades) in the group treated with SLI. We also found a statistically signif-
is very important since the use of prophylactic surfactant is no longer
icantly improved growth (grams per day) in newborns who received
indicated.
SLI.
Even if our study is retrospective, with the limitations of any retro-
Hemodynamic effects of SLI are still being studied. The most recent
spective cohort comparison, we think that our experience could be use-
animal studies do not prove the presence of adverse circulatory events
ful to improve current knowledge about Sustained Lung Inflation and to
linked to the Sustained Lung Inflation at birth and we didn't find any sig-
encourage more randomized studies to confirm the importance of
nificant difference in hemodynamically relevant patent ductus arteriosus
Sustained Lung Inflation at birth in very pre-term infants. It would
[21,22]. Studies on newborns are limited, even for the extreme difficulty
also be interesting to investigate the correlation between SLI, cerebral
to design and to perform them, and although the SLI seems to have no
bleedings and their pathogenesis.
evident adverse events [2,23,24], the most recent data affirm that the

Authors' contributions

Conception and design: Pietro Sciacca and Pasqua Betta.

Collection and assembly of data: Chiara Grasso, Valentina Giacchi,
Caterina Carpinato, Carmine Mattia and Grazia Maria Palano.
Analysis and interpretation of data: Chiara Grasso and Pasqua Betta.
Draft of the manuscript: Chiara Grasso, Pasqua Betta and Pietro
Sciacca.
Critical revision of the manuscript and important intellectual
content: Pasqua Betta and Pietro Sciacca.
Final approval: Pasqua Betta and Pietro Sciacca.

Conflict of interests

The authors declare that they have no competing interests.

Acknowledgment

We acknowledge the excellent technical assistance of Nicola

Fig. 2. Incidence of all intraventricular hemorrhages (IVHs), and incidence of mild (I–II)
Bonanno of the Department of Pediatrics of the University of Catania,
and of severe (III–IV) ones in infants resuscitated with Sustained Lung Inflation (SLI) or Italy. We also acknowledge our secretary Concetta Scuderi for her col-
with conventional maneuvers. laboration in collecting data.
 C. Grasso et al. / Early Human Development 91 (2015) 71–75 75

References [13] Lindner W, Högel J, Pohlandt F. Sustained pressure-controlled inflation or intermit-

tent mandatory ventilation in preterm infants in the delivery room? A randomized,
[1] Vyas H, Milner AD, Hopkin IE, Boon AW. Physiologic responses to prolonged and controlled trial on initial respiratory support via nasopharyngeal tube. Acta Paediatr
slow-rise inflation in the resuscitation of the asphyxiated newborn infant. J Pediatr Mar 2005;94(3):303–9.
1981;99:635–9. [14] Lista G, Castoldi F. Reclutamento alveolare in sala parto: la sustained lung inflation
[2] Lista G, Fontana P, Castoldi F, Cavigioli F, Dani C. Does sustained lung inflation at (Alveolar recruitment in the delivery room: sustained lung inflation). Minerva
birth improve outcome of preterm infants at risk for respiratory distress syndrome. Pediatr Jun 2010;62(3 Suppl. 1):17–8.
Neonatology 2011;99(1):44–50. [15] Lindner W, Vossbeck S, Hummler H, Pohlandt F. Delivery room management of ex-
[3] Harling AE, Beresford MW, Vince GS, Bates M, Yoxall CW. Does sustained lung infla- tremely low birth weight infants: spontaneous breathing or intubation? Pediatrics
tion at resuscitation reduce lung injury in the preterm infant? Arch Dis Child Fetal May 1999;103(5 Pt 1):961–7.
Neonatal Ed 2005;90:F406–10. [16] Dani C, Lista G, Pratesi S, Boni L, Agosti M, Biban P, et al. Sustained lung inflation in
[4] te Pas AB, Walther FJ. A randomized, controlled trial of delivery-room respiratory the delivery room in preterm infants at high risk of respiratory distress syndrome
management in very preterm infants. Pediatrics 2007;120:322–9. (SLI STUDY): study protocol for a randomized controlled trial. Trials Mar 8 2013;
[5] American Heart Association. Part 13: neonatal resuscitation guidelines. Circulation 14:67. http://dx.doi.org/10.1186/1745-6215-14-67.
2005;112:188–95. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.166574 [origi- [17] Finer NN, Waldemar AC, Shahnaz D, et al. Delivery room continuous positive airway
nally published online Nov 28, 2005]. pressure/positive end-expiratory pressure in extremely low birth weight infants: a
[6] Kattwinkel J, Perlman JM, Aziz K, et al. Part 15: neonatal resuscitation: 2010 feasibility trial. Pediatrics 2004;114(3):651–7.
American Heart Association Guidelines for Cardiopulmonary Resuscitation and [18] Aly H, Milner JD, Patel K, El-Mohandes AA. Does the experience with the use of nasal
Emergency Cardiovascular Care. Circulation 2010;122:S909–19. http://dx.doi.org/ continuous positive airway pressure improve over time in extremely low birth
10.1161/CIRCULATIONAHA.110.971119. weight infants? Pediatrics 2004;114(3):697–702.
[7] Cole FS, Alleyne C, Barks JD, Boyle RJ, Carroll JL, Dokken D, et al. NIH Consensus De- [19] Polin RA, Sahni R. Newer experience with CPAP. Semin Neonatol 2002;7(5):379–89.
velopment Conference: inhaled nitric oxide therapy for premature infants. NIH [20] Soll RF, Morley CJ. Prophylactic versus selective use of surfactant in preventing mor-
Consens State Sci Statements 29 2010;27(5):1–34. bidity and mortality in preterm infants. Cochrane Database Syst Rev 2001(2):
[8] Ehrenkranz RA, Walsh MC, Vohr BR, Jobe AH, Wright LL, et al. For the National Insti- CD000510 [Review. Update in: Cochrane Database Syst Rev. 2012;3:CD000510].
tutes of Child Health and Human Development Neonatal Research Network Valida- [21] Polglase GR, Miller SL, Barton SK, et al. Initiation of resuscitation with high tidal vol-
tion of the National Institutes of Health consensus definition of bronchopulmonary umes causes cerebral hemodynamic disturbance, brain inflammation and injury in
dysplasia. Pediatrics 2005;116(6):1353–60. preterm lambs. PLoS One 2012;7(6):e39535.
[9] Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European Asso- [22] Sobotka KS, Hooper SB, Allison BJ, Te Pas AB, Davis PG, Morley CJ, et al. An initial
ciation of Perinatal Medicine European consensus guidelines on the management of sustained inflation improves the respiratory and cardiovascular transition at birth
neonatal respiratory distress syndrome in preterm infants — 2010 update. Neonatol- in preterm lambs. Pediatr Res Jul 2011;70(1):56–60.
ogy 2010;97(4):402–17. [23] Cantagrel S, Saliba E, Tessier V, Chamboux C, Laugier J. High-frequency oscillatory
[10] Sweet D, Bevilacqua G, Carnielli V, et al. European consensus guidelines on the man- ventilation: effects of sustained lung inflations on cerebral hemodynamics. 47
agement of neonatal respiratory distress syndrome. J Perinat Med 2007;35(3): European Society for Pediatric Research Abstracts. Pediatr Res 1996;40:523.
175–86. [24] Lista G, Castoldi F, Cavigioli F, Bianchi S, Fontana P. Alveolar recruitment in the deliv-
[11] Verder H, Robertson B, Greisen G, et al. Surfactant therapy and nasal continuous pos- ery room. J Matern Fetal Neonatal Med Apr 2012;25(Suppl. 1):39–40.
itive airway pressure for newborns with respiratory distress syndrome. N Engl J Med
1994;331(16):1051–5.
[12] Sandri F, Plavka R, Ancora G, et al. CURPAP Study Group. Prophylactic or early selec-
tive surfactant combined with nCPAP in very preterm infants. Pediatrics Jun 2010;
125(6):e1402–9.