• Gianluca Lista, Luca Boni, Fabio Scopesi, Fabio Mosca, Daniele Trevisanuto, Hubert Messner, Giovanni Vento, Rosario Magaldi, Antonio Del Vecchio, Massimo Agosti, Camilla Gizzi, Fabrizio Sandri, Paolo Biban, Massimo Bellettato, Diego Gazzolo, Antonio Boldrini, Carlo Dani, and SLI Trial Investigators.
• Division of Neonatology, "V. Buzzi" Children's Hospital, ICP, Milan, Italy;
• Pediatrics. 2015 Feb 1; 135 (2): e457-64.

BackgroundStudies suggest that giving newly born preterm infants sustained lung inflation (SLI) may decrease their need for mechanical ventilation (MV) and improve their respiratory outcomes.MethodsWe randomly assigned infants born at 25 weeks 0 days to 28 weeks 6 days of gestation to receive SLI (25 cm H2O for 15 seconds) followed by nasal continuous positive airway pressure (nCPAP) or nCPAP alone in the delivery room. SLI and nCPAP were delivered by using a neonatal mask and a T-piece ventilator. The primary end point was the need for MV in the first 72 hours of life. The secondary end points included the need for respiratory supports and survival without bronchopulmonary dysplasia (BPD).ResultsA total of 148 infants were enrolled in the SLI group and 143 in the control group. Significantly fewer infants were ventilated in the first 72 hours of life in the SLI group (79 of 148 [53%]) than in the control group (93 of 143 [65%]); unadjusted odds ratio: 0.62 [95% confidence interval: 0.38-0.99]; P = .04). The need for respiratory support and survival without BPD did not differ between the groups. Pneumothorax occurred in 1% (n = 2) of infants in the control group compared with 6% (n = 9) in the SLI group, with an unadjusted odds ratio of 4.57 (95% confidence interval: 0.97-21.50; P = .06).ConclusionsSLI followed by nCPAP in the delivery room decreased the need for MV in the first 72 hours of life in preterm infants at high risk of respiratory distress syndrome compared with nCPAP alone but did not decrease the need for respiratory support and the occurrence of BPD.Copyright © 2015 by the American Academy of Pediatrics.

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