Comparison of T-piece resuscitator and self-inflating bag in neonatal resuscitation for extremely preterm infants

Comparison of T-piece resuscitator and self-inflating bag in neonatal resuscitation for extremely preterm infants | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of T-piece resuscitator and self-inflating bag in neonatal resuscitation for extremely preterm infants Qingqing Wang, Meihua Piao, Tongyan Han This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6781961/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Extremely preterm infants (<28 weeks gestational age) frequently require positive-pressure ventilation at birth. This study compared resuscitation outcomes between T-piece resuscitators (TPR) and self-inflating bags (SIB) in this population. Methods Cases of extremely preterm infants born at our hospital and transferred to the neonatal intensive care unit between January 1, 2010 and December 31, 2021 were retrospectively collected. According to the application of TPR and SIB during the recovery process, the patients were divided into TPR group (n=111) and SIB group (n=59). The resuscitation process and outcomes were compared between the two groups. Results Among 170 infants (TPR=111, SIB=59), TPR use was associated with significantly lower incidences of pulmonary hemorrhage (17.1% vs. 32.2%, P =0.025) and cerebral white matter injury (26.1% vs. 47.5%, P =0.005). Logistic regression confirmed TPR as a protective factor for both outcomes (OR=0.422 and 0.368, P 0.05). Conclusions The application of a T-piece resuscitator in the resuscitation of extremely preterm infants may be a protective factor for pulmonary haemorrhage and cerebral white matter injury and may be beneficial to the early outcome and long-term prognosis. extremely preterm neonates T-piece resuscitation outcome Figures Figure 1 Background It is estimated that 10% of newborn infants need help to begin breathing at birth and approximately 1% need intensive resuscitative measures to restore cardiorespiratory function 1 . In a study by Niles et al. 2 , approximately 6% of newborns needed positive-pressure ventilation after birth to maintain respiratory and circulatory stability. Extremely preterm infants are preterm infants with a gestational age (GA) of < 28 weeks. Due to their early GA and low birthweight, a high proportion of infants need positive-pressure ventilation at birth (60–95%) 3 – 6 . Self-inflating bags and T-pieces are the most common positive-pressure ventilation devices during resuscitation. Self-inflating bags without a compressed air source are easy to use. The T-piece requires a compressed air source when used, however, it can provide constant peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP). Extremely preterm infants with immature lung development, poor elasticity of the lung tissue, and lack of pulmonary surfactant are prone to alveolar collapse. Studies on newborn animals 7 , 8 have shown that PEEP can promote lung ventilation, increase functional residual volume, prevent distal airway collapse, increase lung surface area and compliance, reduce expiratory resistance, protect lung surfactant, and reduce hyaline membrane formation, alveolar collapse, and expression of proinflammatory mediators. Some studies have found that the use of a T-piece can reduce the rate of tracheal intubation, but the average GA of the patients is ≥ 28 weeks 9 , 10 . Few studies have been conducted in extremely preterm infants. In a study by Dawson et al. 11 , there was no difference in SpO 2 at 5 min among preterm infants with GA < 29 weeks who require a T-piece or self-inflating bag for positive-pressure ventilation at birth. Guinsburg et al. 12 found that the use of a T-piece during resuscitation of preterm infants with GA of 23–33 weeks increases their chances of survival to hospital discharge. The purpose of this study was to compare the application of a T-piece and a self-inflating bag during resuscitation on the resuscitation process and outcome of extremely preterm infants to provide a basis for resuscitation of extremely preterm infants. Method and object A retrospective chart review was conducted for all extremely preterm infants with GA < 28 weeks born at Peking University Third Hospital between January 1, 2010 and December 31, 2021. This study was approved by Peking University Third Hospital Research Ethics Committee (IRB 00006761-M2021255), and all research components adhered to institutional ethical human research guidelines. The need for informed consent was waived owing to the retrospective nature of the study. Medical records were identified using the electronic medical record system of our hospital using the following search criteria: GA < 28 weeks and date of birth within the study period. The exclusion criteria of this study included: births outside the hospital, absence of positive-pressure ventilation during resuscitation and congenital conditions affecting neonatal resuscitation, such as congenital heart disease, chromosomal abnormalities, genetic disorders, or inherited metabolic diseases. Demographic, maternal, and postnatal data were collected. The TPR group received positive-pressure ventilation with a T-piece (Fisher ༆ Paykel Healthcare Ltd) during resuscitation ( PIP setting 15–20 cmH 2 0, PEEP setting 5–6 cmH 2 0, RR 40–60 times/min, FiO 2 setting 30–40% ). The SIB group consisted of patients who used a self-inflating bag (which did not have a manometer or PEEP valve) for positive-pressure ventilation during resuscitation (FiO 2 setting 30–40%, RR 40–60 times/min). Both groups gradually increased the oxygen concentration according to the percutaneous oxygen saturation of the newborn. Resuscitation operator shall perform chest compression, tracheal intubation and other operations according to the neonatal resuscitation process.Outcomes included the resuscitation process in the delivery room and the neonatal outcomes. The resuscitation process included a 1-min Apgar score, 5-min Apgar score, positive-pressure ventilation, intubation, chest compressions, use of epinephrine (either intravenous or endotracheal), and fluid resuscitation. Neonatal outcomes included neonatal respiratory distress syndrome (NRDS), pulmonary haemorrhage within seven days, pneumothorax, early-onset sepsis (EOS), late-onset sepsis ( LOS), intrauterine infectious pneumonia, nosocomial pneumonia, haemodynamically significant patent ductus arteriosus (HsPDA), severe intraventricular haemorrhage (IVH, grade 3 or 4), cerebral white matter injury, hydrocephalus, necrotising enterocolitis (NEC, Bell stage II or greater), heart failure, renal failure, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), mechanical ventilation time, Ventilator application time, death within seven days, improvement and discharge. IVH, cerebral white matter injury and hydrocephalus were monitored by ultrasound. BPD was defined as the use of supplemental oxygen at 36 weeks corrected GA. Refer to the Avery’s Diseases of the Newborn (10th) 13 for the diagnostic criteria for neonatal-related diseases. The diagnostic criteria for perinatal complications were based on the Williams Obstetrics, 25th Edition 14 . Sufficient dexamethasone before delivery refers to intramuscular injection of dexamethasone 6 mg/time for more than 24 h and less than 7 days before delivery (repeated every 12 h, 4 times in total). Statistical software (SPSS 25.0, IBM, Armonk, NY) was used for data processing. The measurement data of normal distribution were described as x ± s , and the t -test of two independent samples was used for comparison between groups. Quantitative data with a skewed distribution were expressed as median (quartile) [P50 (P25, p75)], and the rank-sum test was used for comparison between groups. Count data were described by frequency and rate, and comparisons between groups were performed using the χ 2 test or Fisher’s exact probability method. The risk factors were analysed using binary logistic regression. Statistical significance was set at P < 0.05. Results According to the inclusion criteria, 220 extremely preterm infants were included in this study, and 17 patients transferred from other hospitals, 33 patients had no indication of positive pressure ventilation after initial resuscitation were excluded. A total of 170 extremely preterm infants met the criteria, including 111 cases (65.3%) in the TPR group and 59 cases (34.7%) in the SIB group. GA ranged from 23 + 2 to 27 + 6 weeks, with an average of 26.5 ± 1.1 weeks. Figure 1 shows the proportions of different GAs in both groups. Birth weight ranged from 500 g to 1400 g, and the average birthweight was 893.2 ± 173.3 g. There were 93 male infants (54.7%) and 35 caesarean births (20.6%). The proportion of caesarean section in the TPR group (25.2%) was significantly higher than that in the SIB group (11.9%). There were no significant differences between the two groups in gestational age, birthweight, terms of sex, age of mother, assisted birth, twins, small for GA, foetal distress, premature rupture of membranes, gestational thyroid disease, or the proportion of sufficient dexamethasone before delivery. The details of all included patients are summarised in Table 1 . Table 1 Descriptive statistics for study population TPR Group N = 111 SIB Group N = 59 P-value Gestational age ( x ± s , weeks) 26.4 ± 1.0 26.6 ± 1.1 0.092 Birthweight ( x ± s , g) 876.6 ± 177.2 924.6 ± 162.7 0.085 Male (n, %) 59 (53.2) 34 (57.6) 0.577 Caesarean section (n, %) 28 (25.2) 7 (11.9) 0.040 Mother’s age > 35 years (n, %) 42 (37.8) 21 (35.6) 0.773 Assisted birth (n, %) 48 (43.2) 24 (40.7) 0.747 Twins (n, %) 55 (49.5) 29 (49.2) 0.961 Small for gestational age (n, %) 14 (12.6) 3 (5.1) 0.119 Foetal distress (n, %) 6 (5.4) 2 (3.4) 0.833 Premature rupture of membranes (n, %) 40 (36.0) 25 (42.4) 0.418 Gestational diabetes (n, %) 27 (24.3) 8 (13.6) 0.098 Gestational hypertension (n, %) 27 (24.3) 9 (15.3) 0.168 Gestational thyroid disease (n, %) 14 (12.6) 6 (10.2) 0.638 Sufficient dexamethasone before delivery (n, %) 41 (36.9) 19 (32.2) 0.539 There were no significant differences between the TPR and SIB groups in the proportion of 1-min Apgar score ≤ 7, 5-min Apgar score ≤ 7, positive-pressure ventilation, intubation, chest compression, adrenaline, or fluid expansion (Table 2 ). Table 2 The differences of the Recovery process between the TPR and SIB groups Overall N = 170 TPR Group N = 111 SIB Group N = 59 P-value 1-min Apgar score ≤ 7 (n, %) 111 (65.3) 73 (65.8) 38 (64.4) 0.859 5-min Apgar score ≤ 7 (n, %) 55 (32.4) 39 (35.1) 16 (27.1) 0.288 Tracheal intubation (n, %) 146 (85.9) 97 (87.4) 49 (83.1) 0.440 Chest compression (n, %) 29 (17.1) 21 (18.9) 8 (13.6) 0.376 Adrenaline (n, %) 26 (15.3) 20 (18.0) 6 (10.2) 0.176 Fluid expansion (n, %) 15 (8.8) 9 (8.1) 6 (10.2) 0.652 The incidence of pulmonary haemorrhage was lower in the TPR group than in the SIB group (17.1% vs. 32.2%). The incidence of cerebral white matter injury was lower in the TPR group than in the SIB group (26.1% vs. 47.5%). There were no significant differences in NRDS, pneumothorax, EOS, LOS, intrauterine infectious pneumonia, nosocomial pneumonia, HsPDA, severe IVH, hydrocephalus, NEC, heart failure, renal failure, ROP, BPD, mechanical ventilation time, ventilator application time, death within 7 days, improvement, or discharge between the two groups (Table 3 ). Table 3 The differences of the patient outcomes between the TPR and SIB groups TPR Group N = 111 SIB Group N = 59 P-value NRDS (n, %) 100 (90.1) 58 (98.3) 0.094 Pulmonary haemorrhage (n, %) 19 (17.1) 19 (32.2) 0.025 Pneumothorax (n, %) 3 (2.7) 0 (0) 0.508 EOS (n, %) 13 (11.7) 6 (10.2) 0.746 LOS (n, %) 24 (21.6) 8 (13.6) 0.191 Intrauterine infectious pneumonia (n, %) 25 (22.5) 11 (18.6) 0.537 Nosocomial pneumonia 34 (30.6) 16 (27.1) 0.670 HsPDA (n, %) 67 (60.4) 34 (57.6) 0.730 Severe IVH (n, %) 15 (13.5) 5 (8.5) 0.332 Cerebral white matter injury (n, %) 29 (26.1) 28 (47.5) 0.005 Hydrocephalus (n, %) 3 (2.7) 5 (8.5) 0.210 NEC (n, %) 4 (3.6) 4 (6.8) 0.591 Heart failure (n, %) 4 (3.6) 7 (11.9) 0.114 Renal failure (n, %) 7 (6.3) 4 (6.8) 1.000 ROP (n, %) 30(46.2) * 11 (39.3) * 0.933 BPD (n, %) 16 (24.6) * 5 (17.9) * 0.475 Mechanical ventilation time (h) 168.0 (79.5, 408.0) 252.0 (54.0, 564.0) 0.306 Ventilator application time (h) 1388.0 (1056.0, 1645.5) 1200.0 (900.0, 1404.0) 0.100 Death within 7 days (n, %) 16 (14.4) 13 (22.0) 0.209 Improvement and discharge (n, %) 65 (58.6) 28 (47.5) 0.166 *The incidence of ROP and BPD was the total number of patients / the number of patients improved and discharged The binary logistic regression results showed that the application of the T-piece resuscitator during resuscitation may be a protective factor for pulmonary haemorrhage (Table 4 ) and against cerebral white matter injury in extremely preterm infants (Table 5 ). Table 4 Binary logistic regression analysis of risk factors of pulmonary haemorrhage Factors B Wald OR P -value T-piece -0.905 4.610 0.422 0.032 Pulmonary haemorrhage was considered the independent variable, and the use of T-pieces during resuscitation, gestational age, birthweight, male sex, caesarean section, maternal age > 35 years, assisted birth, twins, small for gestational age, foetal distress, premature rupture of membranes, gestational diabetes, gestational hypertension, gestational thyroid disease, and adequate dexamethasone before delivery were used as covariates. Table 5 Binary logistic regression analysis of risk factors of cerebral white matter injury Factors B Wald OR P -value T-piece -0.876 5.678 0.368 0.017 Cerebral white matter injury was considered the independent variable, and the use of T-pieces during resuscitation, gestational age, birthweight, male sex, caesarean section, maternal age > 35 years, assisted birth, twins, small for gestational age, foetal distress, premature rupture of membranes, gestational diabetes, gestational hypertension, gestational thyroid disease, and adequate dexamethasone before delivery were used as covariates. Discussion In this cohort of 170 extremely preterm infants, we observed that the proportions of extremely preterm infants requiring tracheal intubation, chest compression, and adrenaline during resuscitation were 85.9%, 17.1%, and 15.3%, respectively. In the study by Fischer et al. 15 , the proportion of premature infants with GA < 29 weeks receiving delivery room-extended cardiovascular resuscitation (DR-CPR) was 9.2%. In a study by Goel et al. 16 , the proportion of extremely preterm infants with a GA of 23–25 weeks who received DR-CPR at birth was 17.1%. The proportion of extremely preterm infants who need resuscitation after birth is high. Before the delivery of extremely preterm infants, it is necessary to prepare the manpower and equipment for resuscitation and prepare every link in the resuscitation process. Thakur et al. 9 found that the use of a T-piece resuscitator during resuscitation can reduce the rate of intubation in neonates. In a study by Szyld et al. 10 , the intubation rate of the T-piece group in the delivery room was significantly lower than that of the self-inflating bag group (17% vs. 26%). Ng et al. 17 also found that the application of a T-piece in the delivery room can reduce the intubation rate of newborns from 48.3–35.1%. However, the patients in the above study were mainly term and premature infants. Our study did not find any difference in the intubation rate between the two groups, which may be related to the fact that the patients in this study were all extremely preterm infants, and their lungs and respiratory centres were immature. Pulmonary haemorrhage is a serious complication in neonates that can increase mortality 18 , 19 . A multicentre study in the United States 20 showed that the incidence rate of pulmonary haemorrhage in extremely preterm infants was 0.5%, with a peak incidence of 86.9 cases per 1000 admissions for neonates born at 24 weeks of gestation, and early pulmonary haemorrhage was associated with significant morbidity and mortality in excess of 50%. In this study, the incidence of pulmonary haemorrhage in extremely preterm infants receiving the T-piece during resuscitation was lower than that in the control group. Regression analysis showed that the application of the T-piece during resuscitation may be a protective factor against pulmonary haemorrhage in extremely preterm infants. Injury to the white matter of the brain in premature infants can lead to sequelae in the nervous system, such as cerebral palsy, visual impairment, and cognitive impairment. The incidence of cerebral palsy in extremely preterm infants can be as high as 9.5–10.5% 21,22 , and among these, cerebral white matter injury is a very important cause. In this study, the incidence of cerebral white matter injury in extremely preterm infants receiving the T-piece during resuscitation was lower than that in the control group. The application of a T-piece during resuscitation may be a protective factor against cerebral white matter injury. This may be because the T-piece can provide constant PIP and PEEP, resulting in small fluctuations in blood flow. Further research is required to confirm this mechanism. In this study, there were no significant differences in NRDS, severe BPD, mechanical ventilation time, and ventilator application time between the T-piece application and control groups. Kitsommart et al. 23 studied whether PEEP was applied during the resuscitation of preterm infants with GA ≤ 32 weeks or very low-birthweight infants and found no difference in the application of pulmonary surfactant, pneumothorax, oxygen dependence at 36 weeks, or death by GA between the two groups. In this study, we found that the application of a T-piece in the resuscitation of extremely preterm infants may be a protective factor for pulmonary haemorrhage and cerebral white matter injury. However, this study still has some limitations. Because this is a retrospective study, the proportion of caesarean section in the application group was higher than that in the control group, which may have some impact on the results. In addition, this study did not further investigate the mechanism of reducing pulmonary haemorrhage and cerebral white matter injury by using a T-piece during resuscitation of extremely preterm infants. Further research is needed to confirm our findings. Conclusions The application of a T-piece resuscitation in the resuscitation of extremely preterm infants may be a protective factor for pulmonary haemorrhage and cerebral white matter injury and may be beneficial to the early outcome and long-term prognosis. Declarations Acknowledgements The authors would like to acknowledge Hua Zhang, The Clinical Epidemiology Research Center of Peking University Third Hospital, who provided guidance on statistical analysis. We also thank all extremely preterm infants and their parents included in this study. Author s ’ contributions Qingqing Wang : Conceptualisation, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data Curation, Funding acquistion, Resources, Writing - Original Draft. Meihua Piao: Conceptualisation, Methodology, Data Curation, Validation, Formal analysis, Supervision, Project administration, Writing - Review & Editing. Tongyan Han: Conceptualisation, Methodology, Software, Validation, Data Curation, Visualisation, Supervision, Funding acquistion, Project administration, Writing - Review & Editing,. Funding: This work was supported by the Clinical Cohort Construction Program of Peking University Third Hospital (Grant No. BYSYDL2022010 and BYSYDL2024012). Data availability To protect study participant privacy, data and materials will be made available on request. Ethics approval and consent to participate This study was approved by Peking University Third Hospital Research Ethics Committee (IRB 00006761-M2021255), and all research components adhered to institutional ethical human research guidelines. The need for informed consent was waived owing to the retrospective nature of the study.This study adhered to the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Aziz K, Lee HC, Escobedo MB, et al. Part 5: neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142:S524–550. Niles DE, Cines C, Insley E, et al. Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital. Resuscitation. 2017;115:102–9. Serenius F, Ewald U, Farooqi A, et al. Short-term outcome after active perinatal management at 23–25 weeks of gestation. A study from two Swedish perinatal centres. Part 3: neonatal morbidity. Acta Paediatr. 2004;93:1090–7. Walsh MC, Morris BH, Wrage LA, et al. Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes. J Pediatr. 2005;146:798–804. Gagliardi L, Bellù R, Zanini R, et al. Network Neonatale Lombardo Study Group. Bronchopulmonary dysplasia and brain white matter damage in the preterm infant: a complex relationship. Paediatr Perinat Epidemiol. 2009;23:582–90. Soll RF, Edwards EM, Badger GJ, et al. Obstetric and neonatal care practices for infants 501 to 1500 g from 2000 to 2009. Pediatrics. 2013;132:222–8. Siew ML, Te Pas AB, Wallace MJ, et al. Positive end-expiratory pressure enhances development of a functional residual capacity in preterm rabbits ventilated from birth. J Appl Physiol (1985). 2009;106:1487–93. Probyn ME, Hooper SB, Dargaville PA, et al. Positive end expiratory pressure during resuscitation of premature lambs rapidly improves blood gases without adversely affecting arterial pressure. Pediatr Res. 2004;56:198–204. Thakur A, Saluja S, Modi M, et al. T-piece or self inflating bag for positive pressure ventilation during delivery room resuscitation: an RCT. Resuscitation. 2015;90:21–4. Szyld E, Aguilar A, Musante GA, et al. Delivery Room Ventilation Devices Trial Group. Comparison of devices for newborn ventilation in the delivery room. J Pediatr. 2014;165:234–9. Dawson JA, Schmölzer GM, Kamlin CO, et al. Oxygenation with T-piece versus self-inflating bag for ventilation of extremely preterm infants at birth: a randomized controlled trial. J Pediatr. 2011;158:912–e9181. Guinsburg R, de Almeida MFB, de Castro JS, et al. T-piece versus self-inflating bag ventilation in preterm neonates at birth. Arch Dis Child Fetal Neonatal Ed. 2018;103:F49–55. Gleason CA, Juul SE. Avery's diseases of the newborn: Tenth edition. Amsterdam: Elsevier; 2017. p. 1656. F.Gary Cunningham. 2019. Williams Obstetrics, 25th Edition. Beijing: Scientific and technical documentation press. Fischer N, Soraisham A, Shah PS, et al. Extensive cardiopulmonary resuscitation of preterm neonates at birth and mortality and developmental outcomes. Resuscitation. 2019;135:57–65. Goel D, D’cruz D, Jani P. Outcomes of infants born at borderline viability (23–25 weeks gestation) who received cardiopulmonary resuscitation at birth. J Paediatr Child Health. 2019;55:399–405. Ng KF, Choo P, Paramasivam U, et al. Reduction of intubation rate during newborn resuscitation after transition from self-inflating bag to T-piece resuscitator. Med J Malaysia. 2015;70:228–31. Ferreira CH, Carmona F, Martinez FE. Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns. J Pediatr (Rio J). 2014;90:316–22. Scholl JE, Yanowitz TD. Pulmonary hemorrhage in very low birth weight infants: a case-control analysis. J Pediatr. 2015;166:1083–4. Ahmad KA, Bennett MM, Ahmad SF, et al. Morbidity and mortality with early pulmonary haemorrhage in preterm neonates. Arch Dis Child Fetal Neonatal Ed. 2019;104:F63–68. Hafström M, Källén K, Serenius F, et al. Cerebral palsy in extremely preterm infants. Pediatrics. 2018;141:e20171433. Serenius F, Ewald U, Farooqi A, et al. Neurodevelopmental outcomes among extremely preterm infants 6.5 years after active perinatal care in Sweden. JAMA Pediatr. 2016;170:954–63. Kitsommart R, Nakornchai K, Yangthara B, et al. Positive end-expiratory pressure during resuscitation at birth in very-low birth weight infants: a randomized-controlled pilot trial. Pediatr Neonatol. 2018;59:448–54. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6781961","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485592472,"identity":"85bda0bf-487e-41a1-818b-96e50adab5af","order_by":0,"name":"Qingqing Wang","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qingqing","middleName":"","lastName":"Wang","suffix":""},{"id":485592473,"identity":"fee1649f-3af9-4dab-8f13-345a5afa1d4e","order_by":1,"name":"Meihua Piao","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Meihua","middleName":"","lastName":"Piao","suffix":""},{"id":485592474,"identity":"541bcb1e-d2a8-44a2-9b2f-d700e7194c55","order_by":2,"name":"Tongyan Han","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYBCDBAYG5gPEKeVBaGFLIFkLjwFxWuzZew+/5qm5k8c/u+fjjTcMdnK6DYRs4TmXZs1z7FmxxJ2zmy3nMCQbmx0gpEUix8yYh+1wYsON3G3SPAwHErcRp+Xf4cT5N3KeEa3F+DFv2+HEDTdy2IjUcuaMGePcvsOJG2+kGVvOMSDCL+ztPcYf3nw7nDjvRvLDG28q7OQIagECNilY5EgQGzXMH3/AtRCnYxSMglEwCkYYAADWzUOPlvTEZgAAAABJRU5ErkJggg==","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":true,"prefix":"","firstName":"Tongyan","middleName":"","lastName":"Han","suffix":""}],"badges":[],"createdAt":"2025-05-30 07:08:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6781961/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6781961/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87047362,"identity":"76f1a7eb-0af7-4f8f-8f66-15d836de6da0","added_by":"auto","created_at":"2025-07-18 14:42:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":5713,"visible":true,"origin":"","legend":"\u003cp\u003eThis image is not available with this version.\u003c/p\u003e","description":"","filename":"placeholderimage.png","url":"https://assets-eu.researchsquare.com/files/rs-6781961/v1/a030c03a1eb74fa6fb97db8d.png"},{"id":109168037,"identity":"0359780c-bd84-4a76-97db-431350e79276","added_by":"auto","created_at":"2026-05-13 08:31:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":313483,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6781961/v1/2ddf540a-d4f7-4012-9219-68ff7f274b28.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of T-piece resuscitator and self-inflating bag in neonatal resuscitation for extremely preterm infants","fulltext":[{"header":"Background","content":"\u003cp\u003eIt is estimated that 10% of newborn infants need help to begin breathing at birth and approximately 1% need intensive resuscitative measures to restore cardiorespiratory function \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In a study by Niles et al.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, approximately 6% of newborns needed positive-pressure ventilation after birth to maintain respiratory and circulatory stability. Extremely preterm infants are preterm infants with a gestational age (GA) of \u0026lt;\u0026thinsp;28 weeks. Due to their early GA and low birthweight, a high proportion of infants need positive-pressure ventilation at birth (60\u0026ndash;95%) \u003csup\u003e\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Self-inflating bags and T-pieces are the most common positive-pressure ventilation devices during resuscitation. Self-inflating bags without a compressed air source are easy to use. The T-piece requires a compressed air source when used, however, it can provide constant peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP). Extremely preterm infants with immature lung development, poor elasticity of the lung tissue, and lack of pulmonary surfactant are prone to alveolar collapse.\u003c/p\u003e\u003cp\u003eStudies on newborn animals \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e have shown that PEEP can promote lung ventilation, increase functional residual volume, prevent distal airway collapse, increase lung surface area and compliance, reduce expiratory resistance, protect lung surfactant, and reduce hyaline membrane formation, alveolar collapse, and expression of proinflammatory mediators. Some studies have found that the use of a T-piece can reduce the rate of tracheal intubation, but the average GA of the patients is \u0026ge;\u0026thinsp;28 weeks \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Few studies have been conducted in extremely preterm infants. In a study by Dawson et al.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, there was no difference in SpO\u003csub\u003e2\u003c/sub\u003e at 5 min among preterm infants with GA\u0026thinsp;\u0026lt;\u0026thinsp;29 weeks who require a T-piece or self-inflating bag for positive-pressure ventilation at birth. Guinsburg et al.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e found that the use of a T-piece during resuscitation of preterm infants with GA of 23\u0026ndash;33 weeks increases their chances of survival to hospital discharge. The purpose of this study was to compare the application of a T-piece and a self-inflating bag during resuscitation on the resuscitation process and outcome of extremely preterm infants to provide a basis for resuscitation of extremely preterm infants.\u003c/p\u003e"},{"header":"Method and object","content":"\u003cp\u003eA retrospective chart review was conducted for all extremely preterm infants with GA\u0026thinsp;\u0026lt;\u0026thinsp;28 weeks born at Peking University Third Hospital between January 1, 2010 and December 31, 2021. This study was approved by Peking University Third Hospital Research Ethics Committee (IRB 00006761-M2021255), and all research components adhered to institutional ethical human research guidelines. The need for informed consent was waived owing to the retrospective nature of the study.\u003c/p\u003e\u003cp\u003eMedical records were identified using the electronic medical record system of our hospital using the following search criteria: GA\u0026thinsp;\u0026lt;\u0026thinsp;28 weeks and date of birth within the study period. The exclusion criteria of this study included: births outside the hospital, absence of positive-pressure ventilation during resuscitation and congenital conditions affecting neonatal resuscitation, such as congenital heart disease, chromosomal abnormalities, genetic disorders, or inherited metabolic diseases.\u003c/p\u003e\u003cp\u003eDemographic, maternal, and postnatal data were collected. The TPR group received positive-pressure ventilation with a T-piece (Fisher ༆ Paykel Healthcare Ltd) during resuscitation ( PIP setting 15\u0026ndash;20 cmH\u003csub\u003e2\u003c/sub\u003e0, PEEP setting 5\u0026ndash;6 cmH\u003csub\u003e2\u003c/sub\u003e0, RR 40\u0026ndash;60 times/min, FiO\u003csub\u003e2\u003c/sub\u003e setting 30\u0026ndash;40% ). The SIB group consisted of patients who used a self-inflating bag (which did not have a manometer or PEEP valve) for positive-pressure ventilation during resuscitation (FiO\u003csub\u003e2\u003c/sub\u003e setting 30\u0026ndash;40%, RR 40\u0026ndash;60 times/min). Both groups gradually increased the oxygen concentration according to the percutaneous oxygen saturation of the newborn. Resuscitation operator shall perform chest compression, tracheal intubation and other operations according to the neonatal resuscitation process.Outcomes included the resuscitation process in the delivery room and the neonatal outcomes.\u003c/p\u003e\u003cp\u003eThe resuscitation process included a 1-min Apgar score, 5-min Apgar score, positive-pressure ventilation, intubation, chest compressions, use of epinephrine (either intravenous or endotracheal), and fluid resuscitation. Neonatal outcomes included neonatal respiratory distress syndrome (NRDS), pulmonary haemorrhage within seven days, pneumothorax, early-onset sepsis (EOS), late-onset sepsis ( LOS), intrauterine infectious pneumonia, nosocomial pneumonia, haemodynamically significant patent ductus arteriosus (HsPDA), severe intraventricular haemorrhage (IVH, grade 3 or 4), cerebral white matter injury, hydrocephalus, necrotising enterocolitis (NEC, Bell stage II or greater), heart failure, renal failure, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), mechanical ventilation time, Ventilator application time, death within seven days, improvement and discharge. IVH, cerebral white matter injury and hydrocephalus were monitored by ultrasound. BPD was defined as the use of supplemental oxygen at 36 weeks corrected GA. Refer to the \u003cem\u003eAvery\u0026rsquo;s Diseases of the Newborn\u003c/em\u003e (10th) \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e for the diagnostic criteria for neonatal-related diseases. The diagnostic criteria for perinatal complications were based on the \u003cem\u003eWilliams Obstetrics, 25th Edition\u003c/em\u003e \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Sufficient dexamethasone before delivery refers to intramuscular injection of dexamethasone 6 mg/time for more than 24 h and less than 7 days before delivery (repeated every 12 h, 4 times in total).\u003c/p\u003e\u003cp\u003eStatistical software (SPSS 25.0, IBM, Armonk, NY) was used for data processing. The measurement data of normal distribution were described as \u003cem\u003ex\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003es\u003c/em\u003e, and the \u003cem\u003et\u003c/em\u003e-test of two independent samples was used for comparison between groups. Quantitative data with a skewed distribution were expressed as median (quartile) [P50 (P25, p75)], and the rank-sum test was used for comparison between groups. Count data were described by frequency and rate, and comparisons between groups were performed using the \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e test or Fisher\u0026rsquo;s exact probability method. The risk factors were analysed using binary logistic regression. Statistical significance was set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAccording to the inclusion criteria, 220 extremely preterm infants were included in this study, and 17 patients transferred from other hospitals, 33 patients had no indication of positive pressure ventilation after initial resuscitation were excluded. A total of 170 extremely preterm infants met the criteria, including 111 cases (65.3%) in the TPR group and 59 cases (34.7%) in the SIB group. GA ranged from 23\u003csup\u003e+\u0026thinsp;2\u003c/sup\u003e to 27\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e weeks, with an average of 26.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 weeks. Figure\u0026nbsp;1 shows the proportions of different GAs in both groups. Birth weight ranged from 500 g to 1400 g, and the average birthweight was 893.2\u0026thinsp;\u0026plusmn;\u0026thinsp;173.3 g. There were 93 male infants (54.7%) and 35 caesarean births (20.6%). The proportion of caesarean section in the TPR group (25.2%) was significantly higher than that in the SIB group (11.9%). There were no significant differences between the two groups in gestational age, birthweight, terms of sex, age of mother, assisted birth, twins, small for GA, foetal distress, premature rupture of membranes, gestational thyroid disease, or the proportion of sufficient dexamethasone before delivery. The details of all included patients are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics for study population\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTPR Group\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;111\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSIB Group\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;59\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational age (\u003cem\u003ex\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003es\u003c/em\u003e, weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.092\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirthweight (\u003cem\u003ex\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003es\u003c/em\u003e, g)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e876.6\u0026thinsp;\u0026plusmn;\u0026thinsp;177.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e924.6\u0026thinsp;\u0026plusmn;\u0026thinsp;162.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.085\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 (53.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (57.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.577\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaesarean section (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (25.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (11.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMother\u0026rsquo;s age\u0026thinsp;\u0026gt;\u0026thinsp;35 years (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (37.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.773\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssisted birth (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48 (43.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (40.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.747\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTwins (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55 (49.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.961\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall for gestational age (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (12.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.119\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFoetal distress (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.833\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePremature rupture of membranes (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (36.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (42.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.418\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational diabetes (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (24.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (13.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational hypertension (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (24.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (15.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.168\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational thyroid disease (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (12.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.638\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSufficient dexamethasone before delivery (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (36.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (32.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.539\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThere were no significant differences between the TPR and SIB groups in the proportion of 1-min Apgar score\u0026thinsp;\u0026le;\u0026thinsp;7, 5-min Apgar score\u0026thinsp;\u0026le;\u0026thinsp;7, positive-pressure ventilation, intubation, chest compression, adrenaline, or fluid expansion (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe differences of the Recovery process between the TPR and SIB groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;170\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTPR Group\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;111\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSIB Group\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;59\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1-min Apgar score\u0026thinsp;\u0026le;\u0026thinsp;7 (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e111 (65.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73 (65.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38 (64.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.859\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5-min Apgar score\u0026thinsp;\u0026le;\u0026thinsp;7 (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55 (32.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39 (35.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16 (27.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.288\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTracheal intubation (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e146 (85.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e97 (87.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e49 (83.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.440\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChest compression (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29 (17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21 (18.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8 (13.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.376\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdrenaline (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26 (15.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (18.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6 (10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.176\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFluid expansion (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15 (8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (8.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6 (10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.652\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe incidence of pulmonary haemorrhage was lower in the TPR group than in the SIB group (17.1% vs. 32.2%). The incidence of cerebral white matter injury was lower in the TPR group than in the SIB group (26.1% vs. 47.5%). There were no significant differences in NRDS, pneumothorax, EOS, LOS, intrauterine infectious pneumonia, nosocomial pneumonia, HsPDA, severe IVH, hydrocephalus, NEC, heart failure, renal failure, ROP, BPD, mechanical ventilation time, ventilator application time, death within 7 days, improvement, or discharge between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe differences of the patient outcomes between the TPR and SIB groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTPR Group\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;111\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSIB Group\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;59\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNRDS (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100 (90.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58 (98.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.094\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePulmonary haemorrhage (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19 (17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (32.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePneumothorax (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.508\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEOS (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13 (11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.746\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLOS (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24 (21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (13.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.191\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntrauterine infectious pneumonia (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25 (22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (18.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.537\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNosocomial pneumonia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34 (30.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (27.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.670\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHsPDA (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67 (60.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (57.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.730\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere IVH (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15 (13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.332\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCerebral white matter injury (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29 (26.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHydrocephalus (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.210\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNEC (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.591\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart failure (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (11.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.114\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRenal failure (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eROP (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30(46.2)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (39.3)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.933\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBPD (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (24.6)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (17.9)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.475\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMechanical ventilation time (h)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e168.0 (79.5, 408.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e252.0 (54.0, 564.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.306\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVentilator application time (h)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1388.0 (1056.0, 1645.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1200.0 (900.0, 1404.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath within 7 days (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (22.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.209\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImprovement and discharge (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65 (58.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.166\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*The incidence of ROP and BPD was the total number of patients / the number of patients improved and discharged\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe binary logistic regression results showed that the application of the T-piece resuscitator during resuscitation may be a protective factor for pulmonary haemorrhage (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) and against cerebral white matter injury in extremely preterm infants (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBinary logistic regression analysis of risk factors of pulmonary haemorrhage\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eWald\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT-piece\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.905\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.610\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.422\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePulmonary haemorrhage was considered the independent variable, and the use of T-pieces during resuscitation, gestational age, birthweight, male sex, caesarean section, maternal age\u0026thinsp;\u0026gt;\u0026thinsp;35 years, assisted birth, twins, small for gestational age, foetal distress, premature rupture of membranes, gestational diabetes, gestational hypertension, gestational thyroid disease, and adequate dexamethasone before delivery were used as covariates.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBinary logistic regression analysis of risk factors of cerebral white matter injury\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eWald\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT-piece\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.876\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.678\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCerebral white matter injury was considered the independent variable, and the use of T-pieces during resuscitation, gestational age, birthweight, male sex, caesarean section, maternal age\u0026thinsp;\u0026gt;\u0026thinsp;35 years, assisted birth, twins, small for gestational age, foetal distress, premature rupture of membranes, gestational diabetes, gestational hypertension, gestational thyroid disease, and adequate dexamethasone before delivery were used as covariates.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this cohort of 170 extremely preterm infants, we observed that the proportions of extremely preterm infants requiring tracheal intubation, chest compression, and adrenaline during resuscitation were 85.9%, 17.1%, and 15.3%, respectively. In the study by Fischer et al. \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, the proportion of premature infants with GA\u0026thinsp;\u0026lt;\u0026thinsp;29 weeks receiving delivery room-extended cardiovascular resuscitation (DR-CPR) was 9.2%. In a study by Goel et al. \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, the proportion of extremely preterm infants with a GA of 23\u0026ndash;25 weeks who received DR-CPR at birth was 17.1%. The proportion of extremely preterm infants who need resuscitation after birth is high. Before the delivery of extremely preterm infants, it is necessary to prepare the manpower and equipment for resuscitation and prepare every link in the resuscitation process.\u003c/p\u003e\u003cp\u003eThakur et al. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e found that the use of a T-piece resuscitator during resuscitation can reduce the rate of intubation in neonates. In a study by Szyld et al. \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, the intubation rate of the T-piece group in the delivery room was significantly lower than that of the self-inflating bag group (17% vs. 26%). Ng et al. \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e also found that the application of a T-piece in the delivery room can reduce the intubation rate of newborns from 48.3\u0026ndash;35.1%. However, the patients in the above study were mainly term and premature infants. Our study did not find any difference in the intubation rate between the two groups, which may be related to the fact that the patients in this study were all extremely preterm infants, and their lungs and respiratory centres were immature.\u003c/p\u003e\u003cp\u003ePulmonary haemorrhage is a serious complication in neonates that can increase mortality \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. A multicentre study in the United States \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e showed that the incidence rate of pulmonary haemorrhage in extremely preterm infants was 0.5%, with a peak incidence of 86.9 cases per 1000 admissions for neonates born at 24 weeks of gestation, and early pulmonary haemorrhage was associated with significant morbidity and mortality in excess of 50%. In this study, the incidence of pulmonary haemorrhage in extremely preterm infants receiving the T-piece during resuscitation was lower than that in the control group. Regression analysis showed that the application of the T-piece during resuscitation may be a protective factor against pulmonary haemorrhage in extremely preterm infants.\u003c/p\u003e\u003cp\u003eInjury to the white matter of the brain in premature infants can lead to sequelae in the nervous system, such as cerebral palsy, visual impairment, and cognitive impairment. The incidence of cerebral palsy in extremely preterm infants can be as high as 9.5\u0026ndash;10.5% \u003csup\u003e21,22\u003c/sup\u003e, and among these, cerebral white matter injury is a very important cause. In this study, the incidence of cerebral white matter injury in extremely preterm infants receiving the T-piece during resuscitation was lower than that in the control group. The application of a T-piece during resuscitation may be a protective factor against cerebral white matter injury. This may be because the T-piece can provide constant PIP and PEEP, resulting in small fluctuations in blood flow. Further research is required to confirm this mechanism.\u003c/p\u003e\u003cp\u003eIn this study, there were no significant differences in NRDS, severe BPD, mechanical ventilation time, and ventilator application time between the T-piece application and control groups. Kitsommart et al. \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e studied whether PEEP was applied during the resuscitation of preterm infants with GA\u0026thinsp;\u0026le;\u0026thinsp;32 weeks or very low-birthweight infants and found no difference in the application of pulmonary surfactant, pneumothorax, oxygen dependence at 36 weeks, or death by GA between the two groups.\u003c/p\u003e\u003cp\u003eIn this study, we found that the application of a T-piece in the resuscitation of extremely preterm infants may be a protective factor for pulmonary haemorrhage and cerebral white matter injury. However, this study still has some limitations. Because this is a retrospective study, the proportion of caesarean section in the application group was higher than that in the control group, which may have some impact on the results. In addition, this study did not further investigate the mechanism of reducing pulmonary haemorrhage and cerebral white matter injury by using a T-piece during resuscitation of extremely preterm infants. Further research is needed to confirm our findings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe application of a T-piece resuscitation in the resuscitation of extremely preterm infants may be a protective factor for pulmonary haemorrhage and cerebral white matter injury and may be beneficial to the early outcome and long-term prognosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge Hua Zhang, The Clinical Epidemiology Research Center of Peking University Third Hospital, who provided guidance on statistical analysis. We also thank all extremely preterm infants and their parents included in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003econtributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQingqing Wang\u003c/strong\u003e:\u0026nbsp;Conceptualisation, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data Curation, Funding acquistion, Resources, Writing - Original Draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeihua Piao:\u0026nbsp;\u003c/strong\u003eConceptualisation, Methodology, Data Curation, Validation, Formal analysis, Supervision, Project administration, Writing - Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTongyan Han:\u0026nbsp;\u003c/strong\u003eConceptualisation, Methodology, Software, Validation, Data Curation, Visualisation, Supervision, Funding acquistion, Project administration, Writing - Review \u0026amp; Editing,.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Clinical Cohort Construction Program of Peking University Third Hospital (Grant No. BYSYDL2022010 and BYSYDL2024012).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo protect study participant privacy, data and materials will be made available on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by Peking University Third Hospital Research Ethics Committee (IRB 00006761-M2021255), and all research components adhered to institutional ethical human research guidelines. The need for informed consent was waived owing to the retrospective nature of the study.This study adhered to the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAziz K, Lee HC, Escobedo MB, et al. Part 5: neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142:S524\u0026ndash;550.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNiles DE, Cines C, Insley E, et al. Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital. Resuscitation. 2017;115:102\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSerenius F, Ewald U, Farooqi A, et al. Short-term outcome after active perinatal management at 23\u0026ndash;25 weeks of gestation. A study from two Swedish perinatal centres. Part 3: neonatal morbidity. Acta Paediatr. 2004;93:1090\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWalsh MC, Morris BH, Wrage LA, et al. Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes. J Pediatr. 2005;146:798\u0026ndash;804.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGagliardi L, Bell\u0026ugrave; R, Zanini R, et al. Network Neonatale Lombardo Study Group. Bronchopulmonary dysplasia and brain white matter damage in the preterm infant: a complex relationship. Paediatr Perinat Epidemiol. 2009;23:582\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSoll RF, Edwards EM, Badger GJ, et al. Obstetric and neonatal care practices for infants 501 to 1500 g from 2000 to 2009. Pediatrics. 2013;132:222\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSiew ML, Te Pas AB, Wallace MJ, et al. Positive end-expiratory pressure enhances development of a functional residual capacity in preterm rabbits ventilated from birth. J Appl Physiol (1985). 2009;106:1487\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eProbyn ME, Hooper SB, Dargaville PA, et al. Positive end expiratory pressure during resuscitation of premature lambs rapidly improves blood gases without adversely affecting arterial pressure. Pediatr Res. 2004;56:198\u0026ndash;204.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThakur A, Saluja S, Modi M, et al. T-piece or self inflating bag for positive pressure ventilation during delivery room resuscitation: an RCT. Resuscitation. 2015;90:21\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSzyld E, Aguilar A, Musante GA, et al. Delivery Room Ventilation Devices Trial Group. Comparison of devices for newborn ventilation in the delivery room. J Pediatr. 2014;165:234\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDawson JA, Schm\u0026ouml;lzer GM, Kamlin CO, et al. Oxygenation with T-piece versus self-inflating bag for ventilation of extremely preterm infants at birth: a randomized controlled trial. J Pediatr. 2011;158:912\u0026ndash;e9181.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuinsburg R, de Almeida MFB, de Castro JS, et al. T-piece versus self-inflating bag ventilation in preterm neonates at birth. Arch Dis Child Fetal Neonatal Ed. 2018;103:F49\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGleason CA, Juul SE. Avery's diseases of the newborn: Tenth edition. Amsterdam: Elsevier; 2017. p. 1656.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eF.Gary Cunningham. 2019. Williams Obstetrics, 25th Edition. Beijing: Scientific and technical documentation press.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFischer N, Soraisham A, Shah PS, et al. Extensive cardiopulmonary resuscitation of preterm neonates at birth and mortality and developmental outcomes. Resuscitation. 2019;135:57\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoel D, D\u0026rsquo;cruz D, Jani P. Outcomes of infants born at borderline viability (23\u0026ndash;25 weeks gestation) who received cardiopulmonary resuscitation at birth. J Paediatr Child Health. 2019;55:399\u0026ndash;405.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNg KF, Choo P, Paramasivam U, et al. Reduction of intubation rate during newborn resuscitation after transition from self-inflating bag to T-piece resuscitator. Med J Malaysia. 2015;70:228\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFerreira CH, Carmona F, Martinez FE. Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns. J Pediatr (Rio J). 2014;90:316\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScholl JE, Yanowitz TD. Pulmonary hemorrhage in very low birth weight infants: a case-control analysis. J Pediatr. 2015;166:1083\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmad KA, Bennett MM, Ahmad SF, et al. Morbidity and mortality with early pulmonary haemorrhage in preterm neonates. Arch Dis Child Fetal Neonatal Ed. 2019;104:F63\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHafstr\u0026ouml;m M, K\u0026auml;ll\u0026eacute;n K, Serenius F, et al. Cerebral palsy in extremely preterm infants. Pediatrics. 2018;141:e20171433.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSerenius F, Ewald U, Farooqi A, et al. Neurodevelopmental outcomes among extremely preterm infants 6.5 years after active perinatal care in Sweden. JAMA Pediatr. 2016;170:954\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKitsommart R, Nakornchai K, Yangthara B, et al. Positive end-expiratory pressure during resuscitation at birth in very-low birth weight infants: a randomized-controlled pilot trial. Pediatr Neonatol. 2018;59:448\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"extremely preterm neonates, T-piece, resuscitation, outcome","lastPublishedDoi":"10.21203/rs.3.rs-6781961/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6781961/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eExtremely preterm infants (\u0026lt;28 weeks gestational age) frequently require positive-pressure ventilation at birth. This study compared resuscitation outcomes between T-piece resuscitators (TPR) and self-inflating bags (SIB) in this population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eCases of extremely preterm infants born at our hospital and transferred to the neonatal intensive care unit between January 1, 2010 and December 31, 2021 were retrospectively collected. According to the application of TPR and SIB during the recovery process, the patients were divided into TPR group (n=111) and SIB group (n=59). The resuscitation process and outcomes were compared between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eAmong 170 infants (TPR=111, SIB=59), TPR use was associated with significantly lower incidences of pulmonary hemorrhage (17.1% vs. 32.2%, \u003cem\u003eP\u003c/em\u003e=0.025) and cerebral white matter injury (26.1% vs. 47.5%, \u003cem\u003eP\u003c/em\u003e=0.005). Logistic regression confirmed TPR as a protective factor for both outcomes (OR=0.422 and 0.368, \u003cem\u003eP \u003c/em\u003e\u0026lt;0.05). There were no significant differences in the recovery process between the two groups (\u003cem\u003eP\u0026gt;\u003c/em\u003e0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eThe application of a T-piece resuscitator in the resuscitation of extremely preterm infants may be a protective factor for pulmonary haemorrhage and cerebral white matter injury and may be beneficial to the early outcome and long-term prognosis.\u003c/p\u003e","manuscriptTitle":"Comparison of T-piece resuscitator and self-inflating bag in neonatal resuscitation for extremely preterm infants","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 14:42:18","doi":"10.21203/rs.3.rs-6781961/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c7ba7a13-c236-4932-9b75-3ec2589131e3","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Withdrawn","date":"2026-05-13T08:07:30+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T08:27:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 14:42:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6781961","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6781961","identity":"rs-6781961","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}