Abstract
Sustained inflations and avoidance of endotracheal mechanical ventilation (eMV) are delivery room interventions aimed at preventing bronchopulmonary dysplasia (BPD). Their effectiveness is the subject of the present meta-analysis.
The databases MEDLINE, EMBASE and CENTRAL were searched for randomised controlled trials (RCTs) of preterm infants that compared: 1) sustained inflations with intermittent positive-pressure ventilation; and 2) a non-intubated strategy of respiratory support with one that prescribed eMV at an earlier stage. Data extraction and analysis followed the standard methods of the Cochrane Collaboration. The primary outcome was death or BPD, defined as need for oxygen or positive pressure treatment at 36 weeks' postmenstrual age.
Avoiding eMV (nine RCTs, 3486 infants) reduced the risk of death or BPD, with a risk ratio of 0.90 (95% CI 0.84–0.97) and a number needed to treat of 35. After sustained inflations (six RCTs, 854 infants), the risk ratio was 0.85 (95% CI 0.65–1.12). A current multicentre RCT of sustained inflations in very preterm infants was halted for increased early mortality in the sustained inflations arm.
While strategies aimed at avoiding eMV had a small but significant impact on preventing BPD, sustained inflations had no effect and may even increase mortality in very preterm infants.
Abstract
Meta-analysis of RCTs in preterm infants showed that delivery room strategies to avoid mechanical ventilation reduced bronchopulmonary dysplasia, whereas sustained inflations had no effect and may even increase mortality http://ow.ly/je6u30mxS58
Footnotes
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Provenance: Submitted article, peer reviewed.
Author contributions: Conception: C. Bührer. Design of the respective meta-analyses, data acquisition and risk of bias assessment: H.S. Fischer, C. Bührer, G.M. Schmölzer and P-Y. Cheung. Data analysis and drafting of the manuscript: H.S. Fischer. All authors critically reviewed and revised the manuscript, and approved the final version as submitted.
Conflict of interest: H.S. Fischer has nothing to disclose.
Conflict of interest: G.M. Schmölzer has nothing to disclose.
Conflict of interest: P-Y. Cheung has nothing to disclose.
Conflict of interest: C. Bührer reports personal fees from Chiesi Pharmaceuticals (manufacturer of surfacant), outside the submitted work.
Support statement: Georg M. Schmölzer is a recipient of the Heart and Stroke Foundation/University of Alberta Professorship of Neonatal Resuscitation, a National New Investigator of the Heart and Stroke Foundation Canada and an Alberta New Investigator of the Heart and Stroke Foundation Alberta. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received August 21, 2018.
- Accepted October 23, 2018.
- Copyright ©ERS 2018.
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