Incidence and Severity of Nasal Injuries in Preterm Infants Associated to Non-Invasive Ventilation Using Short Binasal Prong

Abstract

Short binasal prongs can cause skin and mucosal damage in the nostrils of preterm infants. The objective of this study was to investigate the incidence and severity of nasal injuries in preterm infants during the use of short binasal prongs as non-invasive ventilation (NIV) interfaces. A prospective observational study was carried out in the public hospital in a Southern Brazil. The incidence and severity of internal and external nasal injuries were evaluated in 28 preterm infants who required NIV using short binasal prongs for more than 24 hours. In order to identify possible causes of those nasal injuries, the expertise researcher physiotherapist has been carried empirical observations, analyzed the collected data, and correlated them to the literature data. A cause and effect diagram was prepared to present the main causes of the nasal injury occurred in the preterm infants assessed. The incidence of external nasal injuries was 67.86%, and internal ones 71.43%. The external nasal injuries were classified as Stage I (68.42%) and Stage II (31.58%). All the internal injuries had Stage II. The cause and effect diagram was organized into 5 categories containing 17 secondary causes of nasal injuries. There was a high incidence of Stage II-internal nasal injury and Stage I-external nasal injury in preterm infants submitted to NIV using prongs. The injuries genesis can be related to intrinsic characteristics of materials, health care, neonatal conditions, professional competence, and equipment issues.

Impressive Nasal Septum Regeneration after Cord Blood Platelet Gel (CBPG) in Extreme Premature Neonate with Non-Invasive Ventilation: A Case Report

“…Pre-treatment stage was type III ( Figure 1 ), As reported by Ribeiro et al [ 6 ], external nasal lesions were classified as Fischer’s Stage I (68.42%) and Stage II (31.58%). All internal injuries were evaluated as Stage II.…”

“…Nasal trauma is considered to be one of the most serious and frequent complications of nasal tips Continuous Positive Pressure Ventilation (CPAP) use [ 1 , 2 , 3 , 4 , 5 , 6 ]. Binasal tips are the most commonly used interface for the delivery of positive nasal airway pressure (CPAP) in preterm infants [ 7 , 8 ].…”

“…Force applied to the tissues of the nostrils and nasal septum of the most exposed preterm infants can compromise skin integrity and cause severe nasal injury [ 9 ]. The onset of nasal injuries is multifactorial and is in relation to the duration of non-invasive ventilation in the premature subject, which is more susceptible to infections, and his integumentary system is more fragile and vulnerable [ 4 , 5 , 6 ].…”

“…Five categories of primary causes of nose injuries can be distinguished: material hardness, health care, neonatal clinical conditions, professional competence, and equipment. The interface pattern and the sterilization process are associated with material hardness [ 6 ].…”

“…A Brazilian prospective observational study including 28 preterms evaluated the severity and incidence of internal and external nasal lesions after short nasal tip ventilation for more than 24 h: the incidence of internal injuries was 71.43%, and the incidence of external nasal lesions was 67.86% [ 6 ]. Bonfim et al [ 10 ] proved that the incidence of nasal septum injuries found in infants corresponded to 62.9%.…”