Cannula with long and narrow tubing versus short binasal prongs for nasal intermittent positive pressure ventilation in preterm infants with respiratory distress syndrome: a randomised non-inferiority trial
In brief
Long-tube cannula cuts nasal trauma 75% but doesn't meet prongs for ventilation failure
In a trial of 316 preterm infants, nasal intermittent positive pressure ventilation via a long, narrow-tube cannula lowered any nasal injury from 45% to 12% compared with short binasal prongs, while the rate of treatment failure requiring intubation was slightly higher (17% vs 15%) and non-inferiority was not proven. Mortality and major morbidities were similar, leaving clinicians to weigh reduced trauma against a modestly higher risk of early ventilation failure.
- Journal
- Archives of disease in childhood. Fetal and neonatal edition (Q1)
- Published
- 10 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Sikha Sharma, Adil Ahmed Khan, Pradeep Debata, Anita Yadav, Jogender Kumar
- PMID
- 42727984
- DOI
- 10.1136/archdischild-2026-330607
Why clinicians should know about it
- Picked for Neonatology (top studies of the week, 13 September 2026): Randomised non‑inferiority trial of NIPPV interfaces
- Picked for Emergency Medicine (top studies of the week, 13 September 2026): High-quality evidence in a top journal
- Picked for Obstetrics and Gynecology (top studies of the week, 13 September 2026): Neonatal ventilation trial, no obstetric focus
- Picked for Pediatric Surgery (top studies of the week, 13 September 2026): High-quality evidence in a top journal
Abstract
OBJECTIVES: To determine whether nasal intermittent positive pressure ventilation (NIPPV) delivered via a cannula with long and narrow tubing (CLNT) was non-inferior to short binasal prongs (SBP) in preventing treatment failure among preterm infants with respiratory distress syndrome (RDS). DESIGN: Open-label, non-inferiority randomised controlled trial. SETTING: Level III neonatal unit. PATIENTS: Preterm infants (<34 weeks' gestation) requiring primary NIPPV support within 6 hours of birth for RDS. INTERVENTIONS: Infants were randomly assigned (1:1) to receive NIPPV via CLNT or SBP. MAIN OUTCOME MEASURES: The primary outcome was NIPPV failure requiring intubation within 72 hours of randomisation. The prespecified non-inferiority margin was an absolute risk difference of 10%. Secondary outcomes included nasal trauma, mortality and major neonatal morbidities. RESULTS: A total of 316 infants were randomised (158 per group). NIPPV failure occurred in 27 (17.1%) infants in the CLNT group and 23 (14.6%) in the SBP group (risk difference: 2.5%, 95% CI -5.51 to 10.56). Because the upper bound of the 95% CI exceeded the prespecified non-inferiority margin, non-inferiority was not demonstrated. Mortality, bronchopulmonary dysplasia, severe intraventricular haemorrhage, retinopathy of prematurity and duration of respiratory support were similar between groups. Nasal trauma was significantly lower with CLNT (any grade: 12.0% vs 44.9%, RR 0.27, 95% CI 0.17 to 0.42; moderate-to-severe: 4.4% vs 21.5%, RR 0.21, 95% CI 0.09 to 0.45). CONCLUSIONS: CLNT did not demonstrate non-inferiority to SBP according to the prespecified non-inferiority criterion for preventing treatment failure. Nevertheless, CLNT was associated with substantially lower rates of nasal trauma without evidence of increased short-term morbidity or mortality. REGISTRATION NUMBER: Clinical Trial Registry of India (CTRI/2022/09/045914).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.