T-piece resuscitator versus self-inflating bag for resuscitation in the delivery room in preterm neonates: a randomised controlled trial

Objective To compare the efficacy of T-piece resuscitator (TPR) and self-inflating bag (SIB) for resuscitation of preterm neonates in the delivery room. Settings Level III neonatal intensive care unit in North India. Design Open-label, parallel-group, randomised controlled trial. Patient Preterm neonates of>26–34 weeks of gestation requiring positive pressure ventilation (PPV) at birth. Intervention Neonates needing PPV at birth were identified using Neonatal Resuscitation Programme guidelines, 2020, and resuscitated using either TPR or SIB as per permuted block random sequence. Main outcome measures Primary outcome was need for delivery room endotracheal intubation. Secondary outcomes were duration of PPV, oxygen saturation (SpO2) at 2 and 5 min, time to spontaneous respiration and heart rate>100 beats per minute. Results Mean gestation age (weeks; 30±2.1 vs 31±2) and birth weight (g; 1400±408 vs 1450±427) were comparable. Of the total 120, 8 (13.7%) in the TPR group versus 19 (30.6%) neonates in the SIB group were intubated in the delivery room (risk difference (95% CI), −0.16 (–0.31 to −0.02); p=0.03). SpO2 mean (SD) at 5 min in TPR group and SIB group were 82.9±8.7% and 78.9±12.1%, respectively; mean difference (95% CI), 3.99 (0.15 to 7.83); p=0.04). Median (IQR) of combined Apgar at 5 min in TPR group and SIB group were 13 (12–14) and 12 (10–13), p 0.02. Other outcomes were comparable. Conclusion TPR is more efficacious than SIB in terms of lesser delivery room intubation and better SpO2 at 5 min in preterm neonates.