Do Sustained Lung Inflations during Neonatal Resuscitation Affect Cerebral Blood Volume in Preterm Infants? A Randomized Controlled Pilot Study

Background
Sustained lung inflations (SLI) during neonatal resuscitation may promote alveolar recruitment in preterm infants. While most of the studies focus on respiratory outcome, the impact of SLI on the brain hasn’t been investigated yet.
Objective
Do SLI affect cerebral blood volume (CBV) in preterm infants?
Methods
Preterm infants of gestation 28 weeks 0 days to 33 weeks 6 days with requirement for respiratory support (RS) were included in this randomized controlled pilot trial. Within the first 15 minutes after birth near-infrared spectroscopy (NIRS) measurements using ‘NIRO-200-NX’ (Hamamatsu, Japan) were performed to evaluate changes in CBV and cerebral tissue oxygenation. Two groups were compared based on RS: In SLI group RS was given by applying 1–3 SLI (30 cmH2O for 15 s) continued by respiratory standard care. Control group received respiratory standard care only.
Results
40 infants (20 in each group) with mean gestational age of 32 weeks one day (±2 days) and birth weight of 1707 (±470) g were included. In the control group ΔCBV was significantly decreasing, whereas in SLI group ΔCBV showed similar values during the whole period of 15 minutes. Comparing both groups within the first 15 minutes ΔCBV showed a tendency toward different overall courses (p = 0.051).
Conclusion
This is the first study demonstrating an impact of SLI on CBV. Further studies are warranted including reconfirmation of the present findings in infants with lower gestational age. Future investigations on SLI should not only focus on respiratory outcome but also on the consequences on the developing brain.
Trial Registration
German Clinical Trials Register DRKS00005161 https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_EN.do

背景
新生儿复苏期间实施持续肺充气（sustained lung inflations, SLI）或可促进早产儿肺泡复张。目前多数相关研究聚焦于呼吸系统结局，而SLI对脑部的影响尚未得到探索。

目的
SLI是否会影响早产儿的脑血容量（cerebral blood volume, CBV）？

方法
本项随机对照预试验纳入了胎龄28周0天至33周6天、需要呼吸支持（respiratory support, RS）的早产儿。于出生后15分钟内，使用"NIRO-200-NX"（日本滨松）近红外光谱（near-infrared spectroscopy, NIRS）设备开展检测，以评估CBV及脑组织氧合水平的变化。根据呼吸支持方案将受试对象分为两组：SLI组先给予1~3次SLI（30 cmH₂O维持15秒），随后辅以标准呼吸护理；对照组仅接受标准呼吸护理。

结果
最终纳入40例早产儿（每组各20例），平均胎龄为32周1天（±2天），出生体重为1707（±470）g。对照组的ΔCBV呈显著下降趋势，而SLI组的ΔCBV在整个15分钟监测周期内维持相对稳定的水平。对比两组在15分钟内的ΔCBV整体变化趋势，二者呈现出具有统计学边际差异的分化倾向（p=0.051）。

结论
本研究首次证实SLI对CBV存在影响。后续需开展进一步研究以在胎龄更低的早产儿中复现本研究结果，且未来关于SLI的研究不应仅聚焦于呼吸系统结局，还应关注其对发育中脑部的影响。

试验注册
德国临床试验注册库DRKS00005161，网址：https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_EN.do