title: Mask versus Nasal Tube for Stabilization of Preterm Infants at Birth: Respiratory Function Measurements.
abstract: OBJECTIVE
  To compare the nasal tube with face mask as interfaces for stabilization of very preterm infants at birth by using physiological measurements of leak, obstruction, and expired tidal volumes during positive pressure ventilation (PPV).
  
  
  METHODS
  In the delivery room, 43 infants <30 weeks gestation were allocated to receive respiratory support by nasal tube or face mask. Respiratory function, heart rate, and oxygen saturation were measured. Occurrence of obstruction, amount of leak, and tidal volumes were compared using a Mann-Whitney U test or a Fisher exact test.
  
  
  RESULTS
  The first 5 minutes after initiation of PPV were analyzed (1566 inflations in the nasal tube group and 1896 inflations in the face mask group). Spontaneous breathing coincided with PPV in 32% of nasal tube and 34% of face mask inflations. During inflations, higher leak was observed using nasal tube compared with face mask (98% [33%-100%] vs 14 [0%-39%]; P < .0001). Obstruction occurred more often (8.2% vs 1.1%; P < .0001). Expired tidal volumes were significantly lower during inflations when using nasal tube compared with face mask (0.0 [0.0-3.1] vs 9.9 [5.5-12.8] mL/kg; P < .0001) and when spontaneous breathing coincided with PPV (4.4 [2.1-8.4] vs 9.6 [5.4-15.2] mL/kg; P < .0001) but were similar during breathing on continuous positive airway pressure (4.7 [2.8-6.9] vs 4.8 [2.7-7.9] mL/kg; P > 0.05). Heart rate was not significantly different between groups, but oxygen saturation was significantly lower in the nasal tube group the first 2 minutes after start of respiratory support.
  
  
  CONCLUSIONS
  The use of a nasal tube led to large leak, more obstruction, and inadequate tidal volumes compared with face mask.
  
  
  BACKGROUND
  Trial registration Registered with the Dutch Trial Registry (NTR 2061) and the Australia and New Zealand Clinical Trials Register (ACTRN 12610000230055).
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: J.J.van_Vonderen@lumc.nl.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: van Vonderen
authors.affiliation: Department of Neonatology, The Royal Women's Hospital, Melbourne, Victoria, Australia.
authors.forename: C Omar
authors.initials: CO
authors.lastname: Kamlin
authors.affiliation: Department of Neonatology, The Royal Women's Hospital, Melbourne, Victoria, Australia.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Dawson
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Walther
authors.affiliation: Department of Neonatology, The Royal Women's Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynecology, The Royal Women's Hospital, Melbourne, Victoria, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Davis
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arjan B
authors.initials: AB
authors.lastname: te Pas
mesh_terms: D000402:Airway Obstruction / Q000209:etiology; D001315:Australia; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal; D008297:Male; D008397:Masks; D009426:Netherlands; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D056152:Respiratory Rate; D013990:Tidal Volume
chemical_list: D010100:Oxygen