Abstract
Objective
To compare the effectiveness of nasal continuous positive airway pressure delivered by Nasal mask vs Nasal prongs with respect to continuous positive airway pressure failure.
Study design
Randomized, controlled, open label, trial.
Setting
Tertiary care level III neonatal unit.
Participants
118 preterm infants-gestational age (27-34 weeks) requiring nasal continuous positive airway pressure as a primary mode for respiratory distress, who were treated with either nasal mask (n=61) or nasal prongs (n=57) as interface.
Primary outcome
Need for mechanical ventilation within 72 h of initiating support.
Results
Nasal continuous positive airway pressure failure occurred in 8 (13%) of Mask group and 14 (25%) of Prongs group but was statistically not significant (RR 0.53, 95% CI 0.24-1.17) (P = 0.15). The rate of pulmonary interstitial emphysema was significantly less in the Mask group (4.9% vs. 17.5%; RR 0.28, 95% CI 0.08-0.96; P = 0.03). Incidence of moderate nasal trauma (6.5% vs 21%) (P=0.03) and overall nasal trauma (36% vs 58%) (P=0.02) were significantly lower in mask group than in the prongs group.
Conclusion
Nasal continuous positive airway pressure with mask as interface is as effective as prongs but causes less nasal trauma and pulmonary interstitial emphysema.
Similar content being viewed by others
References
Polin RA, Sahni R. Newer experience with CPAP. Semin Neonatol. 2002;7: 379–89
Pillow JJ, Hillman N, Moss TJ. Bubble continuous positive airway pressure enhances lung volume and gas exchange in preterm lambs. Am J Respir Crit Care Med. 2007;176:63–9.
Tapia JL, Urzua S, Bancalari A. Randomized trial of early bubble continuous positive airway pressure for very low birth weight infants. J Pediatr. 2012;161:75–80
Bonner KM, Mainous RO. The nursing care of the infant receiving bubble CPAP therapy. Adv Neonatal Care. 2008;8:78–95.
McCoskey L. Nursing care guidelines for prevention of nasal breakdown in neonates receiving nasal CPAP. Adv Neonatal Care. 2008;8:116–24.
Kattwinkel J, Fleming D, Cha CC, Fanaroff AA, Klaus MH. A device for administration of continuous positive airway pressure by the nasal route. Pediatrics. 1973;52:131–4.
Kieran EA, Walsh H, O’Donnell CPF. Survey of nasal continuous positive airways pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV) use in Irish newborn nurseries. Arch Dis Child Fetal Neonatal Ed. 2011;96: F156.
Kieran EA, Twomey AR, Molloy EJ, Murphy JF, O’Donnell CP. Randomized trial of prongs or mask for nasal continuous positive airway pressure in preterm infants. Pediatrics. 2012;130:1170–6.
Chandrasekaran A, Sachdeva A, Sankar MJ, Agarwal R, Deorari AK, Paul VK. Nasal mask versus nasal prongs in the delivery of continuous positive airway pressure in preterm infants–An open label randomized controlled trial. E-PAS. 2014:2936:512.
Fischer C, Bertelle V, Hohlfeld J, Forcada-Guex M, Stadelmann-Diaw C, Tolsa JF. Nasal trauma due to continuous positive airway pressure in neonates. Arch Dis Child Fetal Neonatal Ed. 2010;95:F447-51.
Yong SC, Chen SJ, Boo NY. Incidence of nasal trauma associated with nasal prong versus nasal mask during continuous positive airway pressure treatment in very low birthweight infants: a randomised control study. Arch Dis Child Fetal Neonatal Ed. 2005;90:480–83.
Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500gm. J Pediatr. 1978;92:529–33.
Kliegman RM, Walsh MC. Necrotizing enterocolitis: pathogenesis, classification and spectrum of illness. Curr Probl Pediatr. 1987;17:213–88.
International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123:991–99.
Bancalari E, Jobe AH. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723–9.
Urs PS, Khan F, Maiya PP. Bubble CPAP-a primary respiratory support for respiratory distress syndrome in newborns. Indian Pediatr. 2009;46:409–11.
Koti J, Murki S, Gaddam P, Reddy A, Reddy MD. Bubble CPAP for respiratory distress syndrome in preterm infants. Indian Pediatr. 2010;47:139–43.
Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB; COIN Trial Investigators.Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008;358:700–8.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Goel, S., Mondkar, J., Panchal, H. et al. Nasal mask versus nasal prongs for delivering nasal continuous positive airway pressure in preterm infants with respiratory distress: A randomized controlled trial . Indian Pediatr 52, 1035–1040 (2015). https://doi.org/10.1007/s13312-015-0769-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13312-015-0769-9