Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. 1221-1222 (doi:10.1542/peds.2007-2497)

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LETTER TO THE EDITOR

Possible Sequelae of Sustained Lung Inflation in Resuscitation of Preterm Infants

Eleanor J. Molloy, MB, PhD, FRCPI
Consultant Neonatologist
National Maternity Hospital
Dublin 2, Ireland

To the Editor.—

I read with interest the recent report by te Pas and Walther,¹ which showed a decrease in intubation and bronchopulmonary dysplasia in preterm infants of >28 weeks' gestation by using sustained inflation and early nasal continuous positive airway pressure.

The first breaths of life in normal term infants are characterized by prolonged expiratory phases, associated with high positive intrathoracic pressure, interspersed with brief inspiratory components.² Vyas et al³ demonstrated that sustained lung inflation during the resuscitation of 10 asphyxiated infants produced a large increase in the tidal volume and the functional residual capacity. However, a long inspiratory time is associated with a significant increase in air leak, as demonstrated in a Cochrane review that included 5 studies, with 694 infants recruited.⁴ In addition, mortality before hospital discharge was increased and reached borderline statistical significance. These studies were conducted before the introduction of antenatal steroids, postnatal surfactant, and the use of synchronized modes of ventilatory support.⁴ However, none of the studies of preterm infants examining sustained inflations during resuscitation^1,5,6 measured respiratory parameters such as tidal volume, inspiratory time, or inflating pressure, and small numbers may prevent statistical significance in either benefits or complications. Harling et al⁶ illustrated the changes in PCO₂, PO₂, mean pH, median fraction of inspired oxygen, and median peak inspiratory pressure over the first 24 hours after either conventional or sustained lung inflation. Were these parameters available to the authors?

Harling et al showed no improvement in outcome after sustained inflations (5 seconds) and suggested that developmentally immature lungs that are deficient in surfactant may be unable to respond to this inflation maneuver. te Pas and Walther¹ showed an increase in complications such as pneumothorax and severe intraventricular hemorrhage in the infants in the intervention group, although they did not reach statistical significance. I wondered whether the authors could provide additional details on the outcome of the subgroup of infants who were <28 weeks' gestation, including complications such as intraventricular hemorrhage and pneumothorax.

REFERENCES

1. te Pas AB, Walther FJ. A randomized, controlled trial of delivery-room respiratory management in very preterm infants. Pediatrics. 2007;120 :322 –329[Abstract/Free Full Text]
2. Karlberg P, Cherry RB, Escardo FE, et al. Pulmonary ventilation and mechanics of breathing in the first minutes of life, including the onset of respiration. Acta Paediatr. 1962;51 :121 –136[Web of Science]
3. Vyas H, Milner AD, Hopkin IE, Boon AW. Physiologic responses to prolonged and slow-rise inflation in the resuscitation of the asphyxiated newborn infant. J Pediatr. 1981;99 :635 –639[CrossRef][Web of Science][Medline]
4. Kamlin CO, Davis PG. Long versus short inspiratory times in neonates receiving mechanical ventilation. Cochrane Database Syst Rev. 2004;(4):CD004503
5. Lindner W, Vossbeck S, Hummler H, Pohlandt F. Delivery room management of extremely low birth weight infants: spontaneous breathing or intubation? Pediatrics. 1999;103 :961 –967[Abstract/Free Full Text]
6. Harling AE, Beresford MW, Vince GS, Bates M, Yoxall CW. Does sustained lung inflation at resuscitation reduce lung injury in the preterm infant? Arch Dis Child Fetal Neonatal Ed. 2005;90 :F406 –F410[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Molloy, E. J. Search for Related Content PubMed PubMed Citation Articles by Molloy, E. J. Related Collections Premature & Newborn Social Bookmarking                         What's this?