Selective or routine face mask application for breathing support of preterm infants at birth: a randomised trial

Most preterm infants breathe spontaneously at birth. Despite this, the majority have a face mask immediately applied for breathing support. Face mask application may inhibit spontaneous breathing in newborn infants. We wished to determine whether selectively applying a mask to give positive pressure ventilation (PPV) for apnoea or bradycardia only compared to routinely applying a mask for continuous positive airway pressure (CPAP) resulted in fewer preterm infants receiving PPV in the delivery room (DR).

Infants born before 32 weeks of gestation were randomly assigned to either SELECTIVE or ROUTINE groups, stratified by gestational age (GA) [<28 and 28-31 weeks]. Infants in the SELECTIVE group were placed supine to breathe spontaneously and were not to receive mask CPAP before five minutes of life. Infants in the ROUTINE group received face mask CPAP as soon as possible after birth. Infants in both groups received mask PPV for apnoea or bradycardia. The primary outcome was face mask PPV in the DR.

Of the 201 who were randomly assigned, we analysed data for 200 infants: 98 in the SELECTIVE group [mean (SD) GA: 28 (3) weeks; birth weight (BW): 1120 (439)g] and 102 in the ROUTINE group [mean (SD) GA: 28 (2) weeks; BW: 1150 (425)g]. PPV rates in the DR were similar between groups [SELECTIVE 63/98 (64 %) versus ROUTINE 53/102 (52 %); RR 1.24, 95 %CI 0.98-1.57, p = 0.08].

Selectively applying a face mask for PPV only did not result in fewer preterm infants receiving PPV in the DR.