Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Steiermark, Austria.
Arch Dis Child Fetal Neonatal Ed. 2021 Sep;106(5):561-567. doi: 10.1136/archdischild-2020-319460. Epub 2021 Jan 27.
The current neonatal resuscitation guidelines recommend positive pressure ventilation via face mask or nasal prongs at birth. Using a nasal interface may have the potential to improve outcomes for newborn infants.
To determine whether nasal prong/nasopharyngeal tube versus face mask during positive pressure ventilation of infants born <37 weeks' gestation in the delivery room reduces in-hospital mortality and morbidity.
MEDLINE (through PubMed), Google Scholar and EMBASE, Clinical Trials.gov and the Cochrane Central Register of Controlled Trials through August 2019.
Randomised controlled trials comparing nasal prong/nasopharyngeal tube versus face mask during positive pressure ventilation of infants born <37 weeks' gestation in the delivery room.
Risk of bias was assessed using the Covidence Collaboration Tool, results were pooled into a meta-analysis using a random effects model.
In-hospital mortality.
Five RCTs enrolling 873 infants were combined into a meta-analysis. There was no statistical difference in in-hospital mortality (risk ratio (RR 0.98, 95% CI 0.63 to 1.52, p=0.92, I=11%), rate of chest compressions in the delivery room (RR 0.37, 95% CI 0.10 to 1.33, p=0.13, I=28%), rate of intraventricular haemorrhage (RR 1.54, 95% CI 0.88 to 2.70, p=0.13, I=0%) or delivery room intubations in infants ventilated with a nasal prong/tube (RR 0.63, 95% CI 0.39,1.02, p=0.06, I=52%).
In infants born <37 weeks' gestation, in-hospital mortality and morbidity were similar following positive pressure ventilation during initial stabilisation with a nasal prong/tube or a face mask.
目前的新生儿复苏指南建议在出生时通过面罩或鼻叉进行正压通气。使用鼻接口可能有潜力改善新生儿的结局。
确定在产房对 <37 周胎龄的婴儿进行正压通气时，使用鼻叉/鼻咽管与面罩相比，是否可以降低院内死亡率和发病率。
通过 PubMed 检索 MEDLINE、Google Scholar 和 EMBASE、ClinicalTrials.gov 和 Cochrane 对照试验中心注册库，检索时间截至 2019 年 8 月。
比较产房内 <37 周胎龄婴儿正压通气时使用鼻叉/鼻咽管与面罩的随机对照试验。
使用 Covidence 协作工具评估偏倚风险，使用随机效应模型对结果进行汇总分析。
院内死亡率。
纳入了 5 项 RCT 共 873 名婴儿，将其合并进行 meta 分析。院内死亡率无统计学差异（风险比（RR）0.98，95%置信区间（CI）0.63 至 1.52，p=0.92，I=11%），产房内胸外按压率（RR 0.37，95% CI 0.10 至 1.33，p=0.13，I=28%）、脑室内出血率（RR 1.54，95% CI 0.88 至 2.70，p=0.13，I=0%）或使用鼻叉/管通气的婴儿在产房内进行气管插管的比例（RR 0.63，95% CI 0.39 至 1.02，p=0.06，I=52%）也无统计学差异。
在 <37 周胎龄的婴儿中，使用鼻叉/管或面罩进行初始稳定正压通气后，院内死亡率和发病率相似。
