Heart Rate Changes following Facemask Placement in Infants Born at ≥32+0Weeks of Gestation

Shiraz Badurdeen, Elisa Brooijmans, Douglas A. Blank, Kristel Leontina Anne Marie Kuypers, Arjan B. Te Pas, Calum Roberts, Graeme R. Polglase, Stuart B. Hooper, Peter G. Davis

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Introduction: Recent reports have raised concerns of cardiorespiratory deterioration in some infants receiving respiratory support at birth. We aimed to independently determine whether respiratory support with a facemask is associated with a decrease in heart rate (HR) in some late-preterm and term infants. Methods: Secondary analysis of data from infants born at ≥32+0 weeks of gestation at 2 perinatal centres in Melbourne, Australia. Change in HR up to 120 s after facemask placement, measured using 3-lead electrocardiography, was assessed every 3 s until 60 s and every 5 s thereafter from video recordings. Results: In the 15 s after facemask placement, 10/68 (15%) infants had a decrease in mean HR by >10 beats per minute (bpm) compared with their individual baseline mean HR in the 15 s before facemask placement. In 4 (6%) infants, HR decreased to <100 bpm. Nine out of 68 (13%) infants had an increase in mean HR by >10 bpm; 7 of these infants had a baseline HR <120 bpm. In univariable comparisons, the following characteristics were found not to be risk factors for a decrease in HR by >10 bpm: prematurity; type of respiratory support; hypoxaemia; early cord clamping; mode of birth; HR <120 bpm before mask placement. Six out of 63 infants (10%) who had HR ≥120 bpm after facemask placement had a late decrease in HR to <100 bpm between 30 and 120 s after facemask placement. Conclusion: Facemask respiratory support at birth is temporally associated with a decrease in HR in a subset of late-preterm and term infants.

Original languageEnglish
Pages (from-to)624–632
Number of pages9
Issue number5
Publication statusPublished - 2023


  • Bradycardia
  • Heart rate
  • Neonate
  • Resuscitation
  • Trigeminocardiac reflex
  • Ventilation

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