Binasal Prong versus Nasal Mask for Applying CPAP to Preterm Infants: A Randomized Controlled Trial

Abstract

Background: Nasal continuous positive airway pressure (NCPAP) is being widely used for the treatment of respiratory distress syndrome (RDS) in preterm infants. However, there are only a few studies which compare different interfaces of NCPAP delivery and their effects on respiratory outcomes. Objective: We aimed to determine whether NCPAP applied with binasal prongs compared to that with a nasal mask (NM) reduces the rate of moderate/severe bronchopulmonary dysplasia (BPD) in preterm infants. Methods: Infants between 26 and 32 weeks' gestation who suffered from RDS and were treated with NCPAP were assessed. Parallel randomization was performed to eligible infants to receive NCPAP either via binasal prongs or NM. Infants were intubated if they fulfilled the predefined failure criteria. Data were collected by using the intention-to-treat principle. Results: One hundred and sixty infants were screened and 149 were randomized. Seventy-five infants in the binasal prong (NP) group and 74 in the NM group were analyzed. Mean gestational ages were 29.3 ± 1.6 vs. 29.1 ± 2.0 weeks (p = 0.55), and birth weights were 1,225 ± 257 vs. 1,282 ± 312 g (p = 0.22) in the NP and NM groups, respectively. The frequency of NCPAP failure within 24 h of life was higher in the NP than the NM group (8 vs. 0%; p = 0.09). The median duration of NCPAP was significantly higher in the NP group [median 4 (1-5) vs. 2 (1-3) h, p < 0.01]. The rate of moderate and severe BPD was significantly lower in the NM (n = 2, 2.7%) when compared with the NP group (n = 11, 14.6%; p < 0.01). The BPD/death rates were not different between the 2 groups (NM group: n = 18 or 24.3%; NP group: n = 19 or 25.3%; p = 0.51). Conclusions: The NM was successfully used for delivering NCPAP in preterm infants, and no NCPAP failure was observed within the first 24 h. These data show that applying NCPAP by NM yielded a shorter duration of NCPAP and statistically reduced the rates of moderate and severe BPD.

Should nasal mask or binasal prongs be used for continuous positive airway pressure in preterm infants?

“…In this particular analysis, a significant heterogeneity (I 2 75%, P for χ 2 0.02) was identified (figure 2). A sensitivity analysis performed after excluding one trial showed reduced heterogeneity (I 2 46%, P for χ 2 0.17) 5. This trial showed significant lower association of moderate to severe CLD in infants receiving mask NCPAP compared with infants binasal prongs NCPAP (14.6% vs 2.7%, P 0.01) 5.…”

“…Only one trial included extremely preterm infants below <26 weeks’ GA 3. The NCPAP systems varied across the trials: three trials used infant flow devices,3 4 6 two trials used bubble NCPAP1 2 and one trial used ventilator NCPAP 5. In the four trials evaluating the primary outcome (endotracheal ventilation/NCPAP failure), the use of caffeine was prophylactic in three trials2 3 5 and therapeutic in one trial 1.…”

“…Chandrasekaran et al 1 defined NCPAP failure as a requirement of fraction inspired oxygen concentration (FiO 2 ) >70% and NCPAP >7 cm H 2 O. The cut-off was NCPAP >8 cm H20 (no oxygen requirement cut-off provided) in the trial by Say et al 5. Similarly, the cut-off was FiO 2 >60% and NCPAP >8 cm H 2 O in the trial by Goel et al 2.…”

Heated Humidified High-Flow Nasal Cannula for Weaning from Continuous Positive Airway Pressure in Preterm Infants: A Randomized Controlled Trial

“…We prefer nasal-mask CPAP because it is easier to care for, delivers a more stable CPAP and is more comfortable for the infants than nasal prongs. Using nasal masks has been shown to shorten the duration on CPAP compared to nasal prongs [21]. Infants weighing <750 g were excluded because the appropriate nasal cannula size was not available.…”

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

“…Using a flow driver to generate CPAP has the theoretical advantage of offloading expiratory work of breathing (the Coanda effect), although no important clinical differences have been shown among devices used to deliver CPAP, but the simplicity of bubble CPAP systems allows their use in low-income settings [94]. Trials comparing interfaces show no differences between nasal prongs and short pharyngeal tubes for initial stabilisation in the delivery room [50], but for prolonged use nasal masks may be most effective [95]. All CPAP interfaces carry a risk of facial distortion and nasal trauma.…”