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Physiological responses to facemask application in newborns immediately after birth
  1. Vincent D Gaertner1,
  2. Christoph Martin Rüegger1,
  3. Eoin O'Currain2,
  4. C Omar Farouk Kamlin3,4,5,
  5. Stuart B Hooper6,
  6. Peter G Davis3,4,5,
  7. Laila Springer7
  1. 1 Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland
  2. 2 School of Medicine and National Maternity Hospital, University College Dublin, Dublin, Ireland
  3. 3 Newborn Research Centre and Neonatal Services, Royal Womens Hospital, Melbourne, Victoria, Australia
  4. 4 Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
  5. 5 Clinical Sciences Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  6. 6 The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia
  7. 7 Department of Neonatology, University Clinic Tübingen, Tübingen, Baden-Württemberg, Germany
  1. Correspondence to Dr Laila Springer, Department of Neonatology, Universitätsklinikum Tübingen, Tubingen D-72076, Baden-Württemberg, Germany; laila.springer{at}


Objective Application of a face mask may induce apnoea and bradycardia, possibly via the trigeminocardiac reflex (TCR). We aimed to describe rates of apnoea and bradycardia in term and late-preterm infants following facemask application during neonatal stabilisation and compare the effects of first facemask application with subsequent applications.

Design Subgroup analysis of a prospective, randomised trial comparing two face masks.

Setting Single-centre study in the delivery room

Patients Infants>34 weeks gestational age at birth

Methods Resuscitations were video recorded. Airway flow and pressure were measured using a flow sensor. The effect of first and subsequent facemask applications on spontaneously breathing infants were noted. When available, flow waveforms as well as heart rate (HR) were assessed 20 s before and 30 s after each facemask application.

Results In total, 128 facemask applications were evaluated. In eleven percent of facemask applications infants stopped breathing. The first application was associated with a higher rate of apnoea than subsequent applications (29% vs 8%, OR (95% CI)=4.76 (1.41–16.67), p=0.012). On aggregate, there was no change in median HR over time. In the interventions associated with apnoea, HR dropped by 38bpm [median (IQR) at time of facemask application: 134bpm (134–150) vs 96bpm (94–102) 20 s after application; p=0.25] and recovered within 30 s.

Conclusions Facemask applications in term and late-preterm infants during neonatal stabilisation are associated with apnoea and this effect is more pronounced after the first compared with subsequent applications. Healthcare providers should be aware of the TCR and vigilant when applying a face mask to newborn infants.

Trial registration number ACTRN12616000768493.

  • neonatology
  • resuscitation

Data availability statement

Data are available upon reasonable request from the corresponding author.

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Data availability statement

Data are available upon reasonable request from the corresponding author.

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  • Contributors All authors were involved in planning, conducting and reporting of the work. VDG watched the videos, performed data analyses and wrote the first version of the manuscript. CMR, EOC, COFK, SBH, PGD and LS were involved in data interpretation, as well as manuscript writing. LS supervised the project. All authors approved the final version of the manuscript.

  • Funding This study was funded by the National Health and Medical Research Council Program (grant 2017-2021; App 1113902, App ID 1059111 (to PGD) and App ID 1073533 (to COFK)). VDG received an Endeavour Research Fellowship (Australia) (ERF_RDDH_5276_2016). LS received a research fellowship from the German Research Society (DFG-grant LO 2162/1-1) and intramural TÜFF Habilitation Program (TÜFF (2459-0-0)). CMR received an early Postdoc Mobility fellowship from the Swiss National Science Foundation (P2ZHP3_161749).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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