Abstract
Background
To compare the outcomes of premature infants stabilized in the delivery room using either the T-piece resuscitator (TPR) or flow-inflating bag (FIB).
Design/methods
Data from five participating level III NICUs within the Canadian Neonatal Network were reviewed. Infants born between 24+0 and 29+6 weeks’ gestational age (GA) from January 1, 2018, to December 31, 2022, receiving mask ventilation in the delivery room were included. Infants who were outborn or had major congenital abnormalities were excluded. The primary composite outcome was death or bronchopulmonary dysplasia (BPD) or severe neurologic injury (intraventricular hemorrhage grade III–IV or periventricular leukomalacia). Logistic regression models adjusted for potential confounders were used to estimate odds ratios with 95% CI for the association with exposure.
Results
Of the 2007 infants admitted to participating sites, 426 were excluded, leaving 1581 who met the inclusion criteria. The primary outcome occurred in 367/745 (49%) infants with the FIB and in 438/836 (52%) infants with the TPR (adjusted OR = 0.87; 95% CI 0.44 to 1.71). There was no association between TPR or FIB with the individual components of the composite outcome (death, BPD, and severe neurological injury).
Conclusions
There were no significant differences in the outcomes of preterm infants stabilized in the delivery room with TPR compared to FIB.
Impact
-
No significant difference in the composite outcome (death, bronchopulmonary dysplasia (BPD), and severe neurological injury) between a flow-inflating bag (FIB) or a T-piece resuscitator (TPR) for respiratory support at birth.
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Large real-world analyses comparing TPR and FIB in clinical settings.
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Respiratory support with either device resulted in no statistically different key clinical outcomes.
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There was no impact on mechanical ventilation or major morbidities with either device.
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This emphasizes the importance of provider experience and consistent device use over the choice of resuscitation device.
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Acknowledgements
The authors gratefully acknowledge all site investigators and abstractors of the Canadian Neonatal Network (CNN) including Carlos Fajardo (Alberta Children’s Hospital, Calgary), Jonathan Wong (British Columbia Women’s Hospital, Vancouver), Andrzej Kajetanowicz (Cape Breton Regional Hospital, Sydney), Bruno Piedboeuf and Christine Drolet (Centre Hospitalier Universitaire de Quebec, Sainte Foy), Valerie Bertelle and Edith Masse (Centre Hospitalier Universitaire de Sherbrooke, Fleurimont), Anie Lapointe, Guillaume Ethier, and Keith Barrington (Centre Hospitalier Universitaire Sainte-Justine, Montreal), Brigitte Lemyre (Children’s Hospital of Eastern Ontario, Ottawa), Hala Makary (Dr. Everett Chalmers Hospital, Fredericton), Ayman Abou Mehrem (Foothills Medical Centre, Calgary), Amit Mukerji (Hamilton Health Sciences Centre, Hamilton), Molly Seshia and Deepak Louis (Health Sciences Centre, Winnipeg), Kyong-Soon Lee (Hospital for Sick Children, Toronto), Jehier Afifi (Izzak Walton Killam (IWK) Health Centre, Halifax), Jo-Anna Hudson (Janeway Children’s Health and Rehabilitation Centre, St. Johns), Victoria Bizgu (Jewish General Hospital, Montreal), Faiza Khurshid (Kingston Health Sciences Centre, Kingston), Orlando da Silva (London Health Sciences Centre, London), Marie St-Hilaire (Maisonneuve-Rosemont Hospital, Montreal), Martine Claveau and Marc Beltempo (McGill University Health Centre, Montreal), Jaya Bodani (Regina General Hospital, Regina), Jennifer Toye and Joseph Ting (Royal Alexandra Hospital & University of Alberta Hospital, Edmonton), Miroslav Stavel (Royal Columbian Hospital, New Westminster), Lannae Strueby (Royal University Hospital / Jim Pattison Children’s Hospital, Saskatoon), Cecil Ojah and Alana Newman (Saint John Regional Hospital, St. John), Ruben Alvaro and Ann Yi (St. Boniface General Hospital, Winnipeg), Eugene Ng (Sunnybrook Health Sciences Centre, Toronto), Rebecca Sherlock (Surrey Memorial Hospital, Surrey), Caio Barbosa de Oliveira (The Moncton Hospital, Moncton), Brigitte Lemyre (The Ottawa Hospital, Ottawa), Jaideep Kanungo (Victoria General Hospital, Victoria), Sajit Augustine (Windsor Regional Hospital, Windsor), and Prakesh Shah (Mount Sinai Hospital, Toronto) for their valuable contributions as CNN investigators.
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The project described in this manuscript was conducted with no specific financial support. No honorarium, grant, or other form of payment was given to anyone to produce this manuscript.
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Conception and design: G.M.S., M.B., J.T., A.S. Collection and assembly of data: G.M.S., J.T., E.N., A.S., R.A., M.B., J.T., Analysis and interpretation of the data: G.M.S., M.S., J.T., E.N., A.S., R.A., M.B., J.T., Drafting of the 1st draft: M.S., Critical revision of the article for important intellectual content: G.M.S., M.S., J.T., E.N., A.S., R.A., M.B., J.T., Final approval of the article: G.M.S., M.S., J.T., E.N., A.S., R.A., M.B., J.T.
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Shaker, M., Toye, J., Ng, E. et al. Outcomes of preterm infants stabilized with flow-inflating bag or T-piece resuscitator at birth—a Canadian neonatal network cohort study. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04467-2
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DOI: https://doi.org/10.1038/s41390-025-04467-2
