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

Razak, Abdul

doi:10.1136/archdischild-2017-314695

Cited by 1 publication

(5 citation statements)

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“…To our knowledge, this is the most up‐to‐date review that investigated the effect of NCPAP given with nasal masks compared with binasal prongs on the incidence of intubation and other relevant outcomes in preterm infants. Our study results are consistent with the previous systematic reviews and meta‐analyses 2‐4,14 . However, the authors in the earlier reviews noted low‐to‐very low certainty in the evidence.…”

Section: Discussionsupporting

confidence: 92%

“…8,12 Systematic reviews and meta-analyses of these clinical trials showed a similar benefit of reduced risk of intubation when NCPAP is provided with nasal masks compared with binasal prongs. [2][3][4] Nonetheless, these systematic reviews suffered significant limitations due to imprecision resulting from the small sample size of the clinical trials and the inability to blind the intervention. [2][3][4] As it is impractical to blind the intervention in clinical trials, the possible way to improve the certainty in the evidence is by enhancing the precision.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] Nonetheless, these systematic reviews suffered significant limitations due to imprecision resulting from the small sample size of the clinical trials and the inability to blind the intervention. [2][3][4] As it is impractical to blind the intervention in clinical trials, the possible way to improve the certainty in the evidence is by enhancing the precision. Hence, we undertook this systematic review to identify whether the confidence in the estimate can be improved by including the additional clinical trials.…”

Section: Introductionmentioning

confidence: 99%

“…However, only a few clinical trials showed NCPAP provided with nasal mask reduces the risk of intubation as compared with NCPAP given with binasal prongs 8,12 . Systematic reviews and meta‐analyses of these clinical trials showed a similar benefit of reduced risk of intubation when NCPAP is provided with nasal masks compared with binasal prongs 2‐4 . Nonetheless, these systematic reviews suffered significant limitations due to imprecision resulting from the small sample size of the clinical trials and the inability to blind the intervention 2‐4 .…”

Section: Introductionmentioning

confidence: 99%

“…Evidence suggests that the use of NCPAP reduces the need for intubation and surfactant treatment in preterm infants 1 . The success of NCPAP that prevents intubation and mechanical ventilation depends on the optimal nasal interface and pressure‐generating device 2‐4 . There are various nasal interfaces available for NCPAP; however, nasal masks and binasal prongs are the nasal interfaces used commonly to deliver NCPAP in preterm infants.…”

Section: Introductionmentioning

confidence: 99%

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Nasal mask vs binasal prongs for nasal continuous positive airway pressure in preterm infants: A systematic review and meta‐analysis

Razak

Patel

2020

Pediatric Pulmonology

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Objective To investigate the effect of nasal continuous positive airway pressure (NCPAP) given with nasal masks (NM) compared with binasal prongs (BNP) on the incidence of intubation within 72 hours in preterm infants (primary outcome) via meta‐analysis of clinical studies. Data Sources We searched for randomized clinical trials (RCTs) or quasi‐RCTs in Medline, PubMed, and Web of Science from inception through 4 December 2019. Data Extraction/Synthesis Two independent co‐authors extracting data performed the meta‐analysis using a fixed‐effect model to yield pooled relative risk (RR) and its 95% confidence interval (CI) for each outcome. We used Cochrane GRADE to evaluate the evidence quality. Results Eleven RCTs met the inclusion criteria. The meta‐analysis showed NCPAP provided via NM significantly reduced the rate of intubation within 72 hours (RR, 0.72; 95% CI, 0.58‐0.90; nine studies; GRADE‐moderate) and nasal trauma (RR, 0.64; 95% CI, 0.55‐0.74; GRADE‐low) compared with NCPAP provided via BNP. Also, NCPAP via NM significantly reduced surfactant treatment (RR, 0.85; 95% CI, 0.74‐0.97; GRADE‐very low) and bronchopulmonary dysplasia (RR, 0.47; 95% CI, 0.23‐0.95; GRADE‐low) compared with BNP in a setting where NCPAP was used as the primary support in respiratory distress syndrome. No statistically significant differences were noted between groups in secondary outcomes except increased NCPAP duration when NCPAP given with NM compared with BNP (mean difference [days], 1.78; 95% CI, 1.67‐1.89; GRADE‐low). Conclusion Among premature infants, NCPAP provided with NM is more effective in preventing intubation and mechanical ventilation within 72 hours of initiating the support compared with NCPAP provided with BNP.

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Section: Discussionsupporting

confidence: 92%