Sustained lung inflations (SI) at birth may recruit functional residual capacity (FRC). Clinically, SI increase oxygenation and decrease need for intubation in preterm infants. We tested whether a SI to recruit FRC would decrease lung injury from subsequent ventilation of fetal, preterm lambs. The preterm fetus (128±1d gestation) was exteriorized from the uterus, a tracheostomy performed, and fetal lung fluid was removed. While maintaining placental circulation, fetuses were randomized to one of four 15 min interventions: 1) PEEP 8 cmH₂O (n=4), 2) 20 sec SI to 50 cmH₂O then PEEP 8 cmH₂O (n=10), 3) mechanical ventilation at V_T 7 mL/kg (n=13) or 4) 20 sec SI then ventilation at V_T 7 mL/kg (n=13). Lambs were ventilated with 95%N₂/5%CO₂ and PEEP 8 cmH₂O. Volume recruitment was measured during SI and fetal tissues were collected after an additional 30 min on placental support. SI achieved a mean FRC recruitment of 15 mL/kg (range 8 to 27). 50% of final FRC was achieved by 2 sec, 65% by 5 sec, and 90% by 15 sec, demonstrating prolonged SI times are needed to recruit FRC. SI alone released acute phase proteins into the fetal lung fluid, and increased mRNA expression of pro-inflammatory cytokines and acute phase response genes in the lung. Mechanical ventilation further increased all markers of lung injury. SI prior to ventilation, regardless of the volume of FRC recruited, did not alter the acute phase and pro-inflammatory responses to mechanical ventilation at birth.