To The Editor: I read the article by Tracy et al with great interest (1). However I would like to point out few issues that need explanation before the study results can be accepted. First, despite of more leak with one person method, the tidal volumes being delivered are not statistically different in both the groups. Hence, the superiority of this technique in decreasing the need of endotracheal intubation and chest compression by improving ventilation is doubtful and should be first tested in clinical studies before its widespread implementation. Second, surprisingly the tidal volumes generated in both the techniques are much above the desired tidal volume of 4-5ml/kg. Animal studies have clearly shown that ventilation even for 15 minutes at high tidal volumes (15ml/kg) initiates' lung injury which in turn cause decreased lung compliance and impaired gas exchange. Third, the current Neonatal Resuscitation Programme guidelines recommend the presence of one person at every delivery and two persons in high risk deliveries (2). This new technique will require one extra resuscitator. The burden of one more resuscitator will be a big challenge for developing countries where 98% of total neonatal deaths occur worldwide (3). Fourth, the sample size calculation has not been elaborated by the authors. Despite these limitations, I appreciate the authors for their work which opens up new arenas of research in mask ventilation and neonatal resuscitation.

References 1.Tracy MB, Klimek J, Coughtrey H, Shingde V, Ponnampalam G, M Hinder M et al. Mask leak in one-person mask ventilation compared to two-person in newborn infant manikin study. Arch Dis Child Fetal Neonatal Ed 2011;96:195 -200.

2.Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J et al. Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122;909-919.

3.Carlo Wa, Goudar SS, Jehan I, Chomba E, Tshefu A, Garces A et al. Newborn-Care Training and Perinatal Mortality in Developing Countries. N Engl J Med 2010;362:614-23.

Conflict of Interest:

None declared