T-piece versus self-inflating bag ventilation in preterm neonates at birth

Objective To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities. 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 leucomalada. 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% Cl 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.Univ Fed Sao Paulo, Div Neonatal Med, Sao Paulo, BrazilUniv Sao Paulo, Dept Pediat, Fac Med Ribeirao Preto, Ribeirao Preto, BrazilUniv Fed Maranhao, Dept Pediat, Sao Luis, BrazilUniv Estadual Campinas, Dept Pediat, Fac Ciencias Med, Campinas, SP, BrazilUniv Sao Paulo, Dept Pediat, Fac Med, Sao Paulo, BrazilUniv Estadual Paulista, Div Neonatol, Fac Med Botucatu, Botucatu, SP, BrazilFundacao Oswaldo Cruz, Div Neonatol, Rio De Janeiro, BrazilPontificia Univ Catolica Rio Grande do Sul, Dept Pediat, Hosp Sao Lucas, Fac Med, Porto Alegre, RS, BrazilUniv Fed Rio Grande do Sul, Div Neonatol, Hosp Clin Porto Alegre, Porto Alegre, RS, BrazilUniv Estado Rio de Janeiro, Dept Pediat, Hosp Univ Pedro Ernesto, Rio De Janeiro, BrazilUniv Fed Minas Gerais, Div Neonatol, Belo Horizonte, MG, BrazilUniv Fed Uberlandia, Pediat, Uberlandia, MG, BrazilMaternidade Hilda Brandao, Dept Pediat, Fac Ciencias Med Minas Gerais, Belo Horizonte, MG, BrazilUniv Sao Paulo, Sch Med, Dept Pediat, Sao Paulo, SP, BrazilHosp Estadual Sumare, Neonatal Div, Sumare, BrazilHosp Geral Pirajussara, Neonatal Unit, Taboao Da Serra, BrazilHosp Estadual Diadema, Neonatal Unit, Diadema, BrazilUniv Estadual Londrina, Dept Pediat, Hosp Univ, Curitiba, Parana, BrazilUniv Fed Parana, Dept Pediat, Hosp Clin, Curitiba, Parana, BrazilInst Med Integral Prof Fernando Figueira, Dept Pediat, Recife, PE, BrazilInst Fernandes Figueira FIOCRUZ, Dept Pediat, Rio De Janeiro, BrazilUniv Fed Sao Paulo, Div Neonatal Med, Sao Paulo, BrazilWeb of Scienc