title: Comparison of devices for newborn ventilation in the delivery room.
abstract: OBJECTIVE
  To evaluate the effectiveness and safety of a T-piece resuscitator compared with a self-inflating bag for providing mask ventilation to newborns at birth.
  
  
  METHODS
  Newborns at ≥26 weeks gestational age receiving positive-pressure ventilation at birth were included in this multicenter cluster-randomized 2-period crossover trial. Positive-pressure ventilation was provided with either a self-inflating bag (self-inflating bag group) with or without a positive end-expiratory pressure valve or a T-piece with a positive end-expiratory pressure valve (T-piece group). Delivery room management followed American Academy of Pediatrics and International Liaison Committee on Resuscitation guidelines. The primary outcome was the proportion of newborns with heart rate (HR)≥100 bpm at 2 minutes after birth.
  
  
  RESULTS
  A total of 1027 newborns were included. There was no statistically significant difference in the incidence of HR≥100 bpm at 2 minutes after birth between the T-piece and self-inflating bag groups: 94% (479 of 511) and 90% (466 of 516), respectively (OR, 0.65; 95% CI, 0.41-1.05; P=.08). A total of 86 newborns (17%) in the T-piece group and 134 newborns (26%) in the self-inflating bag group were intubated in the delivery room (OR, 0.58; 95% CI, 0.4-0.8; P=.002). The mean±SD maximum positive inspiratory pressure was 26±2 cm H2O in the T-piece group vs 28±5 cm H2O in the self-inflating bag group (P<.001). Air leaks, use of drugs/chest compressions, mortality, and days on mechanical ventilation did not differ significantly between groups.
  
  
  CONCLUSIONS
  There was no difference between the T-piece resuscitator and a self-inflating bag in achieving an HR of ≥100 bpm at 2 minutes in newborns≥26 weeks gestational age resuscitated at birth. However, use of the T-piece decreased the intubation rate and the maximum pressures applied.
authors.affiliation: Research Department, FUNDASAMIN, Fundación para la Salud Materno Infantil, Buenos Aires, Argentina. Electronic address: eszyld@gmail.com.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Szyld
authors.affiliation: Research Department, FUNDASAMIN, Fundación para la Salud Materno Infantil, Buenos Aires, Argentina; Masters Program in Clinical Trials, Universidad Abierta Interamericana, Buenos Aires, Argentina.
authors.forename: Adriana
authors.initials: A
authors.lastname: Aguilar
authors.affiliation: Research Department, FUNDASAMIN, Fundación para la Salud Materno Infantil, Buenos Aires, Argentina; Department of Pediatrics, Facultad de Ciencias Biomédicas, Universidad Austral, Buenos Aires, Argentina.
authors.forename: Gabriel A
authors.initials: GA
authors.lastname: Musante
authors.affiliation: Research Department, FUNDASAMIN, Fundación para la Salud Materno Infantil, Buenos Aires, Argentina.
authors.forename: Nestor
authors.initials: N
authors.lastname: Vain
authors.affiliation: Research Department, FUNDASAMIN, Fundación para la Salud Materno Infantil, Buenos Aires, Argentina.
authors.forename: Luis
authors.initials: L
authors.lastname: Prudent
authors.affiliation: Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Jorge
authors.initials: J
authors.lastname: Fabres
authors.affiliation: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation*; D018592:Cross-Over Studies; D003696:Delivery Rooms; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007327:Insufflation / Q000295:instrumentation*; D008297:Male; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D016896:Treatment Outcome