Abstract
Background
To identify the evidence for administering positive pressure ventilation (PPV) to infants at birth by either T-piece resuscitator (TPR) or self-inflating bag (SIB), and to determine whether a full systematic review (SR) is warranted.
Methods
Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews, eligible studies included peer-reviewed human studies, prospectively or retrospectively comparing a TPR vs. SIB for administering PPV at birth. Databases searched were OVID Medline, PubMed, Embase and the Cochrane Central Register of Controlled Trials. Review Manager software was used for the data analysis.
Results
Following electronic literature search and review, data from four eligible studies (3 RCT and 1 observational study), enrolling a total of 2889 patients, were included. Studies differed regarding the investigated populations, reported outcomes and came from different geographical areas. In particular for preterm infants, use of TPR for providing PPV may improve survival, result in fewer intubations at birth and decrease the incidence of bronchopulmonary dysplasia.
Conclusions
This scoping review identified two new studies with substantive new evidence, pointing towards improved survival, decreased bronchopulmonary dysplasia and fewer intubations at birth, in particular among preterm infants treated with TPR. Full SR of the literature is advised.
Impact
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This scoping review identified studies comparing TPR vs. SIB for respiratory support of newborn infants previously not included in the International Liaison Committee on Resuscitation (ILCOR) recommendations.
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Our review found substantive new evidence highlighting that device choice may impact the outcomes of compromised newborn infants’.
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This scoping review stipulates the need for full SR and updated meta-analysis of studies investigating supportive equipment for stabilizing infants at birth in order to inform ILCOR treatment recommendations.
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Acknowledgements
We acknowledge the expert assistance of Liz Callow, Outreach Librarian for Acute General Medicine, Paediatrics, Women’s Centre, Allied Health Professionals, and Pharmacy, Bodleian Health Care Libraries, Cairns Library, John Radcliffe Hospital, Oxford OX3 9DU, UK. The authors are further grateful to the International Liaison Committee on Resuscitation (ILCOR) for commissioning, and for the assistance in coordinating, this review. None of the authors received funding for their work on the manuscript.
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C.C.R. and D.T. planned and coordinated the literature review, both independently assessed and graded the literature. D.T. performed the data analysis. C.C.R. and D.T. drafted the initial manuscript. P.G.D. and G.M.W. provided input in the data analysis and gave expert opinion on the interpretation of the findings. J.W.J. and M.H.W. led the consensus process (ILCOR), which led to the formulation of the research question and commission of the scoping review. All authors contributed to the final completion of the manuscript.
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Roehr, C.C., Davis, P.G., Weiner, G.M. et al. T-piece resuscitator or self-inflating bag during neonatal resuscitation: a scoping review. Pediatr Res 89, 760–766 (2021). https://doi.org/10.1038/s41390-020-1005-4
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DOI: https://doi.org/10.1038/s41390-020-1005-4
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