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Respiratory function monitoring to improve the outcomes following neonatal resuscitation: a systematic review and meta-analysis
  1. Sarah Marie de Medeiros1,
  2. Avneet Mangat2,
  3. Graeme R Polglase3,
  4. G Zeballos Sarrato4,
  5. Peter G Davis5,
  6. Georg M Schmölzer1,2
  1. 1 Centre for the Studies of Asphyxia and Resuscitation, Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
  2. 2 Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  3. 3 The Ritchie Centre, Monash University, Clayton, Victoria, Australia
  4. 4 Neonatology, Complutense University of Madrid, Madrid, Spain
  5. 5 Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia
  1. Correspondence to Dr Georg M Schmölzer, Royal Alexandra Hospital, Edmonton T5H 3V9, Canada; georg.schmoelzer{at}me.com

Abstract

Importance Animal and observational human studies report that delivery of excessive tidal volume (VT) at birth is associated with lung and brain injury. Using a respiratory function monitor (RFM) to guide VT delivery might reduce injury and improve outcomes.

Objective To determine whether use of an RFM in addition to clinical assessment versus clinical assessment alone during mask ventilation in the delivery room reduces in-hospital mortality and morbidity of infants <37 weeks’ gestation.

Study selection Randomised controlled trials (RCTs) comparing RFM in addition to clinical assessment versus clinical assessment alone during mask ventilation in the delivery room of infants born <37 weeks’ gestation.

Data analysis Risk of bias was assessed using Covidence Collaboration tool and pooled into a meta-analysis using a random-effects model. The primary outcome was death prior to discharge.

Main outcome Death before hospital discharge.

Results Three RCTs enrolling 443 infants were combined in a meta-analysis. The pooled analysis showed no difference in rates of death before discharge with an RFM versus no RFM, relative risk (RR) 95% (CI) 0.98 (0.64 to 1.48). The pooled analysis suggested a significant reduction for brain injury (a combination of intraventricular haemorrhage and periventricular leucomalacia) (RR 0.65 (0.48 to 0.89), p=0.006) and for intraventricular haemorrhage (RR 0.69 (0.50 to 0.96), p=0.03) in infants receiving positive pressure ventilation with an RFM versus no RFM.

Conclusion In infants <37 weeks, an RFM in addition to clinical assessment compared with clinical assessment during mask ventilation resulted in similar in-hospital mortality, significant reduction for any brain injury and intraventricular haemorrhage. Further trials are required to determine whether RFMs should be routinely available for neonatal resuscitation.

  • resuscitation
  • neonatology
  • intensive care units
  • neonatal

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Footnotes

  • Twitter @SarahDemedeir, @Gonzalo Zeballos

  • Correction notice This article has been corrected since it was first published. In the ‘Implications for clinicians’ section the authors stated that ‘our meta-analysis showed no differences in in-hospital mortality, but a significant reduction in brain injury and air leaks in infants <37 weeks during mask PPV when clinicians have access to an RFM.’ The wording ‘and air leaks’ has been removed from this sentence.

  • Contributors Conception—GMS, SMdM, AM and PGD. Data acquisition—GMS, SMdM and AM. Data analysis—GMS, SMdM, AM, GZS, GRP and PGD. Interpreting of results—GMS, SMdM, AM, GZS, GRP and PGD. Drafting of the manuscript—GMS, SMdM, AM, GZS, GRP and PGD. Critical revision of the manuscript—GMS, SMdM, AM, GZS, GRP and PGD. Final approval of the manuscript—GMS, SMdM, AM, GZS, GRP and PGD.

  • Funding GRP is supported by a National Heart Foundation of Australia and National Health and Medical Research Council (NHMRC) fellowship (1105526). GZS is supported by Spanish National Health and Health Research Institute, Gregorio Marañón General University Hospital. PGD is supported by an Australian NHMRC Practitioner Fellowship Grant (#1157782). 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.

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

  • 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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