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Mask versus nasal prong leak and intermittent hypoxia during continuous positive airway pressure in very preterm infants
  1. Christian F Poets1,2,
  2. Kathleen Lim3,
  3. Andrew Marshall3,4,
  4. Hamish Jackson1,
  5. Timothy J Gale4,
  6. Peter A Dargaville1,3
  1. 1Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
  2. 2Department of Neonatology, Universitatsklinikum Tubingen, Tubingen, Baden-Württemberg, Germany
  3. 3Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
  4. 4School of Engineering and ICT, University of Tasmania, Hobart, Tasmania, Australia
  1. Correspondence to Dr Peter A Dargaville, Department of Paediatrics, Royal Hobart Hospital, Hobart, TAS 7000, Tasmania, Australia; peter.dargaville{at}dhhs.tas.gov.au

Abstract

Background Nasal continuous positive airway pressure (NCPAP) can be applied via binasal prongs or nasal masks; both may be associated with air leak and intermittent hypoxia. We investigated whether the latter is more frequent with nasal masks or prongs.

Methods Continuous 24 hours recordings of inspired oxygen fraction (FiO2), pulse rate, respiratory rate, pulse oximeter saturation (SpO2) and CPAP level were made in preterm infants with respiratory insufficiency (n=20) managed on CPAP in the NICU at the Royal Hobart Hospital. As part of routine care, nasal interfaces were alternated 4-hourly between mask and prongs. In each recording, the first two segments containing at least 3 hours of artefact-free signal for each interface were selected. Recordings were analysed for episodes with hypoxaemia (SpO2 <80% for ≥10 s) and bradycardia (pulse rate <80/min for ≥4 s) and for episodes of pressure loss at the nasal interface. Data were compared using Wilcoxon-matched pairs test and are reported as median (IQR).

Results Infants had a gestational age at birth of 26 (25-27) weeks and postnatal age of 17 (14–24) days. There was no difference in %time with interface leak between prong and mask (0.9 (0–8)% vs 1.1 (0–18)%, p=0.82), %time with SpO2 <80% (0.15 (0–1.2)% vs 0.06 (0–0.8)%, p=0.74) or heart rate <80/min (0.03 (0–0.2)% vs 0 (0–0.2)%, p=0.64). Three infants had interface leak for >10% of the time with prongs and 5 with the mask.

Conclusion Both interfaces resulted in a similarly stable provision of positive airway pressure, and there was also no difference in the occurrence of intermittent hypoxia.

  • monitoring
  • neonatology
  • sleep
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Footnotes

  • Contributors CFP was involved in data analysis and wrote the first draft of the manuscript, KL, AM and TJG analysed the data and revised the manuscript for important intellectual input, HJ was involved in supervising recordings and revised the manuscript for important intellectual input, and PAD initiated and supervised this study and revised the manuscript for important intellectual input. All authors approved the submitted version of this manuscript and agree to be accountable for all aspects of this work and take full responsibility for it.

  • Funding Supported by a grant (16-203) from the Royal Hobart Hospital Research Foundation. Circuit pressure monitoring equipment was kindly loaned by Fisher & Paykel Healthcare Ltd, East Tamaki, New Zealand.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study had been approved by the institutional ethics committee as an audit of clinical practice.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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