In the January 2018 issue of Indian Pediatrics, Lal, et al. [1] reported that nasal continuous positive airway pressure (nCPAP) helped to reduce respiratory distress significantly compared to standard care in infants. We have certain queries and comments:

Bronchiolitis is a dynamic disease which requires frequent monitoring and management accordingly [2]. So, why did the author choose to see the effect of CPAP on children with bronchiolitis for initial first hour only? Improvement in first hour of admission does not prove the long-term efficacy of the modality. As bronchiolitis has become a major cause of morbidity and bed occupancy in our setting, it would have been very informative had they reported on the effect of CPAP on treatment outcomes like requirement of mechanical ventilation and duration of hospital stay.

Authors have used two scoring systems, Silverman-Anderson Score and Modified Pediatric Society of New Zealand Severity Score, for assessing their secondary outcome. Silverman-Anderson scoring system is mainly used for monitoring respiratory distress in preterm neonates [3]. Though they have used an intention-to-treat analysis, changes in respiratory rate have been compared only in those children who completed the study. The pressures and the type of interface used for the CPAP has not been mentioned. All of these above-mentioned factors make the generalizability of the study doubtful in our set up.

1. Lal SN, Kaur J, Anthwal P, Goyal K, Bahl P, Puliyel JM. Nasal continuous positive airway pressure in bronchiolitis: A randomized controlled trial. Indian Pediatr. 2018;55:27-30.

2. American Academy of Pediatrics subcommittee on diagnosis and management of bronchiolitis. Pediatrics. 2006;118:1774-93.