PEEP resuscitation in preterm neonates, a double blinded, randomized, controlled trial comparing 5cmH2O and 8cmH2O PEEP.

The use of positive end expiratory pressure (PEEP) is a recent development in
the resuscitation of newborn neonates. PEEP creates a positive pressure in the
alveoli during exhaling, preventing the neonatal lungs from collapse.
Furthermore, neonatal lungs are fluid filled after delivery. PEEP *pushes*
fluid in intracellular cavity. Recently, a study showed that resuscitation with
a nasopharyngeal tube, controlled inflation and a consistent PIP and PEEP
should be preferred compared to conventional balloon and mask resuscitation.
Neonates needed less intubation <72 hours post partum, less mechanical
ventilation, less surfactant and developed less bronchopulmonay dysplasia
(BPD). In lamb studies, resuscitation with 8 cmH2O PEEP was significantly
superior to resuscitation with 4 cmH2O PEEP.

In this multicenter trial we compare resuscitation of preterm neonates with
either 5 cm H2O PEEP or 8 cmH2O PEEP. We think resuscitation with 8 cmH2O PEEP
results in a better outcome compared to resuscitation with 5 cmH2O PEEP.

A double-blinded, randomized controlled multicenter trial.

We compare breathing assistance or resuscitation in the neonate with either 5
cmH2O PEEP or 8 cmH2O PEEP.

The neonates in the study will not be exposed to extra tests compared to normal
neonates in the neonatal intensive care unit (NICU). Infants in the study
receive the high care of the NICU. It is not possible to perform this study on
adults as they cannot be compared to neonatal lungs which are fluid filled and
are surfactant deficient just after birth. Our hypothesis is that subjects
have a chance of receiving better resuscitation compared to infants in current
resuscitation practices. Increased PEEP could theoretically give an increased
risk of pneumothoraces. However, previous studies showed a tendency, not
significant, to less pneumothoraces.