Effect of silicon gel sheeting in nasal injury associated with nasal CPAP in preterm infants

Abstract

We conducted this study to investigate the efficacy of the silicon gel application on the nares in prevention of nasal injury in preterm infants ventilated with nasal continuous positive airway pressure (NCPAP). Patients (n=179) were randomized into two groups: Group 1 (n=87) had no silicon gel applied to nares, and in Group 2 (n=92), the silicon gel sheeting was used on the surface of nares during ventilation with NCPAP. Nasal injury developed in 13 (14.9%) neonates in Group 1 and 4 (4.3%) newborns in Group 2 (OR:3.43; 95% CI: 1.1-10.1; P<0.05). The incidence of columella necrosis was also significantly higher in the Group 1 (OR: 6.34; 95% CI: 0.78-51.6; P<0.05). We conclude that the silicon gel application may reduce the incidence and the severity of nasal injury in preterm infants on nasal CPAP.

Hydrocolloid dressing in preventing nasal trauma secondary to nasal continuous positive airway pressure in preterm infants

“…In this short-term study, hydrocolloid dressing appeared to be as effective as silicon gel in preventing nasal trauma in preterm infants ascribed to nCPAP. [12] Moreover, we presumed that the low overall incidence of nasal injury (13.8%) might be underestimated because of relatively longer gestational age and larger birth weight of infants in this study.…”

“…[11] McCoskey [15] reported the important role of positioning the neonate in preventing nasal injury with nCPAP application, and also pointed out concrete proposals by positioning the neonate in prone with the neonate's hand tucked under the chin to keep the mouth closed and less altering of the prongs or mask. Gunlemez [12] investigated the effi cacy of the silicon gel application on the nostrils in prevention of nasal injury in preterm infants ventilated with nCPAP. His results indicated that 4.3% (4/92) of neonates with the silicon gel sheeting on the surface of the nostrils developed nasal injury, but 14.9% (13/87) of the patients without using silicon gel had nasal injury.…”

“…Fischer et al [11] found that 420 (42.5%) of 989 patients developed a nasal trauma. Gunlemez et al [12] demonstrated that the silicon gel on the surface of the nostrils reduced the incidence of nasal injury in preterm infants.…”

Face Masks for Noninvasive Ventilation: Fit, Excess Skin Hydration, and Pressure Ulcers

“…Skin hydration was decreased with the silicone dressing interface, consistent with reduced injury when a silicone dressing was applied to the nose of infants on CPAP. 34 Pressures exerted by masks were significantly higher at the nose bridge versus the cheeks in healthy adults. 35 Thus, greater applied pressure may account for the higher frequency of the nasal stage II, stage III, and deep tissue injury pressure ulcers we observed.…”

Neonatal pressure ulcers: prevention and treatment

“…The main risk factors at neonatal age are the use of therapeutic and diagnostic devices (50-90% of the PUs in neonates), 3,16 presence of endotracheal tube, use of noninvasive mechanical ventilation, hypotension and hypoxemia, prolonged stay in the neonatal intensive care unit (NICU), low birth weight (<2500 g) and prematurity (<37 weeks of GA). [16][17][18][19][20][21] The most frequent locations of PUs in neonates are the occipital region and ears, [22][23][24] as well as anatomical areas where therapeutic or diagnostic systems are at risk, such as fingers and feet (pulse oximetry sensor), skin support areas (vascular catheters), thorax (electrodes), ear lobe (capnaptic clamp sensor), nasal septum, back of the neck, nostrils and cheeks (continuous positive airway pressure interface, both binaural cannulae and face mask). 20,23,25 epidemiology…”