Effects of Sustained Lung Inflation, a lung recruitment maneuver in primary acute respiratory distress syndrome, in respiratory and cerebral outcomes in preterm infants Chiara Grasso, Pietro Sciacca, Valentina Giacchi, Caterina Carpinato, Carmine Mattia, Grazia Maria Palano, Pasqua Betta ⁎ Department of Pediatrics, Neonatology, NICU, University of Catania, “Policlinico of Catania”, Italy abstract article info Article history: Received 27 August 2014 Received in revised form 22 November 2014 Accepted 2 December 2014 Available online xxxx Keywords: Sustained Neonatal resuscitation Surfactant Pulmonary recruitment maneuvers Iatrogenic risks Background: Sustained Lung Inflation (SLI) is a maneuver of lung recruitment in preterm newborns at birth that can facilitate the achieving of larger inflation volumes, leading to the clearance of lung fluid and formation of functional residual capacity (FRC). Aim: To investigate if Sustained Lung Inflation (SLI) reduces the need of invasive procedures and iatrogenic risks. Study design: 78 newborns (gestational age ≤ 34 weeks, weighing ≤ 2000 g) who didn't breathe adequately at birth and needed to receive SLI in addition to other resuscitation maneuvers (2010 guidelines). Subjects: 78 preterm infants born one after the other in our department of Neonatology of Catania University from 2010 to 2012. Outcome measures: The need of intubation and surfactant, the ventilation required, radiological signs, the incidence of intraventricular hemorrhage (IVH), periventricular leukomalacia, retinopathy in prematurity from III to IV plus grades, bronchopulmonary dysplasia, patent ductus arteriosus, pneumothorax and necrotizing enterocolitis. Results: In the SLI group infants needed less intubation in the delivery room (6% vs 21%; p b 0.01), less invasive mechanical ventilation (14% vs 55%; p ≤ 0.001) and shorter duration of ventilation (9.1 days vs 13.8 days; p ≤ 0.001). There wasn't any difference for nasal continuous positive airway pressure (82% vs 77%; p = 0.43); but there was less surfactant administration (54% vs 85%; p ≤ 0.001) and more infants received INSURE (40% vs 29%; p = 0.17). We didn't found any differences in the outcomes, except for more mild intraventricular hemor- rhage in the SLI group (23% vs 14%; p = 0.15; OR = 1.83). Conclusion: SLI is easier to perform even with a single operator, it reduces the necessity of more complicated ma- neuvers and surfactant without statistically evident adverse effects. © 2014 Published by Elsevier Ireland Ltd. 1. Introduction Sustained Lung Inflation (SLI) is a maneuver of lung recruitment characterized by the application of a peak pressure of 25–30 cm H 2 O for 10–20 s in preterm newborns at birth. Vyas et al. [1] in 1981, studied the effects of SLI applied for a time of 5 s in preterm newborn resuscita- tion and proved that this method increased the tidal volume, facilitating the achieving of larger inflation volumes, leading to the clearance of lung fluid and formation of functional residual capacity (FRC) [1]. Lista et al. increased at 10–20 s the time of application of SLI and they asserted that the application of SLI at birth in preterm infants with respi- ratory distress might decrease the need for mechanical ventilation with- out inducing evident adverse effects [2]. Harling et al. conversely showed no improvement in the outcome after sustained inflations of 5 s and suggested that immature lungs may be unable to respond to this inflation maneuver [3]. te Pas and Walther showed an increase of complications in the infants treated with SLI, such as severe intraven- tricular hemorrhage, although they did not reach a statistical signifi- cance [4]. In this retrospective cohort study, we analyze the outcome and the onset of complications in infants receiving (SLI group) and in- fants not receiving it (conventional group). Early Human Development 91 (2015) 71–75 Abbreviations: AHA,AmericanHeartAssociation;BPD,bronchopulmonarydysplasia;CI, confidence interval; FiO 2 , fraction of inspired oxygen; FRC, functional residual capacity; INSURE, INtubation, a dose of SURfactant and Extubation; IUGR, intrauterine growth restric- tion; IVH, intraventricular hemorrhage; MAP, mean airway pressure; n-CPAP, nasal contin- uous positive airway pressure; NICU, neonatal intensive care unit; OR, odds ratio; pCO 2 , pressure of carbon dioxide; PDA, patent ductus arteriosus; PMA, postmenstrual age; PEEP, positive end-expiratory pressure; PROM, premature rupture of membrane; RDS, respiratory distress syndrome; SaO 2 , arterial oxygenation saturation; SD, standard deviation; SLI, Sustained Lung Inflation. ⁎ Corresponding author at: Department of Pediatrics, Neonatology, NICU, University of Catania, “Policlinico of Catania”, Via Santa Sofia 78, 95123 Catania, Italy. Tel.: +39 0953781197; fax: +39 0953781123. E-mail address: mlbetta@yahoo.it (P. Betta). http://dx.doi.org/10.1016/j.earlhumdev.2014.12.002 0378-3782/© 2014 Published by Elsevier Ireland Ltd. Contents lists available at ScienceDirect Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev