Lung recruitment at birth has been advocated as an effective method of improving the respiratory transition at birth. Sustained inflations (SI) and dynamic positive end-expiratory pressure (PEEP) were assessed in clinical and animal studies to define the optimal level. Our working hypothesis was that very low gestational age infants (VLGAI) < 32 weeks’ gestation require an individualized lung recruitment based on combining both manoeuvers. Between 2014 and 2016, 91 and 72 inborn VLGAI, requiring a respiratory support beyond a continuous positive airway pressure (CPAP) = 5 cmH2O, were enrolled before and after introducing these manoeuvers based on progressive increase in SI up to 15 s, with simultaneous gradual increase in PEEP up to 15 cmH2O, according to the cardiorespiratory response. Retrospective comparisons of the incidence of mechanical ventilation (MV) < 72 h of life, short-term and before discharge morbidity were then performed. Among extremely low gestational age infants (ELGAI) < 29 weeks’ gestation, the following outcomes decreased significantly: intubation (90 to 55%) and surfactant administration (54 to 12%) in the delivery room, MV (92 to 71%) and its mean duration < 72 h of life (45 h to 13 h), administration of a 2nd dose of surfactant (35 to 12%) and postnatal corticosteroids (52 to 19%), and the rate of bronchopulmonary dysplasia (23 to 5%). Among VLGAI, all of these results were also significant. Neonatal mortality and morbidity were not different. In our setting, combining two individualized lung recruitment maneuvers at birth was feasible and may be beneficial on short-term and before discharge pulmonary outcomes. A randomized controlled trial is needed to confirm these results.

中文翻译：

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极低胎龄婴儿在出生时结合两种个体化肺募集策略的可行性：一项回顾性队列研究

出生时招募肺是提高出生时呼吸过渡的有效方法。在临床和动物研究中评估了持续通气（SI）和动态呼气末正压（PEEP），以确定最佳水平。我们的工作假设是，小于32周的极低胎龄婴儿（VLGAI）需要根据两种操作组合进行个性化的肺募集。在2014年至2016年之间，根据SI逐渐升高至15 s并同时逐步进行的这些操作，在进行这些操作之前和之后，招募了91和72名先天性VLGAI，它们需要超过持续气道正压通气（CPAP）= 5 cmH2O的呼吸支持。根据心肺反应，PEEP升高至15 cmH2O。回顾性比较了生命中，短期和出院前<72 h的机械通气（MV）的发生率。在小于29周的极低胎龄婴儿（ELGAI）中，以下结局明显降低：分娩时插管（90％至55％）和表面活性剂给药（54％至12％），MV（92％至71％）和平均寿命<72小时（45小时至13小时），第二剂表面活性剂（35至12％）和产后皮质类固醇（52至19％）的给药以及支气管肺发育不良的发生率（23至5％） ）。在VLGAI中，所有这些结果也很重要。新生儿死亡率和发病率没有差异。在我们的环境中 在出生时结合两种个体化的肺部募集策略是可行的，并且可能对短期和出院前的肺结局有益。需要一项随机对照试验来确认这些结果。