Sustained Inflation Versus Intermittent Positive Pressure Ventilation for Preterm Infants at Birth

Objective: To characterize respiratory function monitor (RFM) measurements of sustained inflations and intermittent positive pressure ventilation (IPPV) delivered non-invasively to infants in the Sustained Aeration of Infant Lungs (SAIL) trial and to compare vital sign measurements between treatment arms. Study design: We analyzed RFM data from SAIL participants at five trial sites. We assessed tidal volumes, rates of airway obstruction and mask leak among infants allocated to SI and IPPV, and we compared pulse rate and oxygen saturation (SpO2) measurements between treatment groups. Results: Among 70 SAIL participants (36 SI, 34 IPPV) with RFM measurements, 40 (57%) were spontaneously breathing prior to the randomized intervention. The median expiratory tidal volume (Vte) of SIs administered was 5.3 mL/kg (IQR 1.1-9.2). Significant mask leak occurred in 15% and airway obstruction occurred during 17% of SIs. Among 34 control infants, the median Vte of IPPV inflations was 4.3 mL/kg (IQR 1.3-6.6). Mask leak was present in 3% and airway obstruction was present in 17% IPPV inflations. There were no significant differences in pulse rate or SpO2measurements between groups at any point during resuscitation. Conclusion: Expiratory tidal volumes of SI and IPPV inflations administered in the SAIL trial were highly variable in both treatment arms. Vital sign values were similar between groups throughout resuscitation. SI as operationalized in the SAIL trial was not superior to IPPV to promote lung aeration after birth in this study subgroup.

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