Hood versus mask nebulization in infants with evolving bronchopulmonary dysplasia in the neonatal intensive care unit

Abstract

Objective: To compare infants' discomfort, nursing-time and caregiver preference, and assess the clinical efficiency (as a secondary outcome) of hood versus facemask nebulization in infants with evolving bronchopulmonary dysplasia (BPD) in the neonatal intensive care unit. Study Design:A prospective, open, randomized, controlled crossover clinical trial. In total, 10 infants with BPD who were on inhaled betaagonist bronchodilators and corticosteroids were randomly assigned to receive their nebulized treatments either by a facemask, or by a hood for 2-3 days, and then crossover to receive the same treatments with the other technique for another 2-3 days. Infants' discomfort, nursing-time, caregiver preference and clinical efficiency were compared.Results: At baseline there was no significant clinical difference between the groups. Nurse-time required for administering the hood nebulization (mean±s.e.m.: 1.9±0.1 min) was significantly shorter than the time for mask nebulization (12.0±0.6 min, P<0.0001). Infants' discomfort score was significantly lower (0.1±0.04) for hood versus mask nebulization (2.5±0.2, P<0.0001). Nurses and parents unequivocally preferred the hood treatment. During both mask and hood nebulization therapies (2-3 days) clinical efficiency was comparable. While both methods caused an immediate (20 min post) clinical improvement, the immediate respiratory assessment change score was significantly greater for the hood versus the mask nebulization (0.62±0.27 versus 0.13±0.14, P<0.05).Conclusions: Nebulization of aerosolized medications in infants with evolving BPD by hood was less time-consuming for caregivers and was much better tolerated by the infants while being at least as effective as the conventional facemask nebulization.

Hood Nebulization: Effects of Head Direction and Breathing Mode on Particle Inhalability and Deposition in a 7-Month-Old Infant Model

“…Infants' discomfort score was significantly lower for hood versus mask nebulization, and hood treatment could be less time-consuming for caregivers due to its easy operation. (5) Similar results were also reported by Bar-Yishay et al (6) in their pilot study that compared lung function response to bronchodilator nebulization via hood and mask. Numerical modeling and simulation of hood treatment include reports by Amirav et al (7) and Shakked et al, (8,9) who studied related issues such as the carrier airflow, lung delivery efficiency, and eye depositions.…”

Clinical Controversies in Aerosol Therapy for Infants and Children

“…Moreover, treatment time and discomfort were shown to be lower in infants with chronic lung disease using the hood. 43 In one study, 44 respiratory scores were not different in infants with bronchiolitis receiving bronchodilators via an infant hood or a face mask, and parents preferred the hood over the mask for their babies. A hood represents a feasible option in children who will not tolerate a mouthpiece or mask treatment.…”

Systematic Review of Inhaled Bronchodilator and Corticosteroid Therapies in Infants with Bronchopulmonary Dysplasia: Implications and Future Directions

“…Thirteen articles were excluded during appraisal (4 duplicates, 3 did not focus on BPD, 3 did not evaluate inhaled medications, 2 were incomplete, and 1 evaluated inhaled medications other than bronchodilators, or ICS), leaving 22 articles included in the review ( Fig 1 ). Characteristics of the 22 included studies [ 17 – 38 ] can be found in Table 1 . Quality assessment of the data revealed an overall high risk for potential bias in the included studies as shown in Table 2 .…”

“…Details pertaining to randomization (listed method or unclear), allocation concealment (listed method or unclear), double blinding (yes, no, or unclear), power calculation (yes or no) and reporting of exact point statistical methods (yes or no) were collected. Each study [ 17 – 38 ] was scored for three levels of potential bias (low, high, or unclear). A “no” answer in any category was scored as a high risk for potential bias, whereas one “unclear” with otherwise all “yes” answers was scored as an unclear risk of bias.…”