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Study flow diagram: review update.
Figuras y tablas -
Figure 1

Study flow diagram: review update.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included trial.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included trial.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included trials.
Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included trials.

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Forest plot of comparison: 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions ‒ Outcome: 1.1 Death.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions ‒ Outcome: 1.1 Death.

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Forest plot of comparison: 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions ‒ Outcome: 1.4 Endotracheal intubation.
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions ‒ Outcome: 1.4 Endotracheal intubation.

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Forest plot of comparison: 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions ‒ Outcome: 1.5 Surfactant administration.
Figuras y tablas -
Figure 6

Forest plot of comparison: 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions ‒ Outcome: 1.5 Surfactant administration.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 1 Death.
Figuras y tablas -
Analysis 1.1

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 1 Death.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 2 Endotracheal intubation.
Figuras y tablas -
Analysis 1.2

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 2 Endotracheal intubation.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 3 Surfactant administration.
Figuras y tablas -
Analysis 1.3

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 3 Surfactant administration.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 4 Need for mechanical ventilation.
Figuras y tablas -
Analysis 1.4

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 4 Need for mechanical ventilation.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 5 Duration of NCPAP.
Figuras y tablas -
Analysis 1.5

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 5 Duration of NCPAP.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 6 Duration of mechanical ventilation.
Figuras y tablas -
Analysis 1.6

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 6 Duration of mechanical ventilation.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 7 Duration of respiratory support (NCPAP + MV).
Figuras y tablas -
Analysis 1.7

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 7 Duration of respiratory support (NCPAP + MV).

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 8 Duration of supplemental oxygen requirement.
Figuras y tablas -
Analysis 1.8

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 8 Duration of supplemental oxygen requirement.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 9 Chronic lung disease.
Figuras y tablas -
Analysis 1.9

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 9 Chronic lung disease.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 10 Pneumothorax.
Figuras y tablas -
Analysis 1.10

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 10 Pneumothorax.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 11 Pulmonary interstitial emphysema.
Figuras y tablas -
Analysis 1.11

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 11 Pulmonary interstitial emphysema.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 12 Pneumopericardium.
Figuras y tablas -
Analysis 1.12

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 12 Pneumopericardium.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 13 Cranial ultrasound abnormalities.
Figuras y tablas -
Analysis 1.13

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 13 Cranial ultrasound abnormalities.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 14 Retinopathy of prematurity (ROP) stage ≥ 3.
Figuras y tablas -
Analysis 1.14

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 14 Retinopathy of prematurity (ROP) stage ≥ 3.

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Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 15 Patent ductus arteriosus (PDA).
Figuras y tablas -
Analysis 1.15

Comparison 1 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions, Outcome 15 Patent ductus arteriosus (PDA).

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Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 1 Death.
Figuras y tablas -
Analysis 2.1

Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 1 Death.

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Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 2 Endotracheal intubation.
Figuras y tablas -
Analysis 2.2

Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 2 Endotracheal intubation.

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Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 3 Surfactant administration.
Figuras y tablas -
Analysis 2.3

Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 3 Surfactant administration.

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Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 4 Chronic lung disease.
Figuras y tablas -
Analysis 2.4

Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 4 Chronic lung disease.

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Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 5 Pneumothorax.
Figuras y tablas -
Analysis 2.5

Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 5 Pneumothorax.

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Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 6 Cranial ultrasound abnormalities.
Figuras y tablas -
Analysis 2.6

Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 6 Cranial ultrasound abnormalities.

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Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 7 Retinopathy of prematurity (ROP) stage ≥ 3.
Figuras y tablas -
Analysis 2.7

Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 7 Retinopathy of prematurity (ROP) stage ≥ 3.

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Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 8 Patent ductus arteriosus (PDA).
Figuras y tablas -
Analysis 2.8

Comparison 2 Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions, Outcome 8 Patent ductus arteriosus (PDA).

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Summary of findings for the main comparison. Use of initial sustained inflation compared to standard inflations in newborns receiving resuscitation with no chest compressions for

Use of initial sustained inflation compared to standard inflations in newborns receiving resuscitation with no chest compressions during resuscitation

Population: preterm infants resuscitated by PPV at birth
Settings: delivery room in Europe (Austria, Germany, Italy, the Netherlands), Canada, Egypt, Thailand, USA, Australia, South Korea, and Singapore
Intervention: use of initial sustained inflation in newborns receiving resuscitation with no chest compressions
Comparison: standard inflations in newborns receiving resuscitation with no chest compressions

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Standard inflations in newborns receiving resuscitation with no chest compressions

Use of initial sustained inflation

Death ‒in the delivery room

Study population

RR 2.66
(0.11 to 63.4)

479
(5 studies)

⊕⊕⊝⊝
low1,2

0 per 1000

0 per 1000
(0 to 0)

Medium risk population

0 per 1000

0 per 1000
(0 to 0)

Death ‒before discharge

Study population

RR 1.09
(0.83 to 1.43)

1458
(9 studies)

⊕⊕⊕⊝
moderate1

112 per 1000

122 per 1000
(93 to 160)

Medium risk population

58 per 1000

63 per 1000
(48 to 83)

Rate of mechanical ventilation

Study population

RR 0.89
(0.77 to 1.02)

910
(4 studies)

⊕⊕⊕⊝
moderate1

461 per 1000

410 per 1000
(355 to 470)

Medium risk population

439 per 1000

391 per 1000
(338 to 448)

Chronic lung disease ‒any grade

Study population

RR 0.98
(0.84 to 1.13)

1418
(8 studies)

⊕⊕⊕⊝
moderate1

340 per 1000

333 per 1000
(286 to 384)

Medium risk population

211 per 1000

207 per 1000
(177 to 238)

Chronic lung disease ‒moderate to severe BPD

Study population

RR 0.95
(0.74 to 1.22)

683
(5 studies)

⊕⊕⊕⊝
moderate1

257 per 1000

244 per 1000
(190 to 314)

Medium risk population

211 per 1000

200 per 1000
(156 to 257)

Pneumothorax

Study population

RR 0.89
(0.57 to 1.39)

1458
(9 studies)

⊕⊕⊝⊝
low1,2

52 per 1000

46 per 1000
(30 to 72)

Medium risk population

50 per 1000

44 per 1000
(28 to 69)

Cranial ultrasound abnormalities ‒Intraventricular haemorrhage grade 3 to 4

Study population

RR 0.85
(0.56 to 1.28)

735
(6 studies)

⊕⊕⊝⊝
low1,2

116 per 1000

99 per 1000
(65 to 148)

Medium risk population

54 per 1000

46 per 1000
(30 to 69)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

1 all studies at high or unclear risk of bias in at least one domain (lack of blinding) and 1 study stopped early
2 few events

Figuras y tablas -
Summary of findings for the main comparison. Use of initial sustained inflation compared to standard inflations in newborns receiving resuscitation with no chest compressions for
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Summary of findings 2. Use of initial sustained inflation for

Use of initial sustained inflation for

Population: infants below 33 weeks of postmenstrual age who required resuscitation in the delivery room
Settings: delivery room in Canada
Intervention: use of initial sustained inflation in newborns receiving resuscitation with chest compressions
Comparison: standard inflations in newborns receiving resuscitation with chest compressions

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Use of initial sustained inflation

Death ‒in the delivery room

See comment

See comment

not reported

9 (1 study)

The included study did not report on this outcome

Death ‒before discharge

Study population

RR 4.17
(0.25 to 68.16)

9
(1 study)

⊝⊝⊝⊝
very low1,2

0 per 1000

0 per 1000
(0 to 0)

Medium risk population

0 per 1000

0 per 1000
(0 to 0)

Rate of mechanical ventilation

See comment

See comment

not reported

9 (1 study)

The included study did not report on this outcome

Chronic lung disease ‒any grade

See comment

See comment

not reported

9 (1 study)

The included study did not report on this outcome

Chronic lung disease ‒moderate to severe BPD

Study population

RR 0.89
(0.33 to 2.37)

7
(1 study)

⊝⊝⊝⊝
very low1,2

750 per 1000

668 per 1000
(248 to 1000)

Medium risk population

750 per 1000

668 per 1000
(248 to 1000)

Pneumothorax ‒at any time

See comment

See comment

Not estimable

9
(1 study)

⊝⊝⊝⊝
very low1,2

No events

Cranial ultrasound abnormalities ‒intraventricular haemorrhage grade 3 to 4

Study population

RR 0.4
(0.05 to 2.98)

9
(1 study)

⊝⊝⊝⊝
very low1,2

500 per 1000

200 per 1000
(25 to 1000)

Medium risk population

500 per 1000

200 per 1000
(25 to 1000)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

1 Limitations in study design: downgraded by 1 level due to included study at high or unclear risk of bias in 4 domains
2 Imprecision: downgraded by 2 levels due to extremely low sample size, few events

Figuras y tablas -
Summary of findings 2. Use of initial sustained inflation for
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Table 1. Populations and interventions in included trials

Trial

(no. infants)

Antenatal steroids

Gestational age, weeks

Birth weight, grams

Device/Interface

Interventions/Controls

SLI

Control

SLI

Control

SLI

Control

SLI and control

SLI

Control

Abd 2017 (100)

70% to 80%

55%

 29.3 to 29.7

29.4 (SD 2.1)
 

 1363 to 1367

 mean 1249 (SD 363)

 T‐piece

4 different arms: PIP of either 15 or 20 cmH₂O for either 10 or 20 seconds

PEEP 5 cmH₂O, oxygen 30%
 

El‐Chimi 2017 (112)

39%

34.5%

mean 31.1 (SD 1.7)

mean 31.3 (SD 1.7)

mean 1561 (SD 326)

mean 1510 (SD 319)

Mask and T‐piece in SLI group

Mask and self‐inflating bag with an oxygen reservoir in control group

PIP of 20 cmH₂O for 15 seconds, followed by PEEP of 5 cmH₂O

If needed: a second SLI of 15 seconds of 25 cmH₂O for 15 seconds, followed by PEEP of 6 cmH₂O; then a third SLI of 15 seconds of 30 cmH₂O for 15 seconds, followed by PEEP of 7 cmH₂O

If still not satisfactory: intubated in delivery room

PIP maximum 40 cmH₂O, rate of 40 to 60 breaths/min for 30 seconds

Jiravisitkul 2017 (81)

63%

74%

25 to 28 weeks:
n = 17;

29 to 32 weeks:
n = 26

25 to 28 weeks:
n = 16;

29 to 32 weeks:
n = 22

mean 1206 (SD 367)

mean 1160 (SD 411)

Mask and T‐piece

PIP of 25 cmH₂O for 15 seconds

If HR 60 to 100 beats/min and/or poor respiratory effort: a second SLI (25 cmH₂O, 15 seconds)

PIP 15 to 20 cmH₂O, PEEP 5 cmH₂O for 30 seconds, followed by resuscitation according to AHA guidelines

Kirpalani 2019 (426)
 

97%
 

97%
 

23 to 24 weeks:

n = 76;

25 to 26 weeks:
n = 139

23 to 24 weeks:

n = 75;

25 to 26 weeks:
n = 136

median 725 (IQR 620 to 855)
 

median 731 (IQR 630 to 854)

Either mask or a nasopharyngeal tube (as unit protocol dictated) and T‐piece resuscitator

PIP of 20 cmH₂O for 15 seconds.

If needed: a second SLI of 15 seconds of 25 cmH₂O

PIP with PEEP

Lindner 2005 (61)

81%

80%

median 27.0 (IQR 25.0 to 28.9)

median 26.7 (IQR 25.0 to 28.9)

median 870 (IQR 410 to 1320)

median 830 (IQR 370 to 1370)

Nasopharyngeal tube (fixed at 4 to 5 cm) and mechanical ventilator

PIP of 20 cmH₂O for 15 seconds

If response was not satisfactory: 2 further SLIs of 15 seconds (25 and 30 cmH₂O). Then PEEP at 4 to 6 cmH₂O

PIP 20 cmH₂O, PEEP 4 to 6 cmH₂O; inflation time 0.5 seconds; inflation rate 60 per min. Then, PEEP at 4 to 6 cmH₂O

Lista 2015 (301)

87%

91%

mean 26.8 (SD 1.2);

25 to 26 weeks:
n = 55

27 to 28 weeks:
n = 88

mean 26.8 (SD 1.1);

25 to 26 weeks:
n = 52;

27 to 28 weeks:
n = 96

mean 894 (SD 247)

mean 893 (SD 241)

Mask and T‐piece

PIP 25 cmH₂O for 15 seconds. Then reduced to PEEP of 5 cmH₂O

PEEP 5 cmH₂O, followed by resuscitation according to AHA guidelines

Mercadante 2016 (185)

40%

32%

mean 35.2 (SD 0.8)

mean 35.2 (SD 0.8)

mean 2345 (SD 397)

mean 2346 (SD 359)

Mask and T‐piece

PIP 25 cmH₂O for 15 seconds, followed by PEEP of 5 cmH₂O. In case of persistent heart failure (HR < 100 bpm): SLI repeated

PEEP 5 cmH₂O, followed by resuscitation according to AAP guidelines

Ngan 2017 (162)

78%

70%

mean 28 (SD 2.5)

mean 28 (SD 2.5)

mean 1154 (SD 426)

mean 1140 (SD 406)

Mask and T‐piece

Two PIPs of 24 cmH₂O. Duration of first SLI was 20 seconds. Duration of second SLI was 20 or 10 seconds, guided by ECO₂ values. After SLIs, CPAP if breathing spontaneously or, if found to have apnoea or laboured breathing, mask IPPV at a rate of 40 to 60 bpm

IPPV, rate of 40 to 60 inflations/min until spontaneous breathing, at which time CPAP will be provided

Schmölzer 2018 (9)

80%a

100%a

mean 24.6 (SD 1.3)a

mean 25.6 (SD 2.3)a

mean 707 (SD 208)a

mean 808 (SD 192)a

Mask and T‐piecea

PIP for 20 + 20 secondsa during chest compressions

3:1 compression:ventilation ratio according to resuscitation guidelines

Schwaberger 2015 (40)

not reported

not reported

mean 32.1 (SD 1.4)

mean 32.1 (SD 1.6)

mean 1692 (SD 297)

mean 1722 (SD 604)

Mask and T‐piece

PIP 30 cmH₂O for 15 seconds, to be repeated once or twice with HR remaining < 100 bpm. Infants with HR > 100 bpm: PPV at 30 cmH₂O PIP or CPAP at PEEP level of 5 cmH₂O depending on respiratory rate

Resuscitation according to AHA guidelines

PEEP 5 cmH₂O if respiratory rate > 30 and signs of respiratory distress

PPV at 30 cmH₂O PIP if insufficient breathing efforts

aInformation provided by study authors

Figuras y tablas -
Table 1. Populations and interventions in included trials
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Comparison 1. Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death Show forest plot

9

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Death in the delivery room

5

479

Risk Ratio (M‐H, Fixed, 95% CI)

2.66 [0.11, 63.40]

1.2 Death before discharge

9

1458

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.83, 1.43]

2 Endotracheal intubation Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 intubation in the delivery room (DR)

7

1127

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.73, 0.99]

2.2 intubation in the first 72 hours of age

5

811

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.79, 1.04]

3 Surfactant administration Show forest plot

9

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Surfactant given in the delivery room

4

761

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.88, 1.27]

3.2 Surfactant given at any time

9

1458

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.91, 1.08]

4 Need for mechanical ventilation Show forest plot

4

910

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.77, 1.02]

5 Duration of NCPAP Show forest plot

3

355

Mean Difference (IV, Fixed, 95% CI)

0.26 [‐0.19, 0.72]

6 Duration of mechanical ventilation Show forest plot

5

524

Mean Difference (IV, Fixed, 95% CI)

‐5.37 [‐6.31, ‐4.43]

7 Duration of respiratory support (NCPAP + MV) Show forest plot

2

243

Mean Difference (IV, Fixed, 95% CI)

0.69 [0.23, 1.16]

8 Duration of supplemental oxygen requirement Show forest plot

1

81

Mean Difference (IV, Fixed, 95% CI)

‐9.73 [‐25.06, 5.60]

9 Chronic lung disease Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 BPD any grade

4

735

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.83, 1.18]

9.2 Moderate to severe BPD

5

683

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.74, 1.22]

10 Pneumothorax Show forest plot

9

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 During first 48 hours

1

81

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.06, 13.65]

10.2 At any time

8

1377

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.57, 1.40]

11 Pulmonary interstitial emphysema Show forest plot

1

426

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.39, 3.35]

12 Pneumopericardium Show forest plot

1

426

Risk Difference (M‐H, Fixed, 95% CI)

0.0 [‐0.01, 0.01]

13 Cranial ultrasound abnormalities Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 Intraventricular haemorrhage grade 3‐4

6

735

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.56, 1.28]

13.2 IVH any grade

3

578

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.77, 1.32]

13.3 Cystic periventricular leukomalacia

5

635

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.24, 1.44]

14 Retinopathy of prematurity (ROP) stage ≥ 3 Show forest plot

6

732

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.46, 1.15]

15 Patent ductus arteriosus (PDA) Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

15.1 PDA ‐ pharmacological treatment

7

1127

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.87, 1.12]

15.2 PDA ‐ surgical closure

3

412

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.27, 1.99]
Figuras y tablas -
Comparison 1. Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with no chest compressions
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Comparison 2. Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Death before discharge

1

9

Risk Ratio (M‐H, Fixed, 95% CI)

4.17 [0.25, 68.16]

2 Endotracheal intubation Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Endotracheal intubation in the delivery room

1

9

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.68, 1.46]

3 Surfactant administration Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Surfactant given in the delivery room

1

9

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.31, 1.35]

4 Chronic lung disease Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Moderate to severe BPD

1

7

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.33, 2.37]

5 Pneumothorax Show forest plot

1

Risk Difference (M‐H, Fixed, 95% CI)

Subtotals only

5.1 At any time

1

9

Risk Difference (M‐H, Fixed, 95% CI)

0.0 [‐0.34, 0.34]

6 Cranial ultrasound abnormalities Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Intraventricular haemorrhage grade 3 to 4

1

9

Risk Ratio (M‐H, Fixed, 95% CI)

0.4 [0.05, 2.98]

6.2 IVH any grade

1

9

Risk Ratio (M‐H, Fixed, 95% CI)

0.28 [0.07, 1.15]

7 Retinopathy of prematurity (ROP) stage ≥ 3 Show forest plot

1

9

Risk Ratio (M‐H, Fixed, 95% CI)

0.27 [0.04, 1.68]

8 Patent ductus arteriosus (PDA) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 PDA ‐ pharmacological treatment

1

9

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.17, 1.25]
Figuras y tablas -
Comparison 2. Use of initial sustained inflation vs standard inflations in newborns receiving resuscitation with chest compressions
Ir a la tabla de la revisión