Outcomes of preterm infants stabilized with flow-inflating bag or T-piece resuscitator at birth-a Canadian neonatal network cohort study.

Abstract

Background: To compare the outcomes of premature infants stabilized in the delivery room using either the T-piece resuscitator (TPR) or flow-inflating bag (FIB).

Design/methods: Data from five participating level III NICUs within the Canadian Neonatal Network were reviewed. Infants born between 24⁺⁰ and 29⁺⁶ weeks' gestational age (GA) from January 1, 2018, to December 31, 2022, receiving mask ventilation in the delivery room were included. Infants who were outborn or had major congenital abnormalities were excluded. The primary composite outcome was death or bronchopulmonary dysplasia (BPD) or severe neurologic injury (intraventricular hemorrhage grade III-IV or periventricular leukomalacia). Logistic regression models adjusted for potential confounders were used to estimate odds ratios with 95% CI for the association with exposure.

Results: Of the 2007 infants admitted to participating sites, 426 were excluded, leaving 1581 who met the inclusion criteria. The primary outcome occurred in 367/745 (49%) infants with the FIB and in 438/836 (52%) infants with the TPR (adjusted OR = 0.87; 95% CI 0.44 to 1.71). There was no association between TPR or FIB with the individual components of the composite outcome (death, BPD, and severe neurological injury).

Conclusions: There were no significant differences in the outcomes of preterm infants stabilized in the delivery room with TPR compared to FIB.

Impact: No significant difference in the composite outcome (death, bronchopulmonary dysplasia (BPD), and severe neurological injury) between a flow-inflating bag (FIB) or a T-piece resuscitator (TPR) for respiratory support at birth. Large real-world analyses comparing TPR and FIB in clinical settings. Respiratory support with either device resulted in no statistically different key clinical outcomes. There was no impact on mechanical ventilation or major morbidities with either device. This emphasizes the importance of provider experience and consistent device use over the choice of resuscitation device.