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T-piece resuscitator and Self-inflating Bag

Question Type:
Intervention
Full Question:
Newborns receiving ventilation (PPV) during resuscitation
 (P), does using a T-piece resuscitator or a self-inflating bag with PEEP
 (I), compared with using a self-inflating bag without PEEP
 (C), change survival to hospital discharge, air leak, development of stable spontaneous breathing, Bronchopulmonary dysplasia (O)?
Consensus on Science:
For the following consensus on science statements, the analysis is based on all patients (n=80) from 1 study (Dawson 2011, 912) and from a subgroup analysis (n=453) in a second study.(Szyld 2014, 234)For the critical outcome of death before discharge, we identified low-quality evidence (downgraded for risk of bias and imprecision) from 2 randomized clinical trials (Dawson 2011, 912; Szyld 2014, 234) enrolling 532 patients showing no benefit to the use of a T-piece resuscitator as compared with a self-inflating bag (OR, 0.68; 95% CI, 0.31–1.56). For the critical outcome of bronchopulmonary dysplasia, which was only assessed for infants of less than 1500 g, we identified low-quality evidence (downgraded for risk of bias and imprecision) from 2 randomized clinical trials (Dawson 2011, 912; Szyld 2014, 234) enrolling 151 patients showing no benefit to the use T-piece resuscitator as compared with self-inflating bag (OR, 0.92; 95% CI, 0.59–1.43).For the critical outcome of air leaks, we identified low-quality evidence (downgraded for risk of bias and imprecision) from 2 randomized controlled trials(Dawson 2011, 912; Szyld 2014, 234) enrolling 532 patients showing no benefit to the use of T-piece resuscitator as compared with self-inflating bag (OR, 1.72; 95% CI, 0.51–5.78). For the important outcome of achieving spontaneous breathing or reducing intubation in delivery room, we identified very-low-quality evidence (downgraded for risk of bias, imprecision, and inconsistency) from 2 randomized clinical trials(Dawson 2011, 912; Szyld 2014, 234) enrolling 532 patients showing no benefit to the use of T-piece resuscitator as compared with self-inflating bag (OR, 0.80; 95% CI, 0.59–1.07).
Treatment Recommendation:
There is insufficient evidence, so the recommendation of one device over another would be purely speculative because the confidence in effect estimates is so low.Values, Preferences, and Task Force InsightsThe current studies suggest a benefit to using PEEP to assist establishment of an FRC during transition of the fluid-filled lung to an air-breathing organ. However, the evidence to date is not sufficiently compelling to recommend against using a self-inflating bag (in which reliable administration of PEEP is not achievable with current devices) during neonatal resuscitation, particularly in regions where pressurized gases are not readily available. PEEP is recommended when the facilities and equipment permit it to be given reliably (approximately 5 cm H2O).
CoSTR Attachments:
c2015_worksheet_NRP870_F_n.docx    
ILCORc2015_NRP870_GradeGridform)_F_n.docx    

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