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. Data are available upon reasonable request from the corresponding author.

中文翻译：

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新生儿出生后立即戴口罩的生理反应

目的 使用面罩可能通过三叉心反射 (TCR) 诱发呼吸暂停和心动过缓。我们旨在描述在新生儿稳定期间佩戴口罩后足月和晚期早产儿呼吸暂停和心动过缓的发生率，并比较首次佩戴口罩与后续佩戴口罩的效果。一项比较两种口罩的前瞻性随机试验的设计亚组分析。设置产房中的单中心研究患者婴儿出生时胎龄>34 周 方法 对复苏进行视频记录。使用流量传感器测量气道流量和压力。注意到第一次和随后的面罩应用对自主呼吸婴儿的影响。有空的时候，在每次面罩应用前 20 秒和后 30 秒评估流量波形和心率 (HR)。结果 总共评估了 128 个口罩应用。在 11% 的口罩应用中，婴儿停止呼吸。第一次应用与更高的呼吸暂停率相关（29% vs 8%，OR (95% CI)=4.76 (1.41–16.67)，p=0.012）。总体而言，HR 中位数没有随时间变化。在与呼吸暂停相关的干预措施中，HR 下降了 38bpm [戴口罩时的中位数 (IQR)：134bpm (134-150) vs 96bpm (94-102) 20 秒后；p=0.25] 并在 30 秒内恢复。结论 在新生儿稳定期，足月和晚期早产儿面罩应用与呼吸暂停相关，与后续应用相比，第一次应用后这种影响更为明显。在给新生儿戴口罩时，医疗保健提供者应了解 TCR 并保持警惕。试验注册号 ACTRN12616000768493。数据可根据通讯作者的合理要求提供。