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. Issue 1 (16th September 2020)

• Record Type: Journal Article
• Authors: Dalal, Jagjit Singh; Ajmera, Sanketh Kumar; Prajapat, Kanika; Sahoo, Tanushree; Yadav, Chander Prakash; Rao, P V Madhusudhan; Thakar, Alok; Thukral, Anu; Sankar, Mari Jeeva; Deorari, Ashok Kumar; Agarwal, Ramesh
• Is Part Of: BMJ innovations. Volume 7:Issue 1(2021)
• Page Start: 33
• Page End: 39
• Publication Date: 2020-09-16
• Subjects: nasal interfaces -- nostril dimension -- three dimensional photogrammetry -- nasal trauma -- continuous positive airway pressure; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjinnov-2019-000372
• Languages: English
• ISSNs: 2055-8074

Abstract

Abstract : 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.