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Question 2: Should nasal mask or binasal prongs be used for continuous positive airway pressure in preterm infants?
  1. Abdul Razak
  1. Correspondence to Dr Abdul Razak, Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; razakmdpaed{at}

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An infant born to primigravida mother at 29 weeks’ gestational age (GA) has respiratory distress syndrome (RDS). The fellow on call elected to start nasal continuous positive airway pressure (NCPAP) support. A paediatric resident in her neonatology rotation asks whether nasal mask is better than binasal prongs or vice versa for applying NCPAP support.

Structured clinical question

In a preterm infant <37 weeks’ GA with RDS (patient) whether NCPAP applied with a nasal mask (intervention) compared with that with binasal prongs (comparison) reduces

  1. endotracheal ventilation or NCPAP failure (defined by authors) in first 72 hours (primary outcome)

  2. nasal trauma (all grades, moderate to severe (excoriation/breakdown, bleeding or narrowing of nasal passages)) (secondary outcome) and

  3. chronic lung disease (CLD) (all grades, moderate to severe (oxygen or pressure requirements)) at 36 weeks’ GA (secondary outcome).


Study selection: randomised or quasirandomised clinical trials and systematic reviews comparing NCPAP (bubble, infant flow device or ventilator) applied with a nasal mask to that with binasal prongs in preterm infants for RDS after birth or postextubation were included. Included studies should report ≥1 aforementioned outcomes identified in this review. Studies comparing single nasal prongs or face mask as either intervention or comparison, crossover trials, conference abstracts and studies comparing treatment arms as short-term intervention at birth for initial stabilisation in the delivery room were deemed ineligible. The results of database searches including the individual search strategy and study selection log are provided in figure 1.

Figure 1

Study flow diagram outlining stages of search results and filtering process (as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines).

Of 481 records identified through database searches (Embase: 215 records; Cochrane Central Library: 147 records; MEDLINE: 68 records; Cumulative Index to Nursing and Allied Health Literature: 51 records), seven studies were deemed eligible and included in the study.1–6 The list of studies excluded following a detailed …

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  • Contributors AR solely contributed, conceptualised and designed the study, performed the search and initial screening of the articles, performed analyses including the GRADE assessment, drafted the manuscript and approved the final version.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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