<p>Nasal Prongs: Risks, Injuries Incidence and Preventive Approaches Associated with Their Use in Newborns</p>

Abstract

Purpose: To assess the incidence of nasal injury in newborns submitted to non-invasive ventilation (NIV) via binasal prongs, to identify risks that come with using this interface, and to present actions for nasal injury prevention. Patients and Methods: Observational and descriptive study performed in neonatal intensive care unit (NICU) of a public hospital in the south of Brazil. This research was divided into three stages. In the first one, nasal injury incidence was assessed in 148 newborns, using data collection from medical records. In the second stage, injury incidence, severity and a preliminary analysis of risks associated with the prescription of binasal prongs were analyzed in 33 newborns who required NIV. In the third stage. recommendations were presented to prevent nasal injury during NIV with short binasal prong. Results: The incidence of nasal injury in the first stage was 37.16%, and 63.64% in the second one. As for severity, 68.42% of the injuries showed Stage I severity, and 31.58% Stage II. The main risks associated with the use of binasal prongs were inappropriate prong size, inappropriate prong model, interface reuse, prolonged NIV use exclusively with binasal prongs, incorrect prong position and NIV circuit pulled. A total of 17 preventive approaches were recommended: 13 related to newborns care and not dependent on prior investment. Among them: to choose appropriate prong size; to keep the prong and the NIV circuit well positioned and periodically massages with circular movements in the nasal septum and columella. Conclusion:The inappropriate prong size, interface reuse, prong model, prolonged NIV use with binasal prong and incorrect prong and NIV circuit position may be associated with the high occurrence of injury in the NICU studied. Simple approaches concerning clinical staff care actions towards the newborn in NIV, which do not require a financial investment, can prevent nasal injury.

Prevalence and risk factors of discomfort in infants with severe bronchiolitis

“…However, the use of any type of noninvasive ventilation may also constitute a factor of discomfort, especially in acute settings 7 . An inappropriate interface 8 with an excessive tightening, 9 the presence of unintentional leaks, the presence of gastric dilatation 10 or the occurrence of asynchrony 11 may constitute significant sources of discomfort 12 …”

Nasal Anthropometry among Term and Preterm Indian Neonates- Does Size Matter?

“…5 The major and the most common complication of n-CPAP therapy in preterm neonates is the variable degree of nasal trauma. 6,7 Even though there is no recognized classification specifically addressing to the nasal trauma secondary to n-CPAP in neonates, the US National Pressure Ulcer Advisory Panel 8,9 guidelines for staging have been often used in most of the neonatal studies. This classification has attempted to grade nasal injury from early stage of non-blanchable erythema with intact skin to an advanced stage of necrosis, with full thickness skin loss.…”

“…9 The higher incidence of nasal trauma in smaller babies is most of the times attributed to the soft, fragile skin, ischemia prone underlying tissue and more importantly the ill-fitting, inappropriately sized binasal prongs. 6 The number of the injuries and their severity can be reduced if an appropriate size binasal prongs are used, that are customized to the anatomical measurements of the noses.…”

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

“…The knowledge of the variables associated with the development of injuries due to the use of NIV can help direct infant care and contribute to the elaboration of protocols and training of the multidisciplinary team who are responsible for infants. 14 , 15 …”

“…13 The knowledge of the variables associated with the development of injuries due to the use of NIV can help direct infant care and contribute to the elaboration of protocols and training of the multidisciplinary team who are responsible for infants. 14,15 From the scenario described here, we investigated the incidence and severity of nasal injuries in preterm infants during the use of nasal prongs as non-invasive ventilation interfaces, in the Neonatal Intensive Care Unit (NICU) of a public hospital situated in the metropolitan region of Curitiba, Paraná, in the south region of Brazil.…”