Ventilation devices for neonatal resuscitation at birth: A systematic review and meta-analysis

Initial management of inadequate adaptation to extrauterine life relies on non-invasive respiratory support. Two types of devices are avail-able: fixed pressure devices (FPD; T-pieces or ventilators) and hand driven pressure devices (HDPD; self-or flow-inflating bags). This systematic review and meta-analysis aims to compare clinical outcomes after neonatal resuscitation according to device type. Methods: Four databases were searched from inception to 2022, January. Search strategies included Mesh/Emtree terms as well as free language without any restriction. Randomized, quasi-randomized studies and prospective cohorts comparing the use of the two types of devices in neonatal resuscitation were included. Results: Nine studies recruiting 3621 newborns were included: 5 RCTs, 2 RCTs with interventions bundles and 2 prospective cohorts. Meta -analysis of the 5 RCTs demonstrated significant reductions in bronchopulmonary dysplasia (RR0,68[0,48-0,96]-NNT 31) and other respiratory out-comes: intubation in the delivery room (RR0,72[0,58-0,88]-NNT 13,4), mechanical ventilation requirements (RR0,81[0,67-0,96]-NNT 17) and dura-tion (MD-1,54 days[-3,03--0,05]),need for surfactant (RR0,79[0,64-0,96]-NNT 7,3). The overall analysis found a lower mortality in the FPD group (OR0,57[0,47-0,69]-NNT 12,7) and confirmed decreases in intubation, surfactant requirement and mechanical ventilation rates (OR 0,56[0,40-0,79]-NNT7,5; OR 0,67[0,55-0,82]-NNT10,7 and OR0,58[0,42-0,80]-NNT 7,4 respec-tively). The risk of cystic periventricular leukomalacia (cPVL) decreased significantly with FPD (OR0.59[0.41-0.85]-NNT 27). Pneumothorax rates were similar (OR0.82[0.44-1.52]).Conclusion and relevance: Resuscitation at birth with FPD improves respiratory transition and decreases BPD with a very low to moderate cer-tainty of evidence. There is suggestion of decreases in mortality and cPVL. Further studies are still needed to confirm those results.