Nasal masks or binasal prongs for delivering continuous positive airway pressure in preterm neonates-a randomised trial

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 FiO(2) requirement at 6, 12 and 24 h of CPAP initiation and the area under curve (AUC) of FiO(2) against time during the first 24 h (FiO(2) AUC(0-24)). Secondary outcomes were the incidence of CPAP failure and nasal trauma. FiO(2) requirement 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 FiO(2) AUC(0-24) (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. Trial registration: CTRI2012/08/002868