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Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room
  1. Georg M Schmölzer1,2,3,4,
  2. Jennifer A Dawson1,3,5,
  3. C Omar F Kamlin1,
  4. Colm PF O'Donnell6,
  5. Colin J Morley1,3,
  6. Peter G Davis1,3,5
  1. 1Neonatal Services, The Royal Women's Hospital, Melbourne, Australia
  2. 2Department of Physiology, Monash University, Melbourne, Australia
  3. 3Murdoch Childrens Research Institute, Melbourne, Australia
  4. 4Division of Neonatology, Department of Paediatrics, Medical University, Graz, Austria
  5. 5Department of Obstetrics & Gynaecology, The University of Melbourne, Australia
  6. 6The National Maternity Hospital, Holles Street, Dublin, Ireland
  1. Correspondence to Dr Georg M Schmölzer, The Royal Women's Hospital, Department of Newborn Research, 20 Flemington Road, Parkville, 3052, Victoria, Australia; georg.schmoelzer{at}


Introduction Preterm infants with inadequate breathing receive positive pressure ventilation (PPV) by mask with variable success. The authors examined recordings of PPV given to preterm infants in the delivery room for prevalence of mask leak and airway obstruction.

Methods and patients The authors reviewed recordings of infants at <32 weeks' gestation born between February 2006 and March 2009. PPV was delivered with a T-piece or self-inflating bag and a round silicone face mask. Airway pressures and gas flow were recorded with a respiratory function monitor (RFM). Videos recorded from a web camera were used to review the resuscitation. The first 2 min of PPV were analysed for each infant. Obstruction was arbitrarily defined as a 75% reduction in delivered expired tidal volume (VTe) and significant face-mask leak as >75%.

Results The authors analysed recordings of 56 preterm infants. Obstruction occurred in 14 (26%) recordings and leaks in 27 (51%). Both obstruction and mask leaks were seen in eight (14%) recordings, and neither was seen in 15 (27%). Obstruction occurred at a median (IQR) of 48 (24–60) s after the start of PPV. A median (range) of 22 (3–83) consecutive obstructed inflations were delivered. Face-mask leaks occurred from the first inflation in 19/27 (70%) and in the remaining eight at a median (IQR) of 30 (24–46) s after the start of PPV. A median (range) of 10 (3–117) consecutive inflations with a leak >75% were delivered.

Conclusion Airway obstruction and face-mask leak are common during the first 2 min of PPV. An RFM enables detection of important airway obstruction and mask leak.

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  • Funding JAD, COFK, CPFOD and GMS are recipients of a Royal Women's Hospital Postgraduate Research Degree Scholarship. GMS is supported in part by a Monash International Postgraduate Research Scholarship. PGD is supported in part by an Australian National Health and Medical Research Council Practitioner Fellowship. PGD and CJM hold an Australian National Health and Medical Research Council Program Grant No 384100.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by The Royal Women's Hospital.

  • Patient consent Obtained from the parents.