473 - Systematic Review and Meta-Analysis of Interfaces (Nasal prongs/Mask/Cannulae versus Face Masks) in Newborn Infants Receiving Respiratory Support at Birth

Publication Number: 1455.473

Emediong E.. Idung, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Megan O'Reilly, University of Alberta, Edmonton, AB, Canada; Chelsea Morin, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Georg Schmolzer, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada

Background: 10-20% of newborn infants require respiratory support at birth. Positive pressure ventilation (PPV) is mainly provided via face mask. An alternative might be a nasal prongs. We performed a systematic review and meta-analysis of randomized trials comparing face mask versus nasopharyngeal tube, nasal prong/mask/cannulae during PPV at birth.

Objective: Systematic Review and Meta-Analysis To update the initially published meta-analysis from January 2021 which compared PPV interfaces for infants receiving respiratory support at birth and to investigate how nasal interfaces (prongs/mask/cannulae) impact mortality in neonates < 37 weeks' gestation receiving respiratory support at birth as compared to face mask interface.

Design/Methods: Data Sources: A systematic search of PubMed, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials databases to identify completed and ongoing studies from inception to October 2025.
Study Selection: Only randomized controlled trials (RCTs) comparing nasal interfaces (prongs/mask/cannulae/nasopharyngeal tube) versus face mask during PPV of newborn infants < 37 weeks' gestation in the delivery room were included.
Data analysis: Cochrane risk of bias collaboration tool was used for assessment of included studies, and results were presented in a meta-analysis using a random effect analysis model.
Main Outcome: Neonatal death < 28 days and Death before discharge.

Results: A total of seven RCTs enrolling 1270 newborn infants were pooled into this meta-analysis. There was no statistically significant difference in neonatal death ( < 28 days) or death before discharge both groups (RR = 0.84, 95% CI 0.57 to 1.23; Z = 0.90, P = 0.37, I2 = 0%), rate of IVH grade 3/4 (RR = 1.07, 95% CI 0.60-1.89; Z = 0.22; P = 0.83; I² = 28%), rate of air leaks (pneumothoraxes) - (RR = 0.81, 95% CI 0.32-2.04; Z = 0.45; P = 0.66; I² = 47%). Delivery room intubations for newborn infants indicates a statistically significant difference favoring nasal interfaces (RR = 0.68, 95% CI 0.51-0.90; Z = 2.68; P = 0.007; I² = 32%).

Conclusion(s): In newborn infants born at < 37 weeks' GA, there was no difference in neonatal death ( < 28 days) or death before discharge between infants who received PPV via a face mask or nas interfaces at birth. However, in newborn infants ( < 37 weeks' GA), the use of a nasal interface was associated with less delivery room intubation.

Forrest plots
Fig. 1 - Neonatal death < 28 days and death before discharge
Fig. 2 - Intubation in the DR