title: Supraglottic airway devices during neonatal resuscitation: an historical perspective, systematic review and meta-analysis of available clinical trials.
abstract: BACKGROUND
  Various supraglottic airway devices are routinely used to maintain airway patency in children and adults. However, oropharyngeal airways or laryngeal masks (LM) are not routinely used during neonatal resuscitation.
  
  
  METHODS
  The aim of this article was to review the available literature about the use of supraglottic airway devices during neonatal resuscitation. We reviewed books, resuscitation manuals and articles from 1830 to the present using the search terms "Infant", "Newborn", "Delivery Room", "Resuscitation", "Airway management", "Positive Pressure Respiration", "Oropharyngeal Airway" and "Laryngeal Mask".
  
  
  RESULTS
  No study was identified using oropharyngeal airways during neonatal resuscitation. Four trials including 509 infants compared positive pressure ventilation with a LM, bag and mask or an endotracheal tube. Infants in the LM group were intubated less frequently compared to infants in the bag and mask ventilation group 4/275 vs. 28/234 (OR 0.13, 95% CI 0.05-0.34). Infants resuscitated with the LM had significantly less unsuccessful resuscitations 4/275 vs. 31/234 (OR 0.10, 95% CI 0.03-0.28). Two trials including 34 preterm infants compared surfactant administration via LM vs. endotracheal tube. LM surfactant administration was safe and no adverse events were reported.
  
  
  CONCLUSIONS
  The efficacy and safety of oropharyngeal airways during neonatal resuscitation remain unclear and randomized trials are required. The current evidence suggests that resuscitation with a LM is a feasible and safe alternative to mask ventilation in infants >34 weeks gestation and birth weight >2000 g. However, further randomized control trials are needed to evaluate short- and long-term outcomes following use of laryngeal masks. In addition, surfactant administration via LM should be used only within clinical trials.
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Canada. georg.schmoelzer@me.com
authors.forename: Georg M
authors.initials: GM
authors.lastname: Schmölzer
authors.forename: Manish
authors.initials: M
authors.lastname: Agarwal
authors.forename: C Omar F
authors.initials: CO
authors.lastname: Kamlin
authors.forename: Peter G
authors.initials: PG
authors.lastname: Davis
mesh_terms: D058109:Airway Management / Q000295:instrumentation* / Q000379:methods; D000402:Airway Obstruction / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D017214:Laryngeal Masks / Q000009:adverse effects*; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012151:Resuscitation / Q000295:instrumentation* / Q000379:methods
chemical_list: D011663:Pulmonary Surfactants