[Prevalence of nasal septum injury in premature infants using nasal prongs]

Incidence of nasal pressure injury in preterm infants on nasal mask noninvasive ventilation

OBJECTIVE

The aim of this study was to evaluate the incidence of nasal injury in preterm newborns (NB) using the Neonatal Skin Condition Score within 7 days of noninvasive ventilation (NIV) and to compare the incidence of injury in NB weighing ≥1,000 g and those weighing <1,000 g at the time of initiation of NIV support.

METHODS

This is a prospective, observational study carried out in a neonatal intensive care unit of a public hospital in Rio Grande do Sul from July 2016 to January 2021. Patients were stratified into two groups at the time of NIV initiation: group 1 (weight ≥1,000 g) and group 2 (weight <1,000 g). To assess the condition of nasal injury, a rating scale called the Neonatal Skin Condition Score was applied during the first seven consecutive days on NIV. Kaplan-Meier, log-rank test, and Cox proportional hazards regression were used to estimate the hazard ratio (HR) and 95% confidence interval (CI).

RESULTS

In total, 184 NB were evaluated. Nasal injury was reported in 55 (30%) NB. The risk of nasal injury was 74% higher in group 2 (19/45) than in group 1 (36/139) (HR: 1.74; 95%CI 0.99-3.03, p=0.048).

CONCLUSION

The incidence of nasal injury in infants submitted to NIV by nasal mask was high, and the risk of this injury was greater in preterm infants weighing <1,000 g.

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

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.

Hydrocolloid versus silicone gel for the prevention of nasal injury in newborns submitted to noninvasive ventilation: A randomized clinical trial

Purpose

To compare the effectiveness of the hydrocolloid and the silicone gel on the nasal protection of the newborns (NBs) during the use of noninvasive ventilation (NIV).

Materials and methods

Thirty-three NBs were selected. They were randomly divided into three groups of 11 NBs, according to the type of nasal protection used: hydrocolloid, thick silicone gel, and thin silicone gel. The stage of the nasal injury and need for exchanging nasal protection were assessed before the connection to the NIV and every 24 h until the physician's authorization for NIV's suspension.

Results

The mean gestational age was 32.03 ± 3.93 weeks, and the median birth weight was 1760 g (750–3535 g). The incidence of nasal injury using hydrocolloid, thick silicone gel, and a thin silicone gel group was 36.36%, 81.81%, and 72.72%, respectively (p = 0.06). Regarding the injury stage, there was no statistical significance between the three study groups. The hydrocolloid protection type had the best adhesion (p = 0.03) on the NBs' skin.

Conclusions

Although this study was conducted by local practice patterns, the results showed that the hydrocolloid could be the best choice to prevent the nasal septum base injury in the NB submitted to NIV.

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

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.

Kinesio Taping® as an innovative therapeutic tool to prevent nasal septal lesions in newborns: a case study

Abstract Introduction: The immaturity of the integumentary system in premature newborns (PTNB), associated with ventilatory support, contributes to the higher occurrence of nasal trauma. Objective: This article reports on the case of a newborn submitted to Kinesio® Taping as an innovative prophylactic therapy for nasal trauma. Method: We report on Kinesio® Taping, a material frequently used to treat pain in athletes, as an innovative therapeutic tool to prevent nasal septal lesions in a PTNB undergoing noninvasive mechanical ventilation (NIMV), who, after 13 days on NIMV, presented with nasal septal lesions. Results: The Kinesio® Taping, was positioned to protect the nasal septum from friction caused by direct contact of the nasal prong, maintained NIMV pressure, adapted well to the shape of the nose and improved nasal trauma after 3 days of use. Conclusion: Given that breathing in this period of life occurs predominantly through the nose and maintaining the integrity of this mucosa reduces not only respiratory discomfort, but also deformities and the risk of infections. The present study presents KT as an innovative protective tool against nasal injury in premature newborns submitted to positive pressure ventilation using nasal prongs. Despite describing a single case, the results obtained were promising. However, studies with a larger sample and different groups are needed, primarily to compare with existing methods.

Factors associated with skin and mucosal lesions caused by medical devices in newborns: Observational study

AIM AND OBJECTIVE

To identify the occurrence of skin and mucosal lesions and factors related to the use of medical devices in newborns admitted to a neonatal intensive care unit.

BACKGROUND

The use of medical devices increases the risk of injury in newborns due to the immaturity and fragility of their skin and mucosa.

DESIGN

Observational and longitudinal study.

METHODS

The study included 85 newborns admitted to in a neonatal intensive care unit from a public teaching hospital. Data were collected from February-August 2018. For the evaluation, the Neonatal Skin Condition Score was used, as well as an instrument covering sociodemographic and clinical variables, medical devices in use and materials for skin protection. The study followed the recommendations STROBE. Simple frequency, measures of central tendency and variability, Pearson's correlation coefficient and multiple linear regression analysis were used for data analysis.

RESULTS

Of the n = 85 newborns evaluated, n = 62 (72.9%) presented skin or mucosal lesions caused using medical devices, excoriations being the most observed n = 55 (64.7%), and n = 32 (37.6%) had 1-3 lesions. As the number of devices increased, so did the number of lesions. On the other hand, the age of the newborn and the number of lesions were inversely proportional.

CONCLUSION

Most participants, n = 62 (72.9%), had skin or mucosal lesions associated with medical devices. The number of medical devices used and the age of the newborn were predictors for this occurrence.

RELEVANCE TO CLINICAL PRACTICE

The results show that it is fundamental that nurses know the factors that can interfere in the skin and mucosa conditions and, thus, promote the implementation of injury prevention measures in newborns, supporting safe and quality care.

Continuous positive pressure on aircraft in neonates: care provided by the nursing team

ABSTRACT Objective: to describe the nursing care of the neonate in continuous positive airway pressure (CPAP) with prong analyzing them in the light of the systematization of nursing care / process. Method: Descriptive research, qualitative approach. We interviewed 30 nursing professionals from the neonatal intensive and intermediate care units of a school hospital in Maceió / Alagoas, from August / 2016 to January / 2017, through a semi-structured interview, in the light of Bardin's content analysis. Results: Although unit nurses are aware of the use of CPAP and the care associated with this therapy, mid-level professionals still find it difficult to systematize systematized knowledge about the system. The tripod's correlation between CPAP, the formation of nasal lesions and the assistance provided was highlighted. Conclusion: It is necessary to carry out training, such as raising the awareness of professionals about the importance of keeping records up to date and applying protocols.

Effectiveness and safety of nasal mask versus binasal prongs for providing continuous positive airway pressure in preterm infants-A systematic review and meta-analysis

Continuous positive airway pressure (CPAP) delivered via binasal prongs has been the cornerstone of respiratory management in preterm infants. Though effective, the use of binasal prongs is associated with nasal trauma, and CPAP failure. To overcome these issues, nasal masks are increasingly used to deliver CPAP in preterm infants. The aim was to conduct a systematic review of randomized controlled trials (RCTs) comparing nasal mask versus binasal prongs to deliver CPAP in preterm infants. Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing, and Allied Health Literature, and E-abstracts from the Pediatric Academic Society meetings were searched in May 2017. All RCTs comparing nasal mask versus binasal prongs for delivering CPAP in preterm infants were included. Primary outcome was CPAP failure (need for mechanical ventilation within 72 h of initiating CPAP). Secondary outcomes included duration of CPAP, moderate to severe nasal trauma, any nasal trauma, pneumothorax, severe IVH, bronchopulmonary dysplasia at 36 weeks postmenstrual age, and mortality. Five RCTs with low risk of bias were included. Nasal mask significantly decreased the risk of CPAP failure (4 RCTs [N = 459]; relative risk [RR]: 0.63; 95% confidence interval [CI]: 0.45-0.88; P=.007; I2 = 0%, NNT: 9), and the incidence of moderate to severe nasal trauma (3 RCTs [N = 275], RR: 0.41; 95%CI, 0.24-0.72; P = 0.002; I2 = 74%, NNT: 6). Other outcomes did not differ significantly between the groups. Compared to binasal prongs, nasal mask may provide a safe and effective alternative by minimizing the risk of CPAP failure in preterm infants needing CPAP support.

Nasal septum injury in preterm infants using nasal prongs

OBJECTIVE:

to assess the incidence and risk factors associated with nasal septum injury in premature infants using reused and new nasal prongs.

METHOD:

the study was a cohort from an open therapeutic intervention. The sample included 70 infants with a gestational age inferior to 37 weeks, who used nasal prongs and were hospitalized at the neonatal service of a hospital in Recife-PE, in the Northeast of Brazil. The data were collected in patient files through the assessment of the application of the device and of the nasal septum. Multinomial Logistic Regression and Survival analyses were applied.

RESULTS:

the incidence of nasal injury corresponded to 62.9%. In the multiple analysis, only the length of the infant's treatment was a determinant factor for the occurrence and severity of the injuries.

CONCLUSION:

the type of nasal prong does not serve as a risk factor for the nasal injury. The high incidence of nasal injury indicates the need to adapt the nursing care with emphasis on prevention.

Columella erosion secondary to nasal prongs in the neonate

There is limited awareness of the risks of pressure necrosis to the columella when using nasal prongs in the neonate. Previous studies have found that signs of skin damage can occur rapidly-within days. This case report aims to illustrate a simple technique of prophylactically lowering the risk of septal injury (if prolonged use of nasal prongs is envisaged), as well as a way of conservatively treating already damaged skin areas. Routine daily skin inspections are also recommended.