title: Nasal masks or binasal prongs for delivering continuous positive airway pressure in preterm neonates-a randomised trial.
abstract: The objective of this study was to compare the efficacy and safety of continuous positive airway pressure (CPAP) delivered using nasal masks with binasal prongs. We randomly allocated 72 neonates between 26 and 32 weeks gestation to receive bubble CPAP by either nasal mask (n = 37) or short binasal prongs (n = 35). Primary outcome was mean FiO2requirement at 6, 12 and 24 h of CPAP initiation and the area under curve (AUC) of FiO2against time during the first 24 h (FiO2AUC0-24). Secondary outcomes were the incidence of CPAP failure and nasal trauma. FiO2requirement at 6, 12 and 24 h (mean (SD); 25 (5.8) vs. 27.9 (8); 23.8 (4.5) vs. 25.4 (6.8) and 22.6 (6.8) vs. 22.7 (3.3)) as well as FiO2AUC0-24(584.0 (117.8) vs. 610.6 (123.6)) were similar between the groups. There was no difference in the incidence of CPAP failure (14 vs. 20%; relative risk 0.67; 95% confidence interval 0.24-1.93). Incidence of severe nasal trauma was lower with the use of nasal masks (0 vs. 31%; p < .001).
  
  
  CONCLUSIONS
  Nasal masks appear to be as efficacious as binasal prongs in providing CPAP. Masks are associated with lower risk of severe nasal trauma.
  
  
  BACKGROUND
  CTRI2012/08/002868 What is Known? • Binasal prongs are better than single nasal and nasopharyngeal prongs for delivering continuous positive airway pressure (CPAP) in preventing need for re-intubation. • It is unclear if they are superior to newer generation nasal masks in preterm neonates requiring CPAP. What is New? • Oxygen requirement during the first 24 h of CPAP delivery is comparable with use of nasal masks and binasal prongs. • Use of nasal masks is, however, associated with significantly lower risk of severe grades of nasal injury.
authors.affiliation: Newborn Health Knowledge Centre, ICMR Center for Advanced Research in Newborn Health, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Aparna
authors.initials: A
authors.lastname: Chandrasekaran
authors.affiliation: Newborn Health Knowledge Centre, ICMR Center for Advanced Research in Newborn Health, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Anu
authors.initials: A
authors.lastname: Thukral
authors.affiliation: Newborn Health Knowledge Centre, ICMR Center for Advanced Research in Newborn Health, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: M
authors.initials: M
authors.lastname: Jeeva Sankar
authors.affiliation: Newborn Health Knowledge Centre, ICMR Center for Advanced Research in Newborn Health, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Newborn Health Knowledge Centre, ICMR Center for Advanced Research in Newborn Health, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Paul
authors.affiliation: Newborn Health Knowledge Centre, ICMR Center for Advanced Research in Newborn Health, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India. ashokdeorari_56@hotmail.com.
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Deorari
mesh_terms: D016009:Chi-Square Distribution; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D057194:Intention to Treat Analysis; D008297:Male; D008397:Masks; D009296:Nasal Cavity / Q000293:injuries; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*
keywords: Continuous positive airway pressure; Nasal; Preterm; Randomised trial