Respiratory function monitoring to improve the outcomes following neonatal resuscitation: a systematic review and meta-analysis

In this recent systematic review and meta-analysis, the authors evaluate whether the use of a respiratory function monitor (RFM) in addition to clinical assessment versus clinical assessment alone during mask ventilation in the delivery room reduces in-hospital mortality and morbidity of infants <37 weeks’ gestation. 

The use of a RFM has been shown to be useful in assisting resuscitators to see what is happening during ventilation and resuscitation. An RFM measures key respiratory parameters including expiring tidal volume, mask and endotracheal tube leakage, respiratory rate, PEEP and PIP.  

Studies have reported expired tidal volumes (VTe) during face mask positive pressure ventilation (PPV) to range between 0 and 31 mL/kg. This is also true for mask leakage where studies have reported widely varying numbers. 

In total, 3373 studies were identified and for final review three randomised control trials (RCTs) were included for analysis. The meta-analysis of these three RCTs found that the use of a respiratory function monitor resulted in a significant reduction in brain injury amongst the 443 preterm infants enrolled in the studies. Infant mortality was similar with or without the use of an RFM. Furthermore, a post-hoc pooled analysis showed that there was a significant reduction in excessive VTe as well as significant reduction in brain injury when a RFM was used. 

The authors point out that alhough the results showed significance for brain injury, the clinical effect of 36% reduction in brain injury is unclear and more clinical trials are needed to confirm or refute the results. 

Conclusion

The authors conclude that in infants <37 weeks, an RFM in addition to clinical assessment compared with clinical assessment during mask ventilation resulted in similar in-hospital mortality, significant reduction for any brain injury and intraventricular haemorrhage.