Nasal Mask Versus Nasal Prongs for Delivering Nasal Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress: A Randomized Controlled Trial.

OBJECTIVE: To compare the effectiveness of nasal continuous positive airway pressure delivered by Nasal mask vs Nasal prongs with respect to continuous positive airway pressure failure.

STUDY DESIGN: Randomized, controlled, open label, trial.

SETTING: Tertiary care level III neonatal unit.

PARTICIPANTS: 118 preterm infants-gestational age (27-34 weeks) requiring nasal continuous positive airway pressure as a primary mode for respiratory distress, who were treated with either nasal mask (n=61) or nasal prongs (n=57) as interface.

PRIMARY OUTCOME: Need for mechanical ventilation within 72 h of initiating support.

RESULTS: Nasal continuous positive airway pressure failure occurred in 8 (13%) of Mask group and 14 (25%) of Prongs group but was statistically not significant (RR 0.53, 95% CI 0.24-1.17) (P = 0.15). The rate of pulmonary interstitial emphysema was significantly less in the Mask group (4.9% vs. 17.5%; RR 0.28, 95% CI 0.08-0.96; P = 0.03). Incidence of moderate nasal trauma (6.5% vs 21%) (P=0.03) and overall nasal trauma (36% vs 58%) (P=0.02) were significantly lower in mask group than in the prongs group.

CONCLUSIONS: Nasal continuous positive airway pressure with mask as interface is as effective as prongs but causes less nasal trauma and pulmonary interstitial emphysema.