Discrepancy in the physical dimensions of nose and continuous positive airway pressure (CPAP) interface: a possible reason for high rates of nasal injury in Indian neonates

Background Properly fitting continuous positive airway pressure (CPAP) interface is critical to the efficacy and safety of nasal CPAP therapy in preterm. Unfortunately, there is a perception that CPAP interfaces being used in Indian neonatal intensive care units do not fit well and cause a high rate of nasal injury. Objectives To determine the nasal anthropometric dimensions in preterm (<35 weeks) Indian neonates and compare them with those of commercially available CPAP interfaces. Methods In this cross-sectional study, relevant anterior nasal parameters were measured by three dimensional imaging in 32 preterm newborn (26+0-34+6 weeks) and compared with commercially available 17 short binasal CPAP prongs of multiple sizes made by five manufacturers. Dimensions for best-suited interfaces were generated for Indian neonates. Results The mean (SD) gestation and birth weight of enrolled neonates were 30.6 (3.0) weeks and 1338 (575) g, respectively. The inter prong distance was narrower than the upper bound of the 95% CI of the columellar width in Hudson type CPAP interfaces in <1250 g weight category with discrepancy in measurement varying from 0.2 to 0.5 mm and 0.9-1.4 mm at midpoint and base of columella, respectively. Similarly, the lower bound of 95% CI of the distance between the lateral walls of the nostrils was narrower than the width of the prongs by 1-3 mm. Conclusions There is mismatch between nasal prongs and nose dimension of Indian neonates resulting in possible erosion of columella and distension of nostrils.

Automated summary

The study found a mismatch between nasal dimensions of Indian preterm neonates and commercially available CPAP interfaces, which may lead to nasal injuries.