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Providing Positive End-Expiratory Pressure during Neonatal Resuscitation: A Meta-analysis
Ioannis Bellos1, Anish Pillai2, Aakash Pandita3
1Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Division of Surgery, Athens University Medical School, National and Kapodistrian University of Athens, Greece.
American Journal of Perinatology
|August 30, 2022
Summary
Positive end-expiratory pressure (PEEP) during neonatal resuscitation significantly lowers mortality in preterm infants. Evidence for term infants is inconclusive, highlighting the need for further research on optimal devices and long-term effects.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Evidence-Based Medicine
Background:
- Neonatal resuscitation aims to support cardiorespiratory transition at birth.
- Positive end-expiratory pressure (PEEP) is a critical component in mechanical ventilation.
- The role of PEEP during neonatal resuscitation requires systematic evaluation.
Approach:
- A systematic review and meta-analysis of randomized controlled trials and cohort studies.
- Searched multiple databases (Medline, Web of Science, Scopus, Cochrane, Clinicaltrials.gov) up to December 2020.
- Assessed evidence quality using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).
Key Points:
- PEEP administration during neonatal resuscitation was associated with reduced mortality until discharge (OR 0.60, moderate quality evidence).
- This mortality reduction was significant in preterm neonates (OR 0.57) but not in term neonates (OR 1.03).
- Low-to-moderate quality evidence supports PEEP's benefit for preterm infants, with limited data for term infants.
Conclusions:
- PEEP administration during neonatal resuscitation is linked to lower mortality rates in preterm infants.
- Current evidence for term neonates is insufficient and inconclusive.
- Further research is essential to identify optimal PEEP devices and long-term outcomes.
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