• Ruth Guinsburg, de Almeida Maria Fernanda Branco MFB Division of Neonatal Medicine, Federal University of São Paulo, São Paulo, Brazil., Junia Sampel de Castro, Walusa Assad Gonçalves-Ferri, Patricia Franco Marques, Jamil Pedro Siqueira Caldas, Krebs Vera Lucia Jornada VLJ Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Souza Rugolo Ligia Maria Suppo de LMS Division of Neonatology, Faculdade de Medicinade Botucatu da Universidade Estadual Paulista, Botucatu, Brazil., João Henrique Carvalho Leme de Almeida, Jorge Hecker Luz, Renato S Procianoy, Duarte José Luiz Muniz Bandeira JLMB Department of Pediatrics, Hospital Universitário Pedro Ernesto - Universidade do Estado de Rio de Janeiro, Rio de Janeiro, Brazil., Marcia Gomes Penido, Daniela Marques de Lima Mota Ferreira, Navantino Alves Filho, Edna Maria de Albuquerque Diniz, Juliana Paula Santos, Ana Lucia Acquesta, Cristina Nunes Dos Santos, Maria Rafaela Conde Gonzalez, Regina Pg Vieira Cavalcanti da Silva, Jucile Meneses, José Maria de Andrade Lopes, and Franciscó Eulógio Martinez.
• Division of Neonatal Medicine, Federal University of São Paulo, São Paulo, Brazil.
• Arch. Dis. Child. Fetal Neonatal Ed. 2018 Jan 1; 103 (1): F49-F55.

ObjectiveTo verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities.DesignPragmatic prospective cohort study.Setting20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014-2015 ventilated at birth with 23-33' weeks gestation and birth weight 400-1499 g without malformations. Patients transferred until the 27th day after birth were excluded.InterventionsPositive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist's discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalacia. Logistic regression adjusted for confounding variables was applied for main outcome.Results1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 ± 277 vs 941 ± 279 g, gestational age 28.2±2.5 vs 27.8±2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%. Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% CI 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695).ConclusionThis study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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