BACKGROUND: Sustained lung inflation (SLI) applied at birth has been 
demonstrated to lead to clearance of lung fluid and achievement of a precocious 
functional residual capacity in animal studies.
OBJECTIVES: To verify if the application of SLI in preterm infants at birth may 
reduce the need for mechanical ventilation and improve their respiratory 
outcome.
METHODS: We prospectively studied 89 infants with respiratory distress 
(gestational age (GA) 28.1 ± 2.2 weeks) treated at birth with a SLI (25 cm 
H(2)O, sustained for 15 s) in addition to AAP recommendations versus a 
historical control group (n = 119; GA 28.1 ± 2.0 weeks) treated without SLI with 
the same device (controlled positive end-expiratory pressure of 5 cm H(2)O).
RESULTS: The SLI group had less need for (51 vs. 76%, p < 0.0001) and shorter 
duration of mechanical ventilation (5 ± 11 vs. 11 ± 19 days, p = 0.008), a more 
frequent occurrence of exclusive nasal continuous airway pressure support (49 
vs. 24%, p < 0.0001) and INtubation-SURfactant-Extubation (INSURE) treatment (16 
vs. 3%, p = 0.01), less need for surfactant (45 vs. 61%, p = 0.027) and 
postnatal steroids (10 vs. 25%, p = 0.01), a shorter duration of oxygen therapy 
(21 ± 27 vs. 31 ± 31 days, p = 0.016), and, finally, a lower occurrence of 
bronchopulmonary dysplasia in survivors (7 vs. 25%, p = 0.004). Multiple 
regression analysis showed that 23-27 weeks of GA and birth weight <750 g 
increased the risk of mechanical ventilation, while a clinical risk index for 
babies (CRIB) score <3 as well as INSURE strategy and SLI treatment in the 
delivery room decreased it.
CONCLUSIONS: The application of a SLI at birth in preterm infants with 
respiratory distress may decrease the need for mechanical ventilation without 
inducing evident adverse effects.