• Kristel L A M Kuypers, Tereza Lamberska, Tessa Martherus, Janneke Dekker, Stefan Böhringer, Stuart B Hooper, Richard Plavka, and Arjan B Te Pas.
• Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: k.l.a.m.kuypers@lumc.nl.
• Resuscitation. 2020 Dec 1; 157: 60-66.

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.Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.

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