CPAP with Resuscitation Mask in a Neonate with Cleft Lip and Cleft Palate

Excerpt

To the Editor: Nasal Continuous Positive Airway Pressure (nCPAP) is the standard respiratory therapy to a preterm infant with Respiratory Distress (RD) [1]. As it is difficult to achieve a seal with nCPAP, often preterms with cleft lip and palate with RD are supported with invasive ventilation [2]. In this letter, we report a novel way of achieving seal for nasal CPAP in a preterm infant with respiratory distress and with cleft lip and cleft palate. This is Baby X, 2nd of a dichorionic diamniotic twins (DCDA) twin was delivered preterm at 29 wk of gestation to a primi mother for preterm premature rupture of membranes. Baby cried immediately and developed respiratory distress soon after birth. Examination revealed unilateral cleft lip and palate (Fig. 1). In order to avoid invasive ventilation we initiated CPAP with resuscitation mask (Fig. 2). The infant’s distress improved and was gradually weaned off from the CPAP on day 5 of life. During the therapy the infant was monitored for injury over the face, pain, leakage of gas flow and efficacy of nasal CPAP. Literature review revealed similar reports but some of them tried nCPAP after initial mechanical ventilation [3] and some of them tried nCPAP after placement of orthodontic passive palatal plates with limited success in bilateral cases [4]. But in our case we have started nCPAP with a normal resuscitation mask with adequate fixation to prevent pressure leak. In infants with airway malformations and in settings where standard nasal prongs are not available, resuscitation mask can be used to provide nCPAP, provided monitoring for seal, facial injuries and respiratory distress is adequate.

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