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Lung mechanics and aeration were measured throughout. After an additional 30\u2009minutes of apneic placental support, lung tissue and bronchoalveolar fluid were analyzed for regional lung injury, including proteomics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>The 30\u2009cm H2O \u0394P and dynamic PEEP strategies resulted in quicker aeration and better compliance but higher tidal volumes (often &amp;gt;8\u2009ml\/kg, all P\u2009&amp;lt;\u20090.0001; mixed effects) and injury. \u0394P 20\u2009cm H2O with dynamic PEEP resulted in the same lung mechanics and aeration, but less energy transmission (tidal mechanical power), as \u0394P 30\u2009cm H2O with low PEEP. Dynamic PEEP without any tidal inflations resulted in the least lung injury. Use of any tidal inflating pressures altered metabolic, coagulation and complement protein pathways within the lung.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Inflating pressure is essential for the preterm lung at birth, but it is also the primary mediator of lung injury. Greater focus is needed on strategies that identify the safest application of pressure in the delivery room.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202301-0104oc","type":"journal-article","created":{"date-parts":[[2023,6,5]],"date-time":"2023-06-05T17:32:12Z","timestamp":1685986332000},"page":"589-599","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":22,"title":["Inflating Pressure and Not Expiratory Pressure Initiates Lung Injury at Birth in Preterm Lambs"],"prefix":"10.1093","volume":"208","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1522-4691","authenticated-orcid":false,"given":"David G.","family":"Tingay","sequence":"first","affiliation":[{"name":"Neonatal Research and"},{"name":"Translational Research Unit, Murdoch Children\u2019s Research Institute, Parkville, Victoria, Australia"},{"name":"Department of Paediatrics 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