Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. The Cochrane Neonatal Group has produced 400 Cochrane Reviews over the last two decades, updating these periodically as new evidence becomes available. In March 2020, they published the second update of their review of using sustained or standard inflation to help newborn babies who are struggling to breathe. We asked Dina Muscat Meng, Communications Consultant at Cochrane Sweden, to interview lead author and Director at Cochrane Sweden, Matteo Bruschettini, to tell us about the latest findings.

Dina: Matteo, perhaps you could begin with a few words on why some newborn babies might require a sustained inflation of their lungs?

Matteo: Well, Dina, at birth, a baby’s lungs are filled with fluid, which must be replaced by air if they are to breathe properly. This usually happens naturally, but some babies have difficulty and 1 in every 20 to 30 need help to do so. Our standard practise is to provide short inflations, which mimic a normal baby’s breathing efforts; but sustained inflation, lasting more than 5 seconds, has been suggested as a way to expand the lungs more rapidly and allow them to exchange oxygen and carbon dioxide sooner. 

Dina: So, the review was an opportunity to compare these approaches?

Matteo: Yes. It's important to know if these methods have similar or different effects on a baby's breathing and survival rate and so we looked for evidence on the benefits and harms of sustained lung inflation compared with standard inflation (up to one second).

Dina: What did you find?

Matteo: We found ten studies enrolling nearly 1500 babies who were born before their due date (from 23 to 36 weeks of gestational age). In each study, 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 if the baby did not respond well. There was also one study, with 9 babies, which we analysed separately because it combined use of sustained or standard inflations with chest compressions, an additional intervention that might help babies begin normal breathing.

Dina: And what do the studies tell us about the different types of inflation?

Matteo: They showed no important differences for babies who received sustained or standard inflations on mortality, intubation during the first three days of life, or chronic lung disease; but babies receiving sustained inflation at birth may spend fewer days on mechanical ventilation. However, we have a moderate to low level of certainty in these findings given that there is a relatively small amount of research available to date. There are also several ongoing studies which, when they are finished, might help us to determine whether sustained inflations are beneficial or harmful.

Dina: Looking further into the future, what should new studies aim to investigate?

Matteo: We need studies that provide more detailed monitoring of the procedure, such as measurements of lung volume and presence of apnoea before or during sustained inflation. It will also be important for future randomized trials to enrol infants who are at higher risk of morbidity and mortality, to present data for different gestational age groups and to measure long-term neuro-developmental outcomes.

Dina: Thanks very much for all of this information, Matteo. If people want to learn more, how can they get the review?

Matteo: Thanks Dina. The review is published online and is available at Cochrane Library dot com. If people go to the website and search for 'sustained inflation for neonatal resuscitation', they'll see the link to it.