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Don’t Push! Excessive Neonatal Mask Pressure and Apnea-Bradycardia

February 5, 2024

Written by Carmen Wolfe

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When providing respiratory support to preterm infants with a facemask, avoid excessive force on the face that is associated with apnea and bradycardia.

Know thy strength
Resuscitation of preterm infants often calls for respiratory support via facemask. In this high stress environment, variable levels of force are exerted by practitioners. While the goal of this pressure is to create an effective seal, increased facial pressure can activate the trigeminocardiac reflex, a phenomenon wherein cutaneous stretch receptors of the trigeminal nerve can trigger apnea and bradycardia.

This prospective observational study of 30 preterm (<32 weeks) infants in the Netherlands utilized a custom-made sensor to measure the force applied to the facemask during preterm resuscitations. Median gestational age was about 28 weeks, and median force was 297 grams. Force measurements ranged from 0 to 1,455 grams, with higher median force utilized during PPV (410 grams) as opposed to CPAP (286 grams). There was no significant different in force between one- and two-handed mask holds.

Statistical models demonstrated that the amount of force exerted on the facemask was significantly higher during periods of apnea and bradycardia compared to periods without these features, establishing an association of these variables, but not causation.

How will this change my practice?
I won’t have access to a special sensor to assess facemask pressure during my next preterm infant resuscitation. But I can remember to press just hard enough to create a seal, but no so hard that I potentially cause apnea or bradycardia.

Exerted force on the face mask in preterm infants at birth is associated with apnoea and bradycardia. Resuscitation. 2024;194:110086.

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