Dear Editor,

I read with great interest the article "Pharyngeal pressure in preterm infants receiving nasal CPAP" by AG De Paoli et al. in the January 2005 issue of ADC Fetal and Neonatal edition. It is a well designed study assessing the transmission of applied CPAP to the upper airway by employing active mouth closure.

In the study, active mouth closure was achieved by gentle pressure to the chin by a single finger. It is not unlikely to have fluctuations in such applied pressure as a result of inter and intra observer variability. Chin straps could have been a more objective way of achieving active mouth closure. Favourable results from such studies and similar ones in the future could be implemented in the NICU on a practical basis if a standardized, objective measure of active mouth closure is used, viz chin straps or a similar device.

Although the author mentions about the use of chin straps in some NICUs, there is little documentation of its use in literature. Mention of chin strap use in neonates is found in a randomised control trial comparing early to late use of CPAP [1] and a retrospective study looking at outcomes following a CPAP based approach [2]. There has been no report of any complications related to the use of chin straps in these studies.

There appears to be a short term improved transmission of applied CPAP to the upper airway but long term effects and complications of prolonged active mouth closure especially when instituted in the immediate newborn period ,needs to be determined.

Vijayakumar Praveen MD
Senior Pediatric Resident
Bronx -Lebanon Hospital Center
New York 10457 USA

References

1) Krouskop RW, Brown EG, Sweet AY.The early use of continuous positive airway pressure in the treatment of idiopathic respiratory distress syndrome.J Pediatr. 1975 Aug;87(2):263-7.

2) AM De Klerk and RK De Klerk ,Nasal continuous positive airway pressure and outcomes of preterm infants.Journal of Paediatrics and Child Health,April 2001;37(2):161.

No competing interests