title: Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia: a meta-analysis.
abstract: OBJECTIVE
  Mechanical ventilation via an endotracheal tube is a risk factor for bronchopulmonary dysplasia (BPD), one of the most common morbidities of very preterm infants. Our objective was to investigate the effect that strategies to avoid endotracheal mechanical ventilation (eMV) have on the incidence of BPD in preterm infants <30 weeks' gestational age (GA).
  
  
  METHODS
  In February 2013, we searched the databases Medline, Embase, and the Cochrane Central Register of Controlled Trials. Study selection criteria included randomized controlled trials published in peer-reviewed journals since the year 2000 that compared preterm infants <30 weeks' GA treated by using a strategy aimed at avoiding eMV with a control group in which mechanical ventilation via an endotracheal tube was performed at an earlier stage. Data were extracted and analyzed by using the standard methods of the Cochrane Neonatal Review Group. The authors independently assessed study eligibility and risk of bias, extracted data and calculated odds ratios and 95% confidence intervals, employing RevMan version 5.1.6.
  
  
  RESULTS
  We identified 7 trials that included a total of 3289 infants. The combined odds ratio (95% confidence interval) of death or BPD was 0.83 (0.71-0.96). The number needed to treat was 35. The study results were remarkably homogeneous. Avoiding eMV had no influence on the incidence of severe intraventricular hemorrhage.
  
  
  CONCLUSIONS
  Strategies aimed at avoiding eMV in infants <30 weeks' GA have a small but significant beneficial impact on preventing BPD.
authors.affiliation: Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. hendrik.fischer@charite.de.
authors.forename: Hendrik S
authors.initials: HS
authors.lastname: Fischer
authors.forename: Christoph
authors.initials: C
authors.lastname: Bührer
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D007234:Infant, Premature; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors
keywords: bronchopulmonary dysplasia; mechanical ventilation; newborn; respiratory distress syndrome; surfactant