Efficacy and Safety of T-Piece Resuscitators Versus Self-Inflating Bags for Neonatal Resuscitation: A Systematic...

T-piece resuscitators (TPR) and self-inflating bags (SIB) are the most common devices used to provide positive pressure ventilation (PPV) in neonates. This systematic review and meta-analysis aimed to compare the efficacy and safety of TPR and SIB in neonatal resuscitation.

We searched major databases (Medline, Embase, Web of Science, and CENTRAL) and clinical trial registries (last search: May 13, 2025) for randomized controlled trials (RCTs) comparing TPR with SIB in neonates receiving PPV at birth. The RoB 2.0 tool was used to assess the risk of bias. A random-effects meta-analysis was performed for quantitative synthesis. The primary outcome was all-cause mortality. Secondary outcomes included resuscitation parameters, immediate post-resuscitation interventions, and core neonatal outcomes. The certainty of evidence was assessed using the GRADE approach.

Seven RCTs (1457 neonates) were included. There was no significant difference in neonatal mortality between the TPR and SIB groups (RR, 0.97; 95% CI 0.55-1.71; low-certainty evidence). TPR was associated with a shorter duration of PPV (mean difference: -17.8 s; 95% CI -24.2 to -11.4) and reduced need for chest compressions (RR 0.51; 95% CI 0.28-0.92), though the latter was not significant in fixed-effect sensitivity analyses. No significant differences were found in intubation rates, air leaks, bronchopulmonary dysplasia, or other core neonatal outcomes.

T-piece resuscitators may reduce PPV duration and the need for chest compressions, but do not significantly impact mortality or major neonatal morbidities. More robust clinical trials are needed to assess the effects of TPR on core neonatal outcomes.

The review was reported according to the PRISMA guidelines and registered in PROSPERO (CRD420251047618).