The Pressure Is On!

Ottinger, Daniele; Hicks, J. Braxton; Wilson, Sarah J.; Sperber, Kim; Power, Keely

doi:10.1097/anc.0000000000000348

Cited by 17 publications

(22 citation statements)

References 11 publications

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Section: Discussionmentioning

confidence: 99%

“…The skin matures around week 33 of gestation, but is at this time thin, vulnerable, and has increased transdermal water loss [4, 5]. Although the skin in preterm infants matures within few weeks after birth, special attention to skin care and skin lesions is needed [4, 5]. Significant risk factors for skin injuries in neonates include low birthweight, low gestational age, skin texture, limited number of position changes, and nasal CPAP [4, 5].…”

Section: Discussionmentioning

confidence: 99%

“…Although the skin in preterm infants matures within few weeks after birth, special attention to skin care and skin lesions is needed [4, 5]. Significant risk factors for skin injuries in neonates include low birthweight, low gestational age, skin texture, limited number of position changes, and nasal CPAP [4, 5]. In general, skin lesions as a result of nasal CPAP treatment are mild and a rather common complication affecting 20 to 60% of the patients, whereas severe skin lesions with necrosis are rare [6, 7].…”

Section: Discussionmentioning

confidence: 99%

“…Guidelines for the prevention and early detection of skin trauma of the scalp, ears and nostrils are essential for the use of nasal CPAP. Some studies suggest that general skin assessment should be carried out no less than every 4 h as a part of preventive care [4, 5]. In this process, the Braden Q score is suggested as a useful instrument in evaluating the risk of pressure ulcers [5].…”

Section: Discussionmentioning

confidence: 99%

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Nasal continuous positive airway pressure with head cap fixation as a contributing factor to extensive scalp necrosis in a preterm neonate with early-onset sepsis and scalp hematoma

2019

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BackgroundNasal continuous positive airway pressure (CPAP) is widely used in the treatment and prevention of respiratory distress in preterm neonates, with only few severe adverse skin effects reported.Case presentationA preterm neonate was born at 34 + 1 weeks of gestation, birth weight 1860 g, and presented with early-onset sepsis (EOS) and scalp hematoma. He developed respiratory distress day 2 after birth. Antibiotics, nasal CPAP and other supportive treatment were initiated. A scalp hematoma in the occipital region was complicated by nasal CPAP cap pressure leading to an extensive scalp necrosis equaling 6% of the total body surface. Debridement and skin grafting were performed day 11, and 51, respectively. The boy survived with good healing of the skin graft.ConclusionThe nasal CPAP head cap contributed to the development of severe, but potentially preventable, scalp necrosis in a preterm with birth-related scalp skin injury and EOS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Nasal continuous positive airway pressure with head cap fixation as a contributing factor to extensive scalp necrosis in a preterm neonate with early-onset sepsis and scalp hematoma

2019

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“…Visible scaring to the lips of infants was observed and one infant required plastic surgery (Fujioka et al 2008). The risk of pressure injures to the nasal septum and nasal bridge when providing continuous positive airway pressure via a CPAP driver has also been widely reported (Ottinger et al 2016). (FIGURE 1) Some infants have suffered the loss of their nasal septum (McCoskey, 2008).…”

Section: Neonatal Pressure Injuriesmentioning

confidence: 98%

Prevention of neonatal pressure injuries

Grosvenor

Dowling

2018

Journal of Neonatal Nursing

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Pressure injuries in the neonatal unit can cause infection, unnecessary pain and have the potential for scarring. However there is a dearth of information available on this topic.Preventative strategies to address pressure injury development are essential when caring for vulnerable neonatal patients. This article highlights the issues regarding neonatal pressure injuries in clinical practice. In addition, it explores skin assessment and discusses the use of a neonatal skin risk assessment tool as a quality improvement intervention to improve clinical practice and patient outcomes.

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RAM cannula with Cannulaide versus Hudson prongs for delivery of nasal continuous positive airway pressure in preterm infants: an RCT

Maram

Murki

Nayyar

et al. 2021

Sci Rep

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Nasal continuous positive airway pressure (nCPAP) is the standard non-invasive respiratory support for newborns with respiratory distress. Nasal injury is a common problem with the interfaces used. To compare the incidence and severity of nasal injury in neonates with respiratory distress and supported on nCPAP with Hudson prong or RAM cannula with Cannulaide, a semipermeable membrane. This is an open-label, parallel-arm, gestational age-stratified, bi-centric, randomized control trial including neonates between 28 and 34 weeks gestational age and birth weight > 1000 g needing nCPAP. The size of the interface was chosen as per the manufacturer’s recommendation. Of the 229 neonates enrolled, 112 were randomized to RAM cannula with Cannulaide and 117 to Hudson prong. The baseline characteristics were similar. Any nasal injury at CPAP removal was significantly lower in the RAM cannula with Cannulaide group [6 (5.4%) vs. 31 (26.4%); risk ratio—0.77 (95% CI 0.69–0.87); p = 0.0001]. The incidence of moderate to severe nasal injury, need for mechanical ventilation within 72 h of age, duration of oxygen, and requirement of nCPAP for > 3 days were similar. For preterm infants on nCPAP, RAM cannula with Cannulaide, compared to Hudson prongs, decreases nasal injury without increasing the need for mechanical ventilation.Trail registration: CTRI/2019/03/018333, http://www.ctri.nic.in.

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The Pressure Is On!

Abstract: There are extensive opportunities for adding to our current knowledge in terms of prevention and treatment of skin breakdown associated with device utilization in the neonatal intensive care unit, especially with the increasing use of nCPAP.

Cited by 17 publications

References 11 publications

Nasal continuous positive airway pressure with head cap fixation as a contributing factor to extensive scalp necrosis in a preterm neonate with early-onset sepsis and scalp hematoma

Nasal continuous positive airway pressure with head cap fixation as a contributing factor to extensive scalp necrosis in a preterm neonate with early-onset sepsis and scalp hematoma

Prevention of neonatal pressure injuries

RAM cannula with Cannulaide versus Hudson prongs for delivery of nasal continuous positive airway pressure in preterm infants: an RCT

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