Abstract
PURPOSE: The purpose of this study was to calculate incidence, severity, and risk factors of nasal pressure injuries due to nasal continuous positive airway pressure (NCPAP) treatment in newborns.
DESIGN: A prospective observational study.
SUBJECTS AND SETTING: Newborns admitted between March 2017 and February 2018 to the neonatal intensive care unit of the First Affiliated Hospital of Xiamen University, Xiamen, China.
METHODS: All newborns' noses were examined during NCPAP application. Every NCPAP-related nasal pressure injury including occurrence date, injury severity, outcomes, and pressure injury treatment methods was recorded. These data were collected twice a week by a research nurse. Nasal pressure injuries were classified using the National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel pressure injury classification system.
RESULTS: During the study period, 429 newborns received NCPAP treatment via nasal prongs. Nasal pressure injuries were observed in 149 (34.7%); 99 (66.44%) were classified as Stage 1, 48 (32.31%) were Stage 2, and 2 (1.25%) cases were classified as deep tissue injury. The risk of nasal pressure injury was significantly higher when gestational age was less than 32 weeks (odds ratio [OR], 3.728; 95% confidence interval [CI], 1.18-11.77; P <= .025) and in those who received NCPAP treatment for more than 6 days (OR, 0.262; 95% CI, 0.087-0.787; P <= .017). The mean interval between the application of NCPAP and onset of nasal pressure injury was 4.72 days (SD, 4.78; range, 0-30 days).
CONCLUSIONS: Nasal pressure injuries are a prevalent complication of NCPAP use, especially in preterm newborns. Our results identified a gestational age of less than 32 weeks and longer use of NCPAP are important factors associated with nasal pressure injuries. Methods to prevent the development of injuries such as the use of a prophylactic dressing along and replacement of binasal prongs with nasal masks are advocated.