Nasal Mask versus Nasal prongs for Delivering Nasal Continuous Positive Airway Pressure in preterm Infants with Respiratory Distress

Abstract

Background: Respiratory distress is reported as one of the commonest problems with neonates worldover with an incidence of 3% to7% of all live births and perinatal deaths accounting to 32%-52% are due to respiratory disorders.CPAP is defined as “A form of positive airway pressure ventilator, which applies mild air pressure on a continuous basis. It keep the airways continuously open in people who are able to breathe spontaneously on their own, but need help in keeping their airway unobstructed. It is an alternative to positive end-expiratory pressure (PEEP).
Objective: To Compare the effectiveness of nasal Continous positive airway pressure delivered by mask versus nasal prongs in preterm infants with respiratory distress.
Failure of either modality after 72 hours of initiation of CPAP in preterm infants <34 weeks of gestation.

Participants: In total of 90 subjects, 48(54%) received CPAP via nasal masks while as 42(46%) received CPAP via nasal prongs.
Study Design:Observational study.
Methods:The study was conducted in Neonatal Intensive Care Unit of Department of Pediatrics and Neonatology at Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar.This was an observatioal study conducted over a period of two years. Preterm infants with less than 34 weeks of gestation and respiratory distress were enrolled for the study after taking parental consent. These neonates were put on nasal CPAP either using mask or prongs immediately after birth.
All the patients admitted in NICU with gestational age <34 weeks and respiratory distress were enrolled for the undertaken study. A complete infant and maternal history was taken at the time of admission..Physical examination was done.Respiratory distress was assessed with DOWNE’S Score.All base line investigations including CBC,KFT,LFT, Blood gases, X-rays etc which was daily recorded until discharged or weaned off from oxygen supplementation. Enrolled neonates once received were immediately put on nasal CPAP either using mask or prongs as per the discretion of treating physician
Results:Among the 90 newborns included in the study 48 infants received CPAP via mask while as 42 infants received CPAP via prongs.Mean gestation and mean birth weight of study population was 30.61±0.1.32 weeks and 1.47±0.23 kg respectively. Baseline antenatal and neonatal characteristics were similar among both groups.Cpap failure within 72 hours and after 72 hours of initiation of Cpap therapy was similar in nasal prongs and nasal mask group. Cpap failure within 72 hours in Mask group was (18.8%) while Cpap failure within 72 hours in prongs group was (23.8%).Cpap failure after 72 hours in mask group was (12.5%) while Cpap failure after 72 hours in Prongs group was (7.1%).The duration of CPAP in hours [20.9 vs. 225.5 hrs p=0.59), Duration of oxygen therapy in days [5.5days vs 5.4 days P=0.927] were similar in mask and prongs group respectively.The secondary outcome Death [n=7(14.5 %) vs n= 4(9.5%), p=0.067], BPD[n=2(4.1%) vs n=2(4.7%) p=0.470], Sepsis[n=14(29.1%) vs n=11(26.1%) p=0.123], NEC[n=4(8.3%) vs n=3(7.1%) p=0.213], IVH[n=2(4.2%) vs n=1(2.4%) p=0.378] and Duration of hospital stay in days[26.5days vs 22.5days p=0.748] were similar among mask group and prongs group respectively. Incidence of nasal injury [n=15(31.25%) vs n=34(80.95%) p=0.001] was significantly less in mask group than prongs group.
Conclusion:We conclude that NCPAP with mask as interface is equally effective as providing NCPAP with prongs, but causes less nasal trauma. We have used Bubble CPAP as a primary mode of respiratory support thus making our results more generalisable and applicable in resource-limited settings. We recommend more multicentric RCTs with appropriate sample size to evaluate impact of various delivery interfaces on NCPAP success.