Comparison of nasal masks or binasal prongs for delivering continuous positive airway pressure in preterm neonates of gestational age less than 32 weeks

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Background: Aim was to compare the efficacy and safety of continuous positive airway pressure (CPAP) delivered by nasal masks vs binasal prongs. Methods: This was observational trial where preterm infants less than 32 weeks of gestation with respiratory distress were enrolled after parental consent. Participants: 145 neonates less than 32 weeks gestation requiring nasal CPAP (NCPAP) as a primary mode for respiratory distress, who were treated with either nasal mask (n=45) or nasal prongs (n=99) as interface. Primary outcome: Was the incidence of CPAP failure (need for mechanical ventilation at less than 72 hours). Results: Failure rate in nasal mask group was 13% vs nasal prongs group was 39.4% and the difference was statistically significant. Secondary outcomes were mean FiO2 requirement at 6 hours, duration of CPAP therapy, hospital stay and nasal trauma. There was 3.7±5.78% reduction in oxygen requirement at 6 hours of CPAP initiation with nasal mask as compared to nasal prongs and the difference was statistically significant (p<0.05). the CPAP duration in nasal mask group was 3.4± 4.04 days vs nasal prongs group was 4.5±3.52 days and duration of hospital stay in nasal mask group was 15.4±14.19 vs in nasal prongs group was 20.2±13.86 and the both differences were also statistically significant(p<0.05). Nasal mask had no nasal injury (0%) as compared to infants on nasal prongs (23.2%) and the difference was statistically significant (p<0.05). Conclusions: NCPAP with mask as interface is as effective as prongs but causes less nasal trauma and less CPAP duration and hospital stay.