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