Key messages
• One in every 20 to 30 newborn babies receives help to start breathing well on their own after birth. ‘Sustained lung inflation’ is when a baby is given a long, steady breath, usually lasting about 10 to 15 seconds, to try to help them start normal breathing.
• Compared to standard, intermittent, resuscitation (when a baby’s lungs are inflated repeatedly for less than 1 second), giving newborn babies an initial sustained lung inflation may make little to no difference to the number of babies who die in the delivery room or before discharge from hospital.
• Sustained inflation may reduce the need for newborns to be put on a breathing machine (mechanical ventilation), compared to standard inflation.
Why do some babies have difficulty establishing effective breathing at birth?
At birth, the lungs are filled with fluid which must be replaced by air for babies to breathe properly. Some babies – especially if they are born too early (preterm) – have difficulty establishing effective breathing at birth. One in every 20 to 30 babies receives resuscitation, or help to start breathing well on their own.
What is sustained lung inflation?
A variety of devices are used to help newborn babies begin normal breathing. Some of these devices allow caregivers to give long (or sustained) inflations. ‘Sustained lung inflation’ gently gives the baby an initial long, steady breath, usually lasting about 10 to 15 seconds, to help fill the lungs with air and push fluid out. This can make it easier for a newborn to start breathing on their own. These sustained inflations may be better than ‘standard intermittent resuscitation’, which involves giving the baby short, gentle breaths through a mask, one at a time, to help inflate the lungs. Each breath usually lasts less than 1 second.
What did we want to find out?
We wanted to find out if sustained lung inflation (more than 1 second in duration) is better than standard inflation (up to and including 1 second in duration) to improve survival and other important outcomes among newborn babies receiving resuscitation at birth.
What did we do?
We searched for studies that compared sustained inflation with standard inflation in babies having difficulty establishing effective breathing at birth. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.
What did we find?
We found 14 studies that involved 1766 infants. In all studies, babies were born preterm (from 23 to 36 weeks of gestational age). The sustained inflation lasted between 15 and 20 seconds. Most studies gave the babies one or more additional sustained inflations if the babies did not respond well to the first inflation (for example, if they had a persistent low heart rate). We analysed two studies separately because, in addition to sustained or standard inflations, healthcare professionals treated babies with chest compressions, an additional step that might help them begin normal breathing.
Main results
Compared to standard inflation, sustained inflation with no chest compression may make little to no difference to the number of babies who:
• die in the delivery room;
• die before hospital discharge;
• develop chronic lung disease (a form of lung injury);
• develop pneumothorax (an air leak into the chest); or
• develop severe intraventricular haemorrhage (bleeding into the brain’s fluid-filled spaces).
Compared to standard inflation, sustained lung inflation may reduce the need for newborns to be put on a breathing machine (mechanical ventilation).
Based on the current evidence, we cannot rule out small to moderate differences between the two treatments in terms of these outcomes.
What are the limitations of the evidence?
We have little confidence in the evidence because some studies could have been better designed. The babies’ parents, the delivery room caregivers, and other staff involved in the studies were aware of which treatment the babies were being given. Not all studies provided data about everything that we were interested in. Moreover, only a few studies have explored this treatment approach, and relatively few babies were included in these studies.
How current is this evidence?
The evidence is current to April 2024.