Abstract
ObjectiveApplying a face mask could provoke a trigeminocardiac reflex. We compared the effect of applying bi-nasal prongs with a face mask on breathing and heart rate of preterm infants at birth. MethodsIn a retrospective matched-pairs study of infants <32 weeks of gestation, the use of bi-nasal prongs for respiratory support at birth was compared to the use of a face mask. Infants who were initially breathing at birth and subsequently received respiratory support were matched for gestational age (±4 days), birth weight (±300 g), general anaesthesia and gender. Breathing, heart rate and other parameters were collected before and after interface application and in the first 5 min thereafter. ResultsIn total, 130 infants were included (n = 65 bi-nasal prongs, n = 65 face mask) with a median (IQR) gestational age of 27+2 (25+3–28+4) vs 26+6 (25+3–28+5) weeks. The proportion of infants who stopped breathing after applying the interface was not different between the groups (bi-nasal prongs 43/65 (66%) vs face mask 46/65 (71%), p = 0.70). Positive pressure ventilation was given more often when bi-nasal prongs were used (55/65 (85%) vs 40/65 (62%), p < 0.001). Heart rate (101 (75–145) vs 110 (68–149) bpm, p = 0.496) and oxygen saturation (59% (48–87) vs 56% (35–84), p = 0.178) were similar in the first 5 min after an interface was applied in the infants who stopped breathing. ConclusionApnoea and bradycardia occurred often after applying either bi-nasal prongs or a face mask on the face for respiratory support in preterm infants at birth.
Highlights
The majority of preterm infants breathe at birth, but this is often insufficient and respiratory support is needed.[1]
It is possible that the trigeminocardiac reflex (TCR) has a stimulation threshold, as a reduction in breathing rate and an increase in tidal volume was not observed when a lightweight cardboard was applied in comparison to a face mask.[2]
All infants in the bi-nasal prongs group were born in Prague, whereas 24/65 (37%) infants in the face mask group were born in Prague and 41/65 (63%) infants were born in Leiden. (Fig. 1) Baseline characteristics were not different between both groups. (Table 1)
Summary
The majority of preterm infants breathe at birth, but this is often insufficient and respiratory support is needed.[1]. Previous studies2À4 have shown that applying a face mask can affect breathing in newborns, causing a significant decrease in breathing rate and an increase in tidal volumes or apnoea. Pressing the mask on the face in order to acquire an adequate seal and prevent leak could activate the stretch receptors in any of the three branches of the trigeminal nerve and provoke the TCR.[4,6,7] It is possible that the TCR has a stimulation threshold, as a reduction in breathing rate and an increase in tidal volume was not observed when a lightweight cardboard was applied in comparison to a face mask (rim).[2] avoiding the sensitive area around the mouth by using an alternative interface could possibly decrease the chance for inducing the TCR
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