Title: To Study Effectiveness of Nasal Prong and Nasal Mask in Nasal Continuous Positive Airway Pressure in Preterm Neonates with Respiratory Distress
Authors: Dr Gaurav Kumar, Dr Ajay Kumar Tiwari, Dr Amlin Shukla, Dr Manish Chopra
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.32
Abstract
Objective: To analyse whether nasal continuous positive airway pressure (NCPAP) given with nasal prongs compared with nasal mask reduces the rate of intubation and mechanical ventilation in preterm infants within 72 hours of starting therapy. To compare the effect of both kinds of NCPAP on total duration of NICU stay and the outcome in terms of discharge, death, LAMA or abscond. To compare the profile of side effects caused by both kinds of CPAP interfaces.
Methods: Preterm neonates weighing between 1000gms and 2500gms (at birth) fulfilling the inclusion criteria were included in this study. Both preterm neonates, who were given NCPAP as primary treatment of respiratory distress (primary candidate), and neonates who were given NCPAP post-extubation (secondary candidate) were included. The primary outcome of our study was to observe the number of patients requiring intubation and ventilation within 72 hours of starting NCPAP. Infants were intubated and ventilated if they meet 2 or more of 5 failure criteria and it were taken as failure of NCPAP method. Final outcome and total duration of hospital stay and side effects if any also compared between two study groups.
Results: In our study we enrolled 60 preterm neonate of birth weight between 1000gms to 2500 gms, 30 in each group of nasal prong and nasal mask. Failure of NCPAP was noticed in 11 (36.7%) patients in nasal prong group, while in nasal mask group NCPAP failure was noticed in 5 (16.7%) patients. There was no statistically significant difference found in failure rate between the two groups (P=0.080).Median duration (IQR) in hrs on NCPAP support was 42.5hrs (25-55) in nasal prong group, while in nasal mask group median duration (IQR) was 47.25hrs (36-72) with a P value of 0.181. Median duration (IQR) of total hospital stay was 216hrs (112.5-354) in nasal prong group whereas nasal mask group median duration (IQR) of total hospital stay was 264 hrs (186-456). There was a significant difference found in total duration of hospital stay between both interfaces as nasal prong group was better in terms of total hospital stay(P =0.036). Localised nasal complications were detected in 10 (33.3%) patients in nasal prong, while in nasal mask group they were reported in 6 (20%) patients. There was no significant difference (P=0.136).
Conclusions: NCPAP support in preterm newborn given with nasal mask as well as with nasal prong was found equally effective in terms of primary objective. Significant difference was found in the total duration of stay in nursery between both the groups, as in nasal prong group median duration of total stay in nursery was less in comparison to nasal mask, but there was no difference observed in terms of outcome (discharge, death and LAMA). Complications were observed in the groups, nasal prong as well as nasal mask, but there was no significant difference observed in the frequency of complications between both the groups.
Keywords: NCPAP, Nasal Mask, Nasal Prong, Preterm Neonate, Respiratory Distress.
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