SLI MANEUVER and RESPIRATORY MORBIDITIES

Study Overview
=================
Brief Summary
-----------------
Purpose: The investigators hypothesis is that, as compared to the only nCPAP-applied group, application of SLI maneuver followed by respiratory support with nCPAP immediately afterwards in preterm infants at high risk for RDS would reduce the need for intubation and mechanical ventilation in early period and ultimately will improve respiratory outcomes.

Detailed Description
-----------------
Primary Outcome Measures: Surfactant need, intubation and mechanical ventilation needs within the first 72 hours of life in SLI (Sustained Lung Inflation) maneuver-applied preterm infants and non-SLI-applied preterm infants. Secondary Outcome Measures: Heart rate, fractional inspiratory oxygen, CPAP pressure and oxygen saturation within the first 72 hours of life in preterm infants Total non-invasive, invasive respiratory support time The presence of and the degree of BPD (Bronchopulmonary dysplasia) Premature morbidities such as PDA (patent ductus arteriosus), IVH (intraventricular hemorrhage), NEC (necrotizing enterocolitis), ROP (retinopathy of prematurity) Feeding intolerance, reaching birth weight and transition to full oral feeding time Study Design Randomization Group 1: Group that received SLI maneuver immediately after birth followed by nCPAP. Group 2: Group that received nCPAP after birth. Following the oral and nasal aspirates, SLI at 25 cm H2O pressure will be applied for 15 seconds by using t-piece refreshing and binasal prongs and 5-cm nCPAP at H2O pressure will be applied. Patients will be observed for 5-10 seconds in terms of cardiorespiratory functions following SLI maneuver. If respiratory failure continues during nCPAP (such as apnea, gasping) and/or heart rate is > 60 / min but < 100 / min , SLI maneuver will be repeated at the same pressure for the same time period. If heart rate > 60 / min but <100 / min persists after the second SLI maneuver, resuscitation will be applied in line with the guidelines of American Academy of Pediatrics. The control group of infants will receive nCPAP support at 5 cm H2O pressure and be supported in line with the guidelines of American Academy of Pediatrics.

Official Title
-----------------
THE EFFECT OF SUSTAINED LUNG INFLATION MANEUVER APPLIED THROUGH NASAL PRONG ON EARLY AND LATE RESPIRATORY MORBIDITIES IN PRETERM INFANTS

Conditions
-----------------
Respiratory Distress Syndrome

Intervention / Treatment
-----------------
* Device: Neopuff; Fisher and Paykel, Auckland, New Zealand


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Preterm infant with gestational age of 26 weeks 0 days and 29 weeks 6 days will be included. Exclusion Criteria: Presence of major congenital anomaly, Patients with hydrops fetalis and pulmonary hypoplasia Consent not provided or refused

Ages Eligible for Study
-----------------
Maximum Age: 3 Minutes

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: group 1<br>SLI group In this group the preterm infants will receive sustained lung inflation (SLI) via short binasal prongs in the delivery room. | Device: Neopuff; Fisher and Paykel, Auckland, New Zealand<br>* Following the oral and nasal aspirates, SLI at 25 cm H2O pressure will be applied for 15 seconds by using t-piece refreshing and binasal prongs and 5-cm nCPAP at H2O pressure will be applied.<br>* Other names: SUSTAINED LUNG INFLATION MANEUVER;|
| Placebo Comparator: group 2<br>Preterm infants will be assisted in the delivery room without sustained lung inflation. | Device: Neopuff; Fisher and Paykel, Auckland, New Zealand<br>* Following the oral and nasal aspirates, SLI at 25 cm H2O pressure will be applied for 15 seconds by using t-piece refreshing and binasal prongs and 5-cm nCPAP at H2O pressure will be applied.<br>* Other names: SUSTAINED LUNG INFLATION MANEUVER;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mechanical ventilation requirement | Surfactant requirement, intubation and mechanical ventilation needs within the first 72 hours of life in SLI (Sustained Lung Inflation) maneuver-applied preterm infants and non-SLI-applied preterm infants. | 72 hours |