{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:03:55Z","timestamp":1791813835150,"version":"4.3.4"},"reference-count":35,"publisher":"BMJ","issue":"6","funder":[{"name":"The Lung Association, Canada"},{"DOI":"10.13039\/501100000190","name":"University of Alberta","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000190","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child Fetal Neonatal Ed"],"accepted":{"date-parts":[[2017,3,26]]},"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>A sustained inflation (SI) provided at birth might reduce bronchopulmonary dysplasia (BPD).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This study aims to examine whether an SI-guided exhaled carbon dioxide (ECO<jats:sub>2<\/jats:sub>) compared with positive pressure ventilation (PPV) alone at birth decreases BPD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Randomised controlled trial. Infants were randomly allocated to either SI (SI group) or PPV (PPV group).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Participants of this study include infants between 23<jats:sup>+0<\/jats:sup> and 32<jats:sup>+6<\/jats:sup> weeks gestation with a need for PPV at birth.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention<\/jats:title>\n                  <jats:p>Infants randomised into the SI group received an initial SI with a peak inflation pressure (PIP) of 24 cmH<jats:sub>2<\/jats:sub>O over 20\u2009s. The second SI was guided by the amount of ECO<jats:sub>2<\/jats:sub>. If ECO<jats:sub>2<\/jats:sub> was \u226420\u2009mm Hg, a further SI of 20\u2009s was delivered. If ECO<jats:sub>2<\/jats:sub> was &gt;20\u2009mm Hg the second SI was 10\u2009s. Infants randomised into the PPV group received mask PPV with an initial PIP of 24 cmH<jats:sub>2<\/jats:sub>O.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary outcomes<\/jats:title>\n                  <jats:p>Reduction in BPD defined as the need for respiratory support or supplemental oxygen at corrected gestational age of 36 weeks.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>SI (n=76) and PPV (n=86) group had similar rates of BPD (23% vs 33%, p=0.090, not statistically significant). The duration of mechanical ventilation was significantly reduced with SI versus PPV (63 (10\u2013246) hours versus 204 (17\u2013562) hours, respectively (p=0.045)). No short-term harmful effects were identified from two SI lasting up to 40\u2009s (eg, pneumothorax, intraventricular haemorrhage or patent ductus arteriosus).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Preterm infants &lt;33 weeks gestation receiving SI at birth had lower duration of mechanical ventilation and similar incidence of BPD compared with PPV. Using ECO<jats:sub>2<\/jats:sub> to guide length of SI is feasible.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>NCT01739114; Results.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/archdischild-2016-312286","type":"journal-article","created":{"date-parts":[[2017,6,8]],"date-time":"2017-06-08T21:00:28Z","timestamp":1496955628000},"page":"F525-F531","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":31,"title":["Using exhaled CO<sub>2<\/sub> to guide initial respiratory support at birth: a randomised controlled trial"],"prefix":"10.1136","volume":"102","clinical-trial-number":[{"clinical-trial-number":"nct01739114","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Ashley Y","family":"Ngan","sequence":"first","affiliation":[{"name":"Centre for the Study of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Yin","family":"Cheung","sequence":"additional","affiliation":[{"name":"Centre for the Study of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada"},{"name":"Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Hudson-Mason","sequence":"additional","affiliation":[{"name":"Centre for the Study of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"O\u2019Reilly","sequence":"additional","affiliation":[{"name":"Centre for the Study of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada"},{"name":"Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"van Os","sequence":"additional","affiliation":[{"name":"Centre for the Study of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Kumar","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Aziz","sequence":"additional","affiliation":[{"name":"Centre for the Study of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada"},{"name":"Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9798-2415","authenticated-orcid":false,"given":"Georg M","family":"Schm\u00f6lzer","sequence":"additional","affiliation":[{"name":"Centre for the Study of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada"},{"name":"Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,6,8]]},"reference":[{"key":"2025090513295218000_102.6.F525.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000276"},{"key":"2025090513295218000_102.6.F525.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2008.08.016"},{"key":"2025090513295218000_102.6.F525.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra067279"},{"key":"2025090513295218000_102.6.F525.4","doi-asserted-by":"crossref","first-page":"e531","DOI":"10.1542\/neo.7-10-e531","article-title":"The New BPD","volume":"7","author":"Jobe","year":"2006","journal-title":"Neoreviews"},{"key":"2025090513295218000_102.6.F525.5","doi-asserted-by":"publisher","DOI":"10.1203\/PDR.0b013e3181b1bca4"},{"key":"2025090513295218000_102.6.F525.6","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.91591.2008"},{"key":"2025090513295218000_102.6.F525.7","doi-asserted-by":"publisher","DOI":"10.1542\/peds.103.5.961"},{"key":"2025090513295218000_102.6.F525.8","doi-asserted-by":"publisher","DOI":"10.1159\/000298312"},{"key":"2025090513295218000_102.6.F525.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2014.12.002"},{"key":"2025090513295218000_102.6.F525.10","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-1692"},{"key":"2025090513295218000_102.6.F525.11","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-0114"},{"key":"2025090513295218000_102.6.F525.12","doi-asserted-by":"crossref","unstructured":"O\u2019Donnell CP , Bruschettini M , Davis PG , et al . 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