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138 Mask or Nasal Tube to Provide Positive Pressure Ventilation (PPV) to Preterm Infants in the Delivery Room (DR)-The Mont Trial

Background For initial PPV a face mask is used, but obstruction and leak often occurs. A nasal tube is an alternative interface in the DR to provide PPV. Its safety and efficacy have not been tested in a large RCT in extremely preterm infants. Objective To determine whether a single nasal tube is more effective than face mask during the stabilisation of infants born between 24 and 29 weeks. Design and methods An RCT performed in Melbourne and Leiden. Infants were randomized immediately prior to birth to receive PPV using a T-piece with either a nasal tube or round mask. Resuscitation guidelines were standardised. Criteria for intubation: cardiac compressions, apnea, CPAP >7cmH2O and FiO2 >0.4. Primary outcome: intubation in the first 24 hours from birth. Results In total 368 infants were randomized. Baseline variables, primary and secondary outcomes were similar (table). Abstract 138 Table 1 Baseline characteristics and outcome Mask (N= 187) Nasal Tube (N= 181) OR (95% CI) GA (wks) 27 (26–29) 27 (26–28) - Birthweight (g) 1000 (807–1196) 946 (780–1182) - Intubation in first 24hrs 102 (54) 97 (54) 0.96 (0.64–1.45) Intubation in DR 58 (31) 41 (23) 0.65 (0.41–1.04) Air Leak 14 (8) 11 (6) 0.80 (0.35–1.81) Total (MV+CPAP) days of ventilation 13 (6–41) 16 (4–41) NS Death or BPD 68 (36) 64 (35) 0.96 (0.62–1.47) Conclusions In infants < 30 weeks gestation receiving PPV in the DR, there were no differences in short term outcomes using the nasal tube compared to the face mask.