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Face mask versus nasal prong or nasopharyngeal tube for neonatal resuscitation in the delivery room: a systematic review and meta-analysis
  1. Avneet Mangat1,
  2. Marlies Bruckner2,
  3. Georg M Schmölzer2,3,4
  1. 1 Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Steiermark, Austria
  3. 3 Neonatology, University of Alberta, Edmonton, Alberta, Canada
  4. 4 Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Steiermark, Austria
  1. Correspondence to Dr Georg M Schmölzer, Neonatology, University of Alberta, Edmonton, AB T6G 2R3, Canada; georg.schmoelzer{at}me.com

Abstract

Importance The current neonatal resuscitation guidelines recommend positive pressure ventilation via face mask or nasal prongs at birth. Using a nasal interface may have the potential to improve outcomes for newborn infants.

Objective To determine whether nasal prong/nasopharyngeal tube versus face mask during positive pressure ventilation of infants born <37 weeks’ gestation in the delivery room reduces in-hospital mortality and morbidity.

Data sources MEDLINE (through PubMed), Google Scholar and EMBASE, Clinical Trials.gov and the Cochrane Central Register of Controlled Trials through August 2019.

Study selection Randomised controlled trials comparing nasal prong/nasopharyngeal tube versus face mask during positive pressure ventilation of infants born <37 weeks’ gestation in the delivery room.

Data analysis Risk of bias was assessed using the Covidence Collaboration Tool, results were pooled into a meta-analysis using a random effects model.

Main outcome In-hospital mortality.

Results Five RCTs enrolling 873 infants were combined into a meta-analysis. There was no statistical difference in in-hospital mortality (risk ratio (RR 0.98, 95% CI 0.63 to 1.52, p=0.92, I2=11%), rate of chest compressions in the delivery room (RR 0.37, 95% CI 0.10 to 1.33, p=0.13, I2=28%), rate of intraventricular haemorrhage (RR 1.54, 95% CI 0.88 to 2.70, p=0.13, I2=0%) or delivery room intubations in infants ventilated with a nasal prong/tube (RR 0.63, 95% CI 0.39,1.02, p=0.06, I2=52%).

Conclusion In infants born <37 weeks’ gestation, in-hospital mortality and morbidity were similar following positive pressure ventilation during initial stabilisation with a nasal prong/tube or a face mask.

  • neonatology
  • resuscitation

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Footnotes

  • Contributors Conception: GMS, AM. Data acquisition: GMS, AM, MB. Data analysis: GMS, AM, MB. Interpreting of results: GMS, AM, MB. Drafting of the manuscript: GMS, AM, MB. Critical revision of the manuscript: GMS, AM, MB. Final approval of the manuscript: GMS, AM, MB.

  • Funding GMS is a recipient of the Heart and Stroke Foundation/University of Alberta Professorship of Neonatal Resuscitation, a National New Investigator of the Heart and Stroke Foundation Canada and an Alberta New Investigator of the Heart and Stroke Foundation Alberta.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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