T-piece versus self-inflating bag ventilation in preterm neonates at birth
Ruth Guinsburg, Maria Fernanda Branco de Almeida, Junia Sampel de Castro, Walusa Assad Gonçalves-Ferri, Patricia Franco Marques, Jamil Pedro Siqueira Caldas, Vera Lucia Jornada Krebs, Ligia Maria Suppo de Souza Rugolo, João Henrique Carvalho Leme de Almeida, Jorge Hecker Luz, Renato S Procianoy, José Luiz Muniz Bandeira Duarte
(+12 others)
2017
Archives of Disease in Childhood: Fetal and Neonatal Edition
Objective To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities. Design Pragmatic prospective cohort study. Setting 20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014-2015 ventilated at birth with 23-33' weeks gestation and birth weight 400-1499 g without malformations. Patients
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... d until the 27th day after birth were excluded. Interventions Positive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist's discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalacia. Logistic regression adjusted for confounding variables was applied for main outcome. Results 1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 ± 277 vs 941 ± 279 g, gestational age 28.2±2.5 vs 27.8±2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%. Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% CI 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695). Conclusion This study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates. InTRODuCTIOn Most newborn infants with gestational age <34 weeks need positive pressure ventilation during cardiorespiratory transition at birth. Among 5857 very low birth weight infants (VLBW) with gestational age of 23-33 weeks without malformations born in 2012-2015 in 20 public Brazilian university hospitals, 64% received positive pressure ventilation with facial mask or endotracheal tube in the delivery room. 1 A study of the NICHD Neonatal Research Network, with data from 9565 newborns with gestational age less than 29 weeks born between 2003 and 2007, showed that 67% received positive pressure ventilation at birth. 2 The respiratory transition at birth consists of three distinct phases that overlap in the first minutes of life: in the first, the airways are full of liquid, and respiratory support aims at lung fluid clearance; in the second phase, lung fluid is still in the interstitial space and can return to the airways if the lung is not expanded; and in the last phase, the issues related to lung fluid are not as relevant, and those linked to What this study adds? ► In preterm neonates (23-33 weeks' gestation) without malformations who received ventilation at birth, use of T-piece resuscitator was associated with increased survival without major morbidities.
doi:10.1136/archdischild-2016-312360
pmid:28663283
fatcat:lpgzd7wwvncdxdyb72wovjl7fu
