T-piece versus self-inflating bag ventilation in preterm neonates at birth.
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Guinsburg Ruth, de Almeida Maria Fernanda Branco, de Castro Junia Sampel, Gonçalves-Ferri Walusa Assad, Marques Patricia Franco, Caldas Jamil Pedro Siqueira, Krebs Vera Lucia Jornada, Souza Rugolo Ligia Maria Suppo de, de Almeida João Henrique Carvalho Leme, Luz Jorge Hecker, Procianoy Renato S, Duarte José Luiz Muniz Bandeira, Penido Marcia Gomes, Ferreira Daniela Marques de Lima Mota, Alves Filho Navantino, Diniz Edna Maria de Albuquerque, Santos Juliana Paula, Acquesta Ana Lucia, Santos Cristina Nunes Dos, Gonzalez Maria Rafaela Conde, da Silva Regina Pg Vieira Cavalcanti, Meneses Jucile, Lopes José Maria de Andrade, Martinez Franciscó Eulógio
Аннотация
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.