{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T23:31:40Z","timestamp":1788823900975,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T00:00:00Z","timestamp":1739404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Current resuscitation guidelines recommend a 3:1 chest compression\/ventilation (C:V) ratio, which is associated with high morbidity and mortality. An alternative might be continuous chest compression superimposed with high distending pressure or sustained inflation (CC + SI). Objective: To compare CC + SI with 3:1 C:V during neonatal cardiopulmonary resuscitation (CPR). Methods: MEDLINE (through PubMed), Google Scholar, EMBASE, and Clinical Trials.gov through June 2024. Randomized controlled trials comparing CC + SI with 3:1 C:V during neonatal CPR in the delivery room were included. Data Analysis included Risk of bias was assessed using the Covidence collaboration tool, and results were pooled into a meta-analysis using a fixed effects model. Main outcomes were In-hospital mortality (primary). Time to return of spontaneous circulation (ROSC) and air leak (secondary). Results: Two studies were included. The pooled data suggests no difference in infant mortality between CC + SI versus 3:1 C:V during neonatal CPR (RR 0.64, 95% CI 0.21,1.7, p = 0.33, I2 = 63%). The use of CC + SI during neonatal CPR could result in 182 fewer per 1000 (from 351 fewer to 311 more) infant deaths. The pooled data suggested a significant reduction in time to ROSC with CC + SI versus 3:1 C:V during neonatal CPR (mean difference 115 s (from 184.75 to 45.36 s), p = 0.001, I2 = 26%). Air leak was not different between groups. Conclusions: While in-hospital mortality and air leak were not different between groups, time to ROSC was significantly reduced. A large clinical trial is warranted to assess if CC + SI improves outcomes.<\/jats:p>","DOI":"10.3390\/children12020230","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T12:06:32Z","timestamp":1739448392000},"page":"230","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Chest Compression Superimposed with Sustained Inflation or 3:1 Compression\/Ventilation Ratio During Neonatal Cardiopulmonary Resuscitation in the Delivery Room: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"12","author":[{"given":"Jenny","family":"Koo","sequence":"first","affiliation":[{"name":"Sharp Mary Birch Hospital for Women and Newborns, Neonatal Research Institute, San Diego, CA 92123, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anup C.","family":"Katheria","sequence":"additional","affiliation":[{"name":"Sharp Mary Birch Hospital for Women and Newborns, Neonatal Research Institute, San Diego, CA 92123, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4819-9253","authenticated-orcid":false,"given":"Brenda","family":"Law","sequence":"additional","affiliation":[{"name":"Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB T5H 3V9, Canada"},{"name":"Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8009-7169","authenticated-orcid":false,"given":"Anne Lee","family":"Solev\u00e5g","sequence":"additional","affiliation":[{"name":"Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital Rikshospitalet, 0372 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2405-7143","authenticated-orcid":false,"given":"Gerhard","family":"Pichler","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9798-2415","authenticated-orcid":false,"given":"Georg M.","family":"Schm\u00f6lzer","sequence":"additional","affiliation":[{"name":"Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB T5H 3V9, Canada"},{"name":"Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S524","DOI":"10.1161\/CIR.0000000000000902","article-title":"Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"142","author":"Aziz","year":"2020","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S185","DOI":"10.1161\/CIR.0000000000000895","article-title":"Neonatal Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations","volume":"142","author":"Wyckoff","year":"2020","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.resuscitation.2021.05.029","article-title":"Epidemiology and Outcomes of Infants after Cardiopulmonary Resuscitation in the Neonatal or Pediatric Intensive Care Unit from a National Registry","volume":"165","author":"Handley","year":"2021","journal-title":"Resuscitation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.resuscitation.2016.10.012","article-title":"Incidence, Characteristics, and Survival Following Cardiopulmonary Resuscitation in the Quaternary Neonatal Intensive Care Unit","volume":"110","author":"Foglia","year":"2017","journal-title":"Resuscitation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e20201449","DOI":"10.1542\/peds.2020-1449","article-title":"Duration of Resuscitation at Birth, Mortality, and Neurodevelopment: A Systematic Review","volume":"146","author":"Foglia","year":"2020","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/0002-9149(81)90320-9","article-title":"Augmentation of Carotid Flow during Cardiopulmonary Resuscitation by Ventilation at High Airway Pressure Simultaneous with Chest Compression","volume":"48","author":"Chandra","year":"1981","journal-title":"Am. 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