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38 (95% confidence interval = 1.00-1.91). Together, these findings suggest the potential for harm of SI. The certainty of evidence was very low for death in the delivery room and low for all other outcomes. In this systematic review, we did not find benefit in using 1 or more SI 5 seconds for preterm infants at birth. SI(s) may increase death before discharge among the subgroup born ≤28 + 0 weeks' gestation. There is insufficient evidence to determine the likely effect of SI(s) on other key morbidities. 5 seconds for preterm infants