Interfaces for non-invasive neonatal resuscitation in the delivery room: A systematic review and meta-analysis

Objective: To perform a systematic review of trials comparing interfaces for delivering non-invasive PPV to a newborn in the delivery room (DR).

Methods: MEDLINE, PUBMED, EMBASE, CINAHL and COCHRANE databases were searched on March 1, 2020 and 2826 articles were screened. The review was conducted using the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary outcomes were intubation in the DR and mortality. Secondary outcomes were chest compressions, intraventricular haemorrhage (IVH), necrotising enterocolitis (NEC) and mask leak.

Results: Five randomized-control trials were eligible for inclusion. Sample size and gestational age varied amongst the trials, ranging from 56 to 617 infants and 24-39 weeks' respectively. Three trials compared nasal cannulae (NC) with face masks (FMs). Pooled analysis showed that NC were associated with a decreased use of chest compressions (RR 0.2 (95% CI 0.08-0.47). A reduction in rate of intubation in the DR was statistically significant only in the trial in which bi-nasal rather than single nasal cannulae were used (RR 0.10, 95% CI 0.02-0.44). However, there was no important difference in mortality (RR 0.72, 95% CI 0.47-1.13). Two trials compared different FM models (Laerdal versus Fisher & Paykel and Laerdal versus Resusi-sure) and both found no significant difference in primary and secondary outcomes.

Conclusion: There is little high-quality evidence to guide clinicians choosing an interface to provide PPV during newborn resuscitation. Nasal interfaces, particularly binasal cannulae, appear to offer some advantages over FMs but need further testing in larger, well designed trials.

Study registration: PROSPERO CRD42020151870.