Respiratory function monitoring during neonatal resuscitation: A systematic review

Abstract

Aim: Positive pressure ventilation via a facemask is critical in neonatal resuscitation, but frequently results in mask leak, obstruction, and inadequate respiratory support. This systematic review aimed to determine whether the display of respiratory function monitoring improved resuscitation or clinical outcomes.

Methods: Randomized controlled trials comparing outcomes when respiratory function monitoring was displayed versus not displayed for newborns requiring positive pressure ventilation at birth were selected and from databases (last search August 2022), and assessed for risk of bias using Cochrane Risk of Bias Tools for randomized control trials. The study was registered in the Prospective Register of Systematic Reviews. Grading of Recommendations, Assessment, Development and Evaluations was used to assess the certainty of evidence. Treatment recommendations were approved by the Neonatal Life Support Task Force of the International Liaison Committee on Resuscitation. Results reported primary and secondary outcomes and included resuscitation and clinical outcomes.

Results: Of 2294 unique articles assessed for eligibility, three randomized controlled trials were included (observational studies excluded) (n = 443 patients). For predefined resuscitation and clinical outcomes, these studies either did not report the primary outcome (time to heart rate ≥ 100 bpm from birth), had differing reporting methods (achieving desired tidal volumes, significant mask leak) or did not find significant differences (intubation rate, air leaks, death before hospital discharge, severe intraventricular hemorrhage, chronic lung disease). Limitations included limited sample size for critical outcomes, inconsistent definitions amongst studies and unreported long-term outcomes.

Conclusion: Although respiratory function monitoring has been utilized in clinical care, there is currently insufficient evidence to suggest its benefit for newborn infants receiving respiratory support for resuscitation at birth.

Registration: PROSPERO CRD42021278169 (registered November 27, 2021).

Funding: The International Liaison Committee on Resuscitation provided support that included access to software platforms and teleconferencing.

Keywords: CINAHL, Cumulative Index to Nursing and Allied Health Literature; ECG, electrocardiogram; GRADE, Grading of Recommendations, Assessment, Development and Evaluations; Grading of Recommendations, Assessment, Development and Evaluations (GRADE); ILCOR, International Liaison Committee on Resuscitation; International Liaison Committee on Resuscitation (ILCOR); NICU, neonatal intensive care unit; NLS TF, Neonatal Life Support Task Force; Neonatal Life Support Task Force (NLS TF); Neonatal resuscitation; PRISMA, Preferred Reporting Items for Systematic Reviews and meta-analyses; Positive pressure ventilation (PPV); Preferred Reporting Items for Systematic Reviews and meta-analyses (PRISMA); R F M, Respiratory Function Monitoring; RCTs, randomized controlled trials; Respiratory function monitoring; RoB, risk of bias.

Fig. 1

PRISMA Flow Diagram 32 Studies were excluded because they were categorized as observational studies on humans or simulated patients that will be included in a future systematic review examining team performance. From: Page et al.

Fig. 2

Forest Plots: Selected data represented here while the remaining Forest Plots are listed in Supplement C.