PT  - JOURNAL ARTICLE
AU  - Sarah Marie de Medeiros
AU  - Avneet Mangat
AU  - Graeme R Polglase
AU  - G Zeballos Sarrato
AU  - Peter G Davis
AU  - Georg M Schmölzer
TI  - Respiratory function monitoring to improve the outcomes following neonatal resuscitation: a systematic review and meta-analysis
AID  - 10.1136/archdischild-2021-323017
DP  - 2022 Nov 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - 589--596
VI  - 107
IP  - 6
4099  - http://fn.bmj.com/content/107/6/589.short
4100  - http://fn.bmj.com/content/107/6/589.full
SO  - Arch Dis Child Fetal Neonatal Ed2022 Nov 01; 107
AB  - 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.All data relevant to the study are included in the article or uploaded as supplemental information.