Smaller facemasks for positive pressure ventilation in preterm infants: A randomised trial

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Respiratory Support

Background:

• Standard facemasks for positive pressure ventilation may be too large for preterm infants, potentially causing mask leak and compromising resuscitation.
• Facial measurements suggest a need for masks better suited to the dimensions of preterm infants' faces.

Purpose of the Study:

• To evaluate if a smaller, better-fitting facemask reduces mask leak during ventilation in preterm infants compared to standard facemasks.
• To assess the impact of facemask size on ventilation effectiveness in preterm neonates.

Main Methods:

• A parallel-group, randomized controlled trial involving preterm infants (≤32 weeks' gestation) requiring facemask ventilation.
• Infants were randomized to receive ventilation with either a standard 50mm facemask (control) or a smaller 35mm or 42mm facemask (intervention), stratified by gestational age.
• The primary outcome measured was the air leak between the facemask and the infant's face.

Main Results:

• A total of 131 preterm infants were included in the final analysis (66 intervention, 65 control).
• The median leak percentage was similar between the intervention (42%) and control (39%) groups (P=0.43).
• Lowest oxygen saturation levels were also comparable between the groups, indicating no significant difference in ventilation efficacy.

Conclusions:

• The use of smaller facemasks did not significantly reduce mask leak in preterm infants undergoing positive pressure ventilation.
• High mask leak rates were prevalent in both groups, particularly in infants with gestational age ≤26 weeks.