Prolonged lung inflation for neonatal resuscitation

Bruschettini M, O'Donnell CPF, Davis PG, Morley CJ, Moja L, Zappettini S, Calevo M

Review question

Does the use of prolonged (or sustained, > 1 second duration) lung inflation rather than standard inflations (≤ 1 second) improve survival and other important outcomes among newly born babies receiving resuscitation at birth?


At birth, the lungs are filled with fluid, which must be replaced by air for babies to breathe properly. Some babies have difficulty establishing effective breathing at birth, and 1 in every 20 to 30 babies receives help to do so. A variety of devices are used to help babies begin normal breathing. Some of these devices allow caregivers to give long (or sustained) inflations. These sustained inflations may help inflate the lungs and may keep the lungs inflated better than if they are not used.

Study characteristics

We collected and analysed all relevant studies to answer the review question and found eight studies enrolling 941 infants. In all studies, babies were born before the due date (from 23 to 36 weeks of gestational age). The sustained inflation lasted between 15 and 20 seconds at pressure between 20 and 30 cmH2O. Most studies provided one or more additional sustained inflations in cases of poor clinical response, for example, persistent low heart rate. We analysed one study (which included only nine babies) separately because researchers combined use of sustained or standard inflations with chest compressions.

Key results

The included studies showed no important differences among babies who received sustained versus standard inflations in terms of mortality, need for intubation during the first three days of life, or chronic lung disease. Babies receiving sustained inflation at birth may spend fewer days on mechanical ventilation. Several ongoing studies might help us to clarify whether differences between the two techniques may occur, as now we cannot exclude that small to moderate differences exist.

Quality of evidence

The quality of evidence is low to moderate because overall only a small number of studies have looked at this intervention; few babies were included in these studies; and some studies could have been better designed.

How up-to-date is this review?

We searched for studies that had been published up to February 2017.

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