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Our objective was to conduct a systematic review and meta-analysis evaluating the effects of administering positive end-expiratory pressure (PEEP) during neonatal resuscitation at birth. Medline, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov databases were systematically searched from inception to 15 December 2020. Randomized controlled trials and cohort studies were held eligible. Studies were included if they compared the administration of PEEP using either a T-piece resuscitator or a self-inflating bag with a PEEP valve versus resuscitation via a self-inflating bag without a PEEP valve. Data were extracted by two reviewers independently. The credibility of evidence was appraised with the Grading of Recommendations, Assessment, Development, and Evaluations approach. Random-effects models were fitted to provide pooled estimates of risk ratio (RR) and 95% confidence intervals (CIs). Overall, 10 studies were included, comprising 4,268 neonates. This included five randomized controlled trials, one quasi-randomized trial, and four cohort studies. The administration of PEEP was associated with significantly lower rates of mortality till discharge (odds ratio [OR]: 0.60, 95% CI: 0.49–0.74, moderate quality of evidence). The association was significant in preterm (OR: 0.57, 95% CI: 0.46–0.69) but not in term (OR: 1.03, 95% CI: 0.52–2.02) neonates. Low-to-moderate quality evidence suggests that providing PEEP during neonatal resuscitation is associated with lower rates of mortality in preterm neonates. Evidence regarding term neonates is limited and inconclusive. Future research is needed to determine the optimal device and shed more light on the long-term effects of PEEP administration during neonatal resuscitation. This study is registered with PROSPERO with registration number: CRD42020219956. Key Points PEEP administration during neonatal resuscitation in the delivery room reduces mortality in preterm. Evidence regarding term neonates is limited and inconclusive. Future research is needed to determine the optimal device. [ABSTRACT FROM AUTHOR]

Respiratory distress in neonatal period is of diverse etiology and require timely diagnosis and treatment for a good outcome. This study was aimed to determine the outcome of neonates having respiratory distress admitted in the NICU of a tertiary care hospital. Methods This prospective study was conducted in the neonatal intensive care unit of Dr. M R Khan Shishu Hospital & ICH, from July 2021 to June 2022. Neonates presented with signs of respiratory distress were enrolled in the study. History, examination and investigations were performed to find out various etiologies. Neonates were managed accordingly and were followed up to hospital stay. Primary outcome was measured in terms of discharge and death, and secondary outcomes were pattern of respiratory supports required. Data was analyzed using SPSS 20. Results Among 1225 admitted newborns, 720 (59%) had respiratory distress. Mean gestational age was 37.54 ± 2.1 weeks and mean birth weight was 2692.96 ± 651 g. Common causes of respiratory distress were sepsis (35.4%) and perinatal asphyxia (27%) followed by transient tachypnea of newborn (11.4%). Most of the babies required only nasal oxygen support (72%) and 15% were treated with CPAP and 8% got mechanical ventilator. Mortality rate was 2.5% and congenital pneumonia was significantly associated with neonatal death (p=0.02). Conclusion The common causesfor respiratory distress were sepsis, asphyxia, TTNB, RDS, MAS and congenital pneumonia. Congenital pneumonia was significantly associated with mortality [ABSTRACT FROM AUTHOR]