Article Text
Abstract
Introduction As gestational age decreases, incidence of bronchopulmonary dysplasia (BPD) and chronic lung disease increases. There are many interventions used in the delivery room to prevent acute lung injury and consequently BPD in these patients. The availability of different treatment options often poses a practical challenge to the practicing neonatologist when it comes to making an evidence-based choice as the multitude of pairwise systematic reviews including Cochrane reviews that are currently available only provide a narrow perspective through head-to-head comparisons.
Methods and analysis We will conduct a systematic review of all randomised controlled trials evaluating delivery room interventions within the first golden hour after birth for prevention of BPD. The primary outcome includes BPD. Secondary outcomes include death at 36 weeks of postmenstrual age or before discharge; severe intraventricular haemorrhage (grade 3 or 4 based on the Papile criteria); any air leak syndromes (including pneumothorax or pulmonary interstitial emphysema); retinopathy of prematurity (any stage) and neurodevelopmental impairment at 18–24 months. We will search from their inception to August 2018, the following databases: Medline, EMBASE and Cochrane Central Register of Controlled Trials as well as grey literature resources. Two reviewers will independently screen titles and abstracts, review full texts, extract information and assess the risk of bias and the confidence in the estimate (with Grading of Recommendations Assessment, Development and Evaluation approach). This review will use Bayesian network meta-analysis approach which allows the comparison of the multiple delivery room interventions for prevention of BPD. We will perform a Bayesian network meta-analysis to combine the pooled direct and indirect treatment effect estimates for each outcome, effectiveness and safety of delivery room interventions for prevention of BPD.
Ethics and dissemination The proposed protocol is a network meta-analysis, which has been registered on PROSPERO International prospective register of systematic reviews (CRD42018078648). The results will provide an evidence-based guide to choosing the right sequence of early postnatal interventions that will be associated with the least likelihood of inducing lung injury and BPD in preterm infants. Furthermore, we will identify knowledge gaps and will encourage further research for other therapeutic options. Therefore, its results will be disseminated through peer-reviewed publications and conference presentations. Due to the nature of the design, no ethics approval is necessary.
- infants
- newborn
- delivery room
- bronchopulmonary dysplasia
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Footnotes
Contributors Conception and design: GS and SM; Data analysis plan: GMS, SM, GP, TD, BDS, HM, VC and KJ; Drafting of the article: GS, SM, GP, TD, BDS, HM, VC and KJ; Critical revision of the article for important intellectual content: GS, SM, GP, TD, BDS, HM, VC and KJ; Final approval of the article: GS, SM, GP, TD, BDS, HM, VC and KJ.
Funding We would like to thank the public for donating money to our funding agencies: GMS is a recipient of the Heart and Stroke Foundation/University of Alberta Professorship of Neonatal Resuscitation, a National New Investigator of the Heart and Stroke Foundation Canada and an Alberta New Investigator of the Heart and Stroke Foundation Alberta. This research has been facilitated by the Women and Children’s Health Research Institute through the generous support of the Stollery Children's Hospital Foundation.
Competing interests TD provides methodological advice for Cornerstone Research Group Inc. Cornerstone Research Group Inc. consults for various pharmaceutical and medical device companies. BD has provided device training and educational presentations to clinicians on behalf of Mallinckrodt Pharmaceuticals. GS has registered the RETAIN neonatal resuscitation board (Tech ID 2017083) and RETAIN neonatal resuscitation video game (Tech ID 2017086) under Canadian copyright, and GS is the owner of RETAIN Labs Inc. (https://www.playretain.com), which is distributing these games.
Patient consent for publication Not required.
Ethics approval Final approval of the article: GS, SM, GP, TD, BDS, HM, VC, KJ.
Provenance and peer review Not commissioned; externally peer reviewed.