Mask ventilation with two different face masks in the delivery room for preterm infants: a randomized controlled trial

BACKGROUND: If an infant fails to initiate spontaneous breathing after birth, international guidelines recommend a positive pressure ventilation (PPV). However, PPV by face mask is frequently inadequate because of leak between the face and mask. Despite a variety of available face masks, none have been prospectively compared in a randomized fashion. We aimed to evaluate and compare leak between two commercially available round face masks (Fisher & Paykel (F&P) and Laerdal) in preterm infants <33 weeks gestational age in the delivery room. METHODS: Infants born at the Royal Alexandra Hospital from April to September 2013 at <33 weeks gestational age who received mask PPV in the delivery room routinely had a flow sensor placed between the mask and T-piece resuscitator. Infants were randomly assigned to receive PPV with either a F&P or Laerdal face mask. All resuscitators were trained in the use of both face masks. We compared mask leak, airway pressures, tidal volume and ventilation rate between the two groups. RESULTS: Fifty-six preterm infants (n = 28 in each group) were enrolled; mean +/- s.d. gestational age 28 +/- 3 weeks; birth weight 1210 +/- 448 g; and 30 (52%) were male. Apgar scores at 1 and 5 min were 5 +/- 3 and 7 +/- 2, respectively. Infants randomized to the F&P face mask and Laerdal face mask had similar mask leak (30 (25-38) versus 35 (24-46)%, median (interquartile range), respectively, P = 0.40) and tidal volume (7.1 (4.9-8.9) versus 6.6 (5.2-8.9) ml kg(-1), P = 0.69) during PPV. There were no significant differences in ventilation rate, inflation time or airway pressures between groups. CONCLUSION: The use of either face mask during PPV in the delivery room yields similar mask leak in preterm infants o33 weeks gestational age.