TY - JOUR
T1 - Devices for administering ventilation at birth
T2 - A systematic review
AU - International Liaison Committee on Resuscitation Neonatal Life Support Task Force
AU - Trevisanuto, Daniele
AU - Roehr, Charles Christoph
AU - Davis, Peter G.
AU - Schmölzer, Georg M.
AU - Wyckoff, Myra Helen
AU - Liley, Helen G.
AU - Rabi, Yacov
AU - Weiner, Gary Marshall
AU - de Almeida, Maria Fernanda
AU - El-Naggar, Walid
AU - Fabres, Jorge
AU - Fawke, Joe
AU - Foglia, Elizabeth
AU - Guinsburg, Ruth
AU - Hosono, Shigeharu
AU - Isayama, Tetsuya
AU - Kapadia, Vishal S.
AU - Kawakami, Mandira
AU - Kim, Han Suk
AU - McKinlay, Chris
AU - Perlman, Jeffrey
AU - Sugiura, Takahiro
AU - Wyllie, Jonathan
N1 - Publisher Copyright:
Copyright © 2021 by the American Academy of Pediatrics
PY - 2021/7/1
Y1 - 2021/7/1
N2 - CONTEXT: Positive pressure ventilation (PPV) is the most important intervention during neonatal resuscitation. OBJECTIVE: To compare T-piece resuscitators (TPRs), self-inflating bags (SIBs), and flow-inflating bags for newborns receiving PPV during delivery room resuscitation. DATA SOURCES: Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, and trial registries (inception to December 2020). STUDY SELECTION: Randomized, quasi-randomized, interrupted time series, controlled before-and-after, and cohort studies were included without language restrictions. DATA EXTRACTION: Two researchers independently extracted data, assessed the risk of bias, and evaluated the certainty of evidence. The primary outcome was in-hospital mortality. When appropriate, data were pooled by using fixed-effect models. RESULTS: Meta-analysis of 4 randomized controlled trials (1247 patients) revealed no significant difference between TPR and SIB for in-hospital mortality (risk ratio 0.74; 95% confidence interval [CI] 0.40 to 1.34). Resuscitation with a TPR resulted in a shorter duration of PPV (mean difference - 19.8 seconds; 95% CI - 27.7 to - 12.0 seconds) and lower risk of bronchopulmonary dysplasia (risk ratio 0.64; 95% CI 0.43 to 0.95; number needed to treat 32). No differences in clinically relevant outcomes were found in 2 randomized controlled trials used to compare SIBs with and without positive end-expiratory pressure valves. No studies used to evaluate flow-inflating bags were found. LIMITATIONS: Certainty of evidence was very low or low for most outcomes. CONCLUSIONS: Resuscitation with a TPR compared with an SIB reduces the duration of PPV and risk of bronchopulmonary dysplasia. A strong recommendation cannot be made because of the low certainty of evidence. There is insufficient evidence to determine the effectiveness of positive end-expiratory pressure valves when used with SIBs.
AB - CONTEXT: Positive pressure ventilation (PPV) is the most important intervention during neonatal resuscitation. OBJECTIVE: To compare T-piece resuscitators (TPRs), self-inflating bags (SIBs), and flow-inflating bags for newborns receiving PPV during delivery room resuscitation. DATA SOURCES: Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, and trial registries (inception to December 2020). STUDY SELECTION: Randomized, quasi-randomized, interrupted time series, controlled before-and-after, and cohort studies were included without language restrictions. DATA EXTRACTION: Two researchers independently extracted data, assessed the risk of bias, and evaluated the certainty of evidence. The primary outcome was in-hospital mortality. When appropriate, data were pooled by using fixed-effect models. RESULTS: Meta-analysis of 4 randomized controlled trials (1247 patients) revealed no significant difference between TPR and SIB for in-hospital mortality (risk ratio 0.74; 95% confidence interval [CI] 0.40 to 1.34). Resuscitation with a TPR resulted in a shorter duration of PPV (mean difference - 19.8 seconds; 95% CI - 27.7 to - 12.0 seconds) and lower risk of bronchopulmonary dysplasia (risk ratio 0.64; 95% CI 0.43 to 0.95; number needed to treat 32). No differences in clinically relevant outcomes were found in 2 randomized controlled trials used to compare SIBs with and without positive end-expiratory pressure valves. No studies used to evaluate flow-inflating bags were found. LIMITATIONS: Certainty of evidence was very low or low for most outcomes. CONCLUSIONS: Resuscitation with a TPR compared with an SIB reduces the duration of PPV and risk of bronchopulmonary dysplasia. A strong recommendation cannot be made because of the low certainty of evidence. There is insufficient evidence to determine the effectiveness of positive end-expiratory pressure valves when used with SIBs.
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U2 - 10.1542/peds.2021-050174
DO - 10.1542/peds.2021-050174
M3 - Review article
C2 - 34135096
AN - SCOPUS:85109131048
SN - 0031-4005
VL - 148
JO - Pediatrics
JF - Pediatrics
IS - 1
M1 - e2021050174
ER -