Heart Rate Changes following Facemask Placement in Infants Born at ≥32+0 Weeks of Gestation

Abstract

<b><i>Introduction:</i></b> Recent reports have raised concerns of cardiorespiratory deterioration in some infants receiving respiratory support at birth. We aimed to independently determine whether respiratory support with a facemask is associated with a decrease in heart rate (HR) in some late-preterm and term infants. <b><i>Methods:</i></b> Secondary analysis of data from infants born at ≥32<sup>+0</sup> weeks of gestation at 2 perinatal centres in Melbourne, Australia. Change in HR up to 120 s after facemask placement, measured using 3-lead electrocardiography, was assessed every 3 s until 60 s and every 5 s thereafter from video recordings. <b><i>Results:</i></b> In the 15 s after facemask placement, 10/68 (15%) infants had a decrease in mean HR by >10 beats per minute (bpm) compared with their individual baseline mean HR in the 15 s before facemask placement. In 4 (6%) infants, HR decreased to <100 bpm. Nine out of 68 (13%) infants had an increase in mean HR by >10 bpm; 7 of these infants had a baseline HR <120 bpm. In univariable comparisons, the following characteristics were found not to be risk factors for a decrease in HR by >10 bpm: prematurity; type of respiratory support; hypoxaemia; early cord clamping; mode of birth; HR <120 bpm before mask placement. Six out of 63 infants (10%) who had HR ≥120 bpm after facemask placement had a late decrease in HR to <100 bpm between 30 and 120 s after facemask placement. <b><i>Conclusion:</i></b> Facemask respiratory support at birth is temporally associated with a decrease in HR in a subset of late-preterm and term infants.

Significance of Neonatal Heart Rate in the Delivery Room—A Review

“…However, even with the increasing use of ECGs, which have been shown to provide an HR faster than pulse oximetry [33], studies indicate that respiratory support is being initiated later. Badurdeen et al [37] showed that in late preterm and term infants with an anticipated need for resuscitation, respiratory support was initiated at a median (IQR) age of 63 (41-112) s. As there was a wide range of HRs when respiratory support was initiated, the authors speculated that insufficient respiratory efforts, rather than bradycardia, were common reasons for commencing positive pressure ventilation (PPV), which is in agreement with Kibsgaard et al [33].…”

“…Badurdeen et al [37] investigated the trigemino-cardiac reflex in late preterm and term infants and found that in initially depressed infants, the application of a facemask resulted in an increased not a decreased HR. These findings prompted the authors to speculate that the trigemino-cardiac reflex is suppressed in asphyxiated infants, i.e., those with a low or unstable baseline HR.…”