Comparison Of T-Piece Resuscitator With Other Flow – Inflating Bags For Providing Positive Pressure Ventilation During Neonatal Resuscitation: A Systematic Review


      Effective positive pressure ventilation is indispensible for successful resuscitation in neonates who fail to establish spontaneous breathing. In this review we sought to compare the T-piece resuscitator (TPR) with other flow-inflating bags for providing positive pressure ventilation during neonatal resuscitation.


      We searched Pubmed, EMBASE and Cochrane databases from the inception to June 2015 for randomized controlled trials with specific search terms. All studies published in English language which compared TPR with flow-inflating bags were eligible for inclusion. Our primary outcome was intubation rate and secondary outcomes were heart rate, oxygen saturations, APGAR scores at 5 minutes, number of days of mechanical ventilation, length of stay, and mortality rates. Two reviewers independently performed study selection, data extraction and quality assessment procedures.


      A total of five studies with 1607 neonates were included in this review. There were less intubation rates observed in the TPR group as compared to other groups (8% to 27% vs 6% to 34%; four trials). One study showed significant reduction in intubation rates in TPR group compared to self inflating bags (odds ratio 0.58; 95% CI, 0.4 to 0.8). The response to resuscitation as showed by APGAR scores at 5min. was higher with T-piece as compared to other groups. The oxygen saturations, mechanical ventilation days, length of hospital stay and mortality were observed lesser in TPR group compared to other groups.


      Our review found that neonatal resuscitation with TPR decreases the intubation rates, mechanical ventilation days, length of hospital stay and mortality. However, further more trials with large sample size are warranted.