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T-piece versus self-inflating bag ventilation in preterm neonates at birth
  1. Ruth Guinsburg1,
  2. Maria Fernanda Branco de Almeida1,
  3. Junia Sampel de Castro1,
  4. Walusa Assad Gonçalves-Ferri2,
  5. Patricia Franco Marques3,
  6. Jamil Pedro Siqueira Caldas4,
  7. Vera Lucia Jornada Krebs5,
  8. Ligia Maria Suppo de Souza Rugolo6,
  9. João Henrique Carvalho Leme de Almeida7,
  10. Jorge Hecker Luz8,
  11. Renato S Procianoy9,
  12. José Luiz Muniz Bandeira Duarte10,
  13. Marcia Gomes Penido11,
  14. Daniela Marques de Lima Mota Ferreira12,
  15. Navantino Alves Filho13,
  16. Edna Maria de Albuquerque Diniz14,
  17. Juliana Paula Santos15,
  18. Ana Lucia Acquesta16,
  19. Cristina Nunes dos Santos17,
  20. Maria Rafaela Conde Gonzalez18,
  21. Regina PG Vieira Cavalcanti da Silva19,
  22. Jucile Meneses20,
  23. José Maria de Andrade Lopes21,
  24. Franciscó Eulógio Martinez2
  1. 1 Division of Neonatal Medicine, Federal University of São Paulo, São Paulo, Brazil
  2. 2 Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
  3. 3 Department of Pediatrics, Universidade Federal do Maranhão, São Luis, Brazil
  4. 4 Department of Pediatrics, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, Brazil
  5. 5 Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  6. 6 Division of Neonatology, Faculdade de Medicinade Botucatu da Universidade Estadual Paulista, Botucatu, Brazil
  7. 7 Division of Neonatology, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
  8. 8 Department of Pediatrics, Hospital São Lucas – Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
  9. 9 Division of Neonatology, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
  10. 10 Department of Pediatrics, Hospital Universitário Pedro Ernesto – Universidade do Estado de Rio de Janeiro, Rio de Janeiro, Brazil
  11. 11 Division of Neonatology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  12. 12 Pediatrics, Universidade Federal de Uberlandia, Uberlandia, Brazil
  13. 13 Department of Pediatrics, Maternidade Hilda Brandão – Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
  14. 14 Department of Pediatrics, University of São Paulo, School of Medicine, SP – Brasil, São Paulo, Brazil
  15. 15 Neonatal Division, Hospital Estadual Sumaré, Sumaré, Brazil
  16. 16 Neonatal Unit, Hospital Geral de Pirajussara, Taboão da Serra, Brazil
  17. 17 Neonatal Unit, Hospital Estadual de Diadema, Diadema, Brazil
  18. 18 Department of Pediatrics, Hospital Universitário – Universidade Estadual de Londrina, Curitiba, Brazil
  19. 19 Department of Pediatrics, Hospital de Clínicas – Universidade Federal do Paraná, Curitiba, Brazil
  20. 20 Department of Pediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
  21. 21 Department of Pediatrics, Instituto Fernandes Figueira – FIOCRUZ, Rio de Janeiro, Brazil
  1. Correspondence to Dr Ruth Guinsburg, Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo CEP 01410-020, Brazil; ruthgbr{at}, ruth.guinsburg{at}


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 transferred 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.

  • preterm newborn infant
  • very low birthweight newborn infant
  • neonatal resuscitation
  • delivery room
  • self-inflating bag
  • T-piece resuscitator

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  • Contributors RG and MFBdA have participated in the concept and design, analysis and interpretation of data, and drafting and revising the manuscript. All other authors have participated in the design of the study, collection and interpretation of data and revising the manuscript. All authors listed on the manuscript approved the submission of this version of the manuscript and take full responsibility for the manuscript.

  • Competing interests None declared.

  • Patient consent This is a prospective collection of data of all very low birth weight neonates born in 20 Brazilian public hospitals and affiliated to the Brazilian Network on Neonatal Research. There are no interventions and the present study used this database. The IRB approved the use of this registry for the present study.

  • Ethics approval Committee on Ethics in Research of Instituto Fernandes Figueira – Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data from the submitted study. The database is available, upon request, from the main authors (RG and MFBdA).

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

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