Benefit of a sustained inflation manoeuvre in postnatal stabilization of extremely preterm infants born on the threshold of viability
Abstract
Background and objective: The need for intubation in the delivery room is high and negatively dependent on gestational age in extremely preterm infants. Sustained inflation manoeuvre (SIM) is a physiological concept that can reduce the need for intubation in the delivery room and thus positively influence long-term outcome of extremely premature infants.
Method: Retrospective analysis of prospectively collected data of premature infants stabilised after delivery in a unique research resuscitation bed, which allows two simultaneous video recordings. Data has been collected since 2010.
Infants born at <30 weeks of gestation were resuscitated according to the internal guideline based on the ILCOR recommendation. In 2013, SIM with a pressure of 25 cm H2O for 15-20 seconds was implemented to the resuscitation procedure.
The primary outcome was the need for intubation in the delivery room before and after the introduction of the SIM. The incidence of death before discharge and severe neonatal morbidity were also compared.
Results: After the introduction of the SIM, the need for intubation in the delivery room was reduced. For a subgroup of infants born at <25 weeks of gestation age was a statistically significant reduction (18/25, 72% versus 8/24, 33%, p<0.007).
There was a significant reduction in the need for artificial ventilation in the first 72 hours of life (9/24, 37% versus 16/25, 64%, p=0.064) and severe intraventricular hemorrhage (3/24, 12% vs. 9/25, 36%, p=0.055). In contrast, the incidence of patent ductus arteriosus significantly increased (10/24, 41% vs. 4/25, 16%, p<0.05).
Conclusion: The introduction of SIM to the clinical practice has reduced the need for intubation in the delivery room, especially in extremely preterm infants born on the threshold of the viability, which could have a positive effect on reducing the incidence of cranial morbidity. Promising results should be confirmed in randomised trials focusing on this unique, fragile population.