Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2019 Jan 31;14(1):e0211476.
doi: 10.1371/journal.pone.0211476. eCollection 2019.

'Nasal mask' in comparison with 'nasal prongs' or 'rotation of nasal mask with nasal prongs' reduce the incidence of nasal injury in preterm neonates supported on nasal continuous positive airway pressure (nCPAP): A randomized controlled trial

Tanveer Bashir  1 , Srinivas Murki  1 , Sai Kiran  1 , Venkat Kallem Reddy  1 , Tejo Pratap Oleti  1
Affiliations
Randomized Controlled Trial

'Nasal mask' in comparison with 'nasal prongs' or 'rotation of nasal mask with nasal prongs' reduce the incidence of nasal injury in preterm neonates supported on nasal continuous positive airway pressure (nCPAP): A randomized controlled trial

Tanveer Bashir et al. PLoS One. .

Abstract

Background: With increasing use of nCPAP, the safety and comfort associated with nCPAP have come into the forefront. The reported incidence of nasal injuries associated with the use of nCPAP is 20% to 60%. A recent meta-analysis concluded that the use of nasal masks significantly decreases CPAP failure and the incidence of moderate to severe nasal injury and stress the need for a well powered RCT to confirm their findings.

Methods: In this Open label, 3 arms, sequential, stratified randomized controlled trial, we evaluated the incidence and severity of nasal injury at removal of nCPAP when using two different nasal interfaces and in three groups (i.e. rotation group, mask continue group, prong continue group). Preterm infants with gestation ≤ 30 weeks and respiratory distress within the first 6 hours of birth and in need of CPAP were eligible for the study.

Results: Among the 175 newborns included in the study, incidence of nasal injury in mask continue group [n = 19/57 (33.3%)] was significantly less as compared to prong continue group [n = 55/60 (91.6%)] and rotation group [33/ 58 (56.9%), p value <0.0001]. Median maximum nasal injury score was significantly less in Mask continue group as compared to Prong continue group and Rotation group [Injury Score 0 (IQR 0-1) vs. Injury Score 3 (IQR 2-5) vs. Injury Score 1 (IQR 0-2), p value = <0.0001] respectively. The proportion of infants failing nCPAP was similar across the three groups.

Conclusion: nCPAP with nasal masks significantly reduces nasal injury in comparison with nasal prongs or rotation of nasal prongs and nasal masks. However, the type of interface did not affect the nCPAP failure rates.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Consort flow diagram of the study participants.
Fig 2
Fig 2. Drager BabyFlow mask.
Fig 3
Fig 3. Hudson short binasal prongs.
Fig 4
Fig 4. Clinical trial protocol for titration, weaning and removal of CPAP.
See this image and copyright information in PMC

References

    1. De Paoli AG, Davis PG, Faber B, Morley CJ. Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates. Cochrane Database Syst Rev. 2008;CD002977 10.1002/14651858.CD002977.pub2 - DOI - PubMed
    1. Robertson NJ, McCarthy LS, Hamilton PA, Moss AL. Nasal deformities resulting from flow driver continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed. 1996;75:F209–12. - PMC - PubMed
    1. Yong S-C, Chen S-J, Boo N-Y. 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:F480–483. 10.1136/adc.2004.069351 - DOI - PMC - PubMed
    1. Buettiker V, Hug MI, Baenziger O, Meyer C, Frey B. Advantages and disadvantages of different nasal CPAP systems in newborns. Intensive Care Med. 2004;30:926–30. 10.1007/s00134-004-2267-8 - DOI - PubMed
    1. Rego MAC, Martinez FE. Comparison of two nasal prongs for application of continuous positive airway pressure in neonates. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2002;3:239–43. - PubMed

Publication types

Supplementary concepts