Importance Most preterm infants require respiratory support to establish lung aeration after birth. Intermittent positive pressure ventilation and continuous positive airway pressure are standard therapies. An initial sustained inflation (inflation time >5 seconds) is a widely practiced alternative strategy. Objective To conduct a systematic review and meta-analysis of sustained inflation vs intermittent positive pressure ventilation and continuous positive airway pressure for the prevention of hospital mortality and morbidity for preterm infants. Data Sources MEDLINE (through PubMed), Embase, the Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials were searched through June 24, 2019. Study Selection Randomized clinical trials of preterm infants born at less than 37 weeks' gestation that compared sustained inflation (inflation time >5 seconds) vs standard resuscitation with either intermittent positive pressure ventilation or continuous positive airway pressure were included. Studies including other cointerventions were excluded. Data Extraction and Synthesis Two reviewers assessed the risk of bias of included studies. Meta-analysis of pooled outcome data used a fixed-effects model specific to rarer events. Subgroups were based on gestational age and study design (rescue vs prophylactic sustained inflation). Main Outcomes and Measures Death before hospital discharge. Results Nine studies recruiting 1406 infants met inclusion criteria. Death before hospital discharge occurred in 85 of 736 infants (11.5%) treated with sustained inflation and 62 of 670 infants (9.3%) who received standard therapy for a risk difference of 3.6% (95% CI, -0.7% to 7.9%). Although analysis of the primary outcome identified important heterogeneity based on gestational age subgroups, the 95% CI for the risk difference included 0 for each individual gestational age subgroup. There was no difference in the primary outcome between subgroups based on study design. Sustained inflation was associated with increased risk of death in the first 2 days after birth (risk difference, 3.1%; 95% CI, 0.9%-5.3%). No differences in the risk of other secondary outcomes were identified. The quality-of-evidence assessment was low owing to risk of bias and imprecision. Conclusions and Relevance There was no difference in the risk of the primary outcome of death before hospital discharge, and there was no evidence of efficacy for sustained inflation to prevent secondary outcomes. These findings do not support the routine use of sustained inflation for preterm infants after birth.

中文翻译：

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早产儿持续充气与标准复苏

重要性 大多数早产儿在出生后需要呼吸支持来建立肺通气。间歇正压通气和持续气道正压通气是标准疗法。初始持续充气（充气时间 > 5 秒）是一种广泛采用的替代策略。目的 对持续充气与间歇正压通气和持续气道正压通气预防早产儿住院死亡率和发病率进行系统评价和荟萃分析。数据来源 MEDLINE（通过 PubMed）、Embase、护理和相关健康文献累积索引以及 Cochrane 对照试验中央登记册的检索时间截至 2019 年 6 月 24 日。 研究选择 37 周以下早产儿的随机临床试验' 将持续充气（充气时间 >5 秒）与标准复苏与间歇正压通气或持续气道正压通气进行比较的妊娠包括在内。包括其他联合干预在内的研究被排除在外。数据提取和综合 两名评审员评估了纳入研究的偏倚风险。汇总结果数据的荟萃分析使用特定于罕见事件的固定效应模型。亚组基于胎龄和研究设计（救援与预防性持续充气）。主要结果和措施 出院前死亡。结果 招募 1406 名婴儿的 9 项研究符合纳入标准。736 名接受持续充气治疗的婴儿中有 85 名 (11.5%) 在出院前死亡，670 名婴儿中有 62 名 (9. 3%）接受标准治疗的风险差异为 3.6%（95% CI，-0.7% 至 7.9%）。尽管对主要结局的分析确定了基于胎龄亚组的重要异质性，但风险差异的 95% CI 包括每个胎龄亚组的 0。根据研究设计，亚组之间的主要结果没有差异。持续通胀与出生后前 2 天死亡风险增加有关（风险差异，3.1%；95% CI，0.9%-5.3%）。未发现其他次要结果的风险存在差异。由于存在偏倚和不精确的风险，证据质量评估较低。结论和相关性 出院前死亡的主要结局风险没有差异，并且没有证据表明持续通胀可以有效预防次要结果。这些发现不支持对出生后的早产儿常规使用持续充气。