313 - A randomised trial of Routine Or Selective Application of a face mask for breathing support of preterm infants at birth; The ROSA trial

Face mask positive pressure ventilation (PPV) is recommended for newly born infants who have apnoea or bradycardia. Though the majority of preterm infants breathe spontaneously at birth, most have a mask applied for continuous positive airway pressure (CPAP) shortly after delivery. Applying a face mask may inhibit spontaneous breathing.

Objective:

To determine whether selectively applying a face mask to give PPV to preterm infants for apnoea or bradycardia only, rather than routinely giving face mask CPAP, resulted in fewer infants receiving PPV in the DR.

Design/Methods:

Infants born before 32 weeks’ gestation were randomly assigned before birth to ‘Routine’ or ‘Selective’ groups, stratified by gestational age (GA) [< 28 and 28⁺⁰– 31⁺⁶ weeks]. ‘Routine’ infants had a face mask applied to give CPAP as soon as possible after birth. ‘Selective’ infants were placed supine to breathe spontaneously and were not to receive mask CPAP before 5 minutes of life. Infants in both groups were given mask PPV for apnoea or bradycardia (heart rate < 100bpm). All other aspects of DR care were the same. The primary outcome was face mask PPV in the first 5 minutes of life. Secondary outcomes in the DR included use of face mask CPAP, face mask PPV, endotracheal intubation, and chest compressions; and heart rate and oxygen saturations at 5 minutes. Secondary outcomes in the NICU included endotracheal ventilation and surfactant administration.

Results:

We enrolled 200 infants; 100 were randomly assigned to “Routine” [mean (SD) GA 28 (2) weeks and birth weight (BW) 1162 (429) g] and 100 to “Selective” [mean (SD) GA 28 (3) weeks and BW 1132 (438) g]. There was no difference in the proportion of babies who received PPV in the first 5 minutes of life [51/100 (51%) vs 60/100 (60%), P = .147 ] between the groups. More infants in the Routine group received mask CPAP in the DR, in accordance with the protocol. There were no differences between the groups in other secondary outcomes.

Conclusion(s):

Selective application of a face mask for PPV did not result in fewer preterm infants receiving PPV in the DR.