The effect of a face mask for respiratory support on breathing in preterm infants at birth

Kristel L.A.M. Kuypers, Tereza Lamberska, Tessa Martherus, Janneke Dekker, Stefan Böhringer, Stuart B. Hooper, Richard Plavka, Arjan B. te Pas

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26 Citations (Scopus)


Objective: Applying a mask on the face for respiratory support could induce a trigeminocardiac reflex leading to apnoea and bradycardia. We have examined the effect of applying a face mask on breathing and heart rate in preterm infants at birth. Methods: Resuscitation videos of infants ≤ 32 weeks gestation recorded from 2010 until 2018 at the Leiden University Medical Centre and the General University Hospital in Prague were reviewed. All infants received respiratory support via face mask. Breathing and heart rate were noted before and after application of the face mask and over the first 5 min. Results: Recordings of 429 infants were included (median (IQR) gestational age of 28+6 (27+1-30+4) weeks). In 368/429 (86%) infants breathing was observed before application of the face mask and 197/368 (54%) of these infants stopped breathing following application of the face mask. Apnoea occurred at a median of 5 (3–17) seconds after application of the face mask with a duration of 28 (22–34) seconds of the first minute. In a logistic regression model, the occurrence of apnoea after face mask application was inversely associated with gestational age (OR = 1.424 (1.281–1.583), p < 0.001). Infants who stopped breathing had a significantly lower heart rate 82 (66–123) vs 134 (97–151) bpm, p < 0.001) and oxygen saturation (49% (33–59) vs 66% (50–82), p < 0.001) over the first minute after face mask application, compared to infants who continued breathing. Conclusion: Applying a face mask for respiratory support affects breathing in a large proportion (54%) of preterm infants and this effect is gestational age dependent.

Original languageEnglish
Pages (from-to)178-184
Number of pages7
Publication statusPublished - 1 Nov 2019


  • Breathing
  • Face mask
  • Preterm infants
  • Respiratory support
  • Trigeminocardiac reflex

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