ORIGINAL ARTICLE

Does sustained lung inflation at resuscitation reduce lung injury in the preterm infant?

A E Harling¹, M W Beresford¹, G S Vince², M Bates², C W Yoxall¹

¹ NICU, Liverpool Women’s Hospital, Liverpool L8 7SS, UK
² Immunology Department, University of Liverpool, Liverpool L69 3GA, UK

Correspondence to:
Miss Harling
Neonatal Intensive Care Unit, Liverpool Women’s Hospital, Crown Street, Liverpool L8 7SS, UK; Elizabeth.Harling{at}lwh-tr.nwest.nhs.uk

Background: Bronchopulmonary dysplasia (BPD) is a common outcome of preterm birth. Experimental animal work has shown that initial ventilation strategies injure the immature lung and may lead to BPD. Studies with asphyxiated babies have shown that, if tidal ventilation at birth is preceded by sustained lung inflation, larger inflation volumes can be achieved, which is thought to lead to clearance of lung fluid and formation of the functional residual capacity (FRC).

Objective: To see if sustained lung inflation at initial resuscitation of preterm babies would facilitate the removal of lung fluid, establish the FRC, and allow an even distribution of alveolar opening, permitting less aggressive ventilation, leading to a reduction in pulmonary inflammation and subsequent BPD.

Method: The outcomes of 52 babies of less than 31 weeks gestation, resuscitated at birth using either a sustained lung inflation of five seconds or a conventional lung inflation of two seconds for the first assisted breath of resuscitation, were examined. Evidence of pulmonary inflammation was determined by quantification of interleukins 6, 10, and 1ß and tumour necrosis factor in bronchoalveolar lavage fluid by enzyme linked immunosorbent assay.

Results: There were no significant differences in any of the cytokines. Death occurred in 3/26 babies in the conventional group and 6/26 babies in the sustained lung inflation group. Survival without BPD occurred in 13/26 and 14/26 respectively.

Conclusion: The use of sustained lung inflation at resuscitation did not reduce lung injury, as measured by inflammatory markers.

Abbreviations: BAL, bronchoalveolar lavage; BPD, bronchopulmonary dysplasia; CLI, conventional lung inflation; FRC, functional residual capacity; IL, interleukin; SLI, sustained lung inflation; TNF, tumour necrosis factor

Keywords: bronchoalveolar lavage fluid; bronchopulmonary dysplasia; cytokines; lung inflation

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