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Original research
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
  1. Jagjit Singh Dalal1,2,
  2. Sanketh Kumar Ajmera3,
  3. Kanika Prajapat3,
  4. Tanushree Sahoo1,
  5. Chander Prakash Yadav4,
  6. P V Madhusudhan Rao3,
  7. Alok Thakar1,
  8. Anu Thukral1,
  9. Mari Jeeva Sankar1,
  10. Ashok Kumar Deorari1,
  11. Ramesh Agarwal1
  1. 1 All India Institute of Medical Sciences, New Delhi, India
  2. 2 Pt B D Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
  3. 3 Indian Institute of Technology, New Delhi, India
  4. 4 National Institute of Malaria Research, New Delhi, India
  1. Correspondence to Professor Ramesh Agarwal, All India Institute of Medical Sciences, New Delhi, India; ra.aiims{at}


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.

  • nasal interfaces
  • nostril dimension
  • three dimensional photogrammetry
  • nasal trauma
  • continuous positive airway pressure

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  • Contributors JSD conceptualised and designed the study, developed the protocol, recruited the patients, also wrote the first draft of the manuscript. PVMR, SKA and JSD performed the measurements. SKA, KP, PVMR and JSD analysed the data. TS, JSD, CPY, AlT and AnT contributed to statistical analysis and gave critical inputs in performing the study, reviewed the manuscript for intellectual content. AKD helped in protocol development and critically reviewed the manuscript. RA conceptualised and designed the study, developed protocol and reviewed and finalised the manuscript. He was the guarantor of the manuscript. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional ethical clearance from All India Institute of Medical sciences, New Delhi, Ethics committee was obtained before initiation of study. We obtained informed consent from either of parents/legally accepted representative before enrolling study subjects.

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

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.