Providing Positive End Expiratory Pressure during Neonatal Resuscitation: A Meta-analysis

Abstract

Objective: To conduct a systematic review and metanalysis evaluating the effects of administering positive end-expiratory pressure (PEEP) during neonatal resuscitation at birth. Data Sources: Medline, Web of Science, Scopus, CENTRAL and Clinicaltrials.gov databases were systematically searched from inception to 15 December 2020. Study selection: Randomized controlled trials and cohort studies were held eligible. Studies were included if they compared the administration of PEEP using either a T-piece resuscitator or a self-inflating bag with a PEEP valve with the resuscitation via a self-inflating bag without a PEEP valve. Data Extraction and Synthesis: Data was extracted by two reviewers independently. The credibility of evidence was appraised with the Grading of Recommendations, Assessment, Development and Evaluations approach. Random-effects models were fitted to provide pooled estimates of risk ratio (RR) and 95% confidence intervals (CI). Results: Overall, 10 studies were included, comprising 4,149 neonates. This included 5 RCTs, 1 quasi-randomized trial and 4 cohort studies. The administration of PEEP was associated with significantly lower rates of mortality till discharge (odds ratio-OR: 0.60, 95% confidence intervals-CI: 0.49-0.74, moderate quality of evidence). The association was significant in preterm (OR: 0.57, 95% CI: 0.46-0.69) but not in term (OR: 1.03, 95% CI: 0.52-2.02) neonates. Conclusions: Providing PEEP during neonatal resuscitation associated with lower rates of mortality, in preterm neonates. Evidence regarding term neonates is limited and inconclusive. Future research is needed to determine the optimal device and shed more light on the long-term effects of PEEP administration during neonatal resuscitation. PROSPERO registration number: CRD42020219956