Nasal CPAP complications in very low birth weight preterm infants

Reporting nasal pressure injuries in neonates receiving non-invasive ventilation: a scoping review

BACKGROUND/OBJECTIVES

Although neonates receiving Non-Invasive Ventilation (NIV) for respiratory support are at risk for nasal pressure injuries, efforts to standardize reporting are limited. A scoping review was conducted to identify the reporting systems used for describing these injuries.

SUBJECTS/METHODS

PubMed, Embase, and Web of Science were queried for papers reporting nasal injury with NIV usage in neonates. The primary outcome was reporting system usage.

RESULTS

705 titles and abstracts were screened. 40 papers met inclusion criteria. Most studies were Randomized Clinical Trials (37.5%) or cohort studies (37.5%). Most commonly, nasal injuries were reported using a unique, descriptive scale developed by the authors (10 studies, 25%). The Fischer et al 2010 scale, a three-stage reporting system, was used in 8 studies (20%). While 15 studies (38.0%) reported on specific anatomic subsite injury, only 2 studies (5.0%) employed endoscopy for assessment.

CONCLUSIONS

Wide heterogeneity in pressure injury reporting secondary to NIV exists across specialties, institutions, and literature.

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.

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

BACKGROUND

We evaluated the efficacy of Cord Blood Platelet Gel (CBPG) in the regenerative reconstruction of the nasal septal tissue of a preterm infant undergoing non-invasive ventilation.

METHODS

A CBPC treatment was used to enhance the regeneration of the nasal septum of a premature patient in an experimental way, evaluating the efficacy described in the literature (selective bibliographic search in PubMed) of the use of blood products for non-transfusion purposes.

RESULTS

A partial but satisfactory regeneration of the patient's nasal septum was observed. Using the free NIH Image J online software, we were able to calculate the regenerated surface (about 83% of the destroyed cartilage).

CONCLUSIONS

The use of platelet gel has been a promising alternative to surgical treatment in patients with severe damage to the nasal septum.

A randomised trial comparing weaning from CPAP alone with weaning using heated humidified high flow nasal cannula in very preterm infants: the CHiPS study

OBJECTIVE

To determine whether weaning from nasal continuous positive airway pressure (nCPAP) using heated humidified high flow nasal cannula (nHF) was non-inferior to weaning using nCPAP alone in relation to time on respiratory support.

STUDY DESIGN

Single-centre, non-inferiority, randomised controlled trial.

SETTING

Neonatal Intensive Care Unit, Middlemore Hospital, Auckland, New Zealand.

PATIENTS

120 preterm infants, <30 weeks' gestation at birth, stable on nCPAP for at least 48 hours.

INTERVENTIONS

Infants underwent stratified randomisation to nHF 6 L/min or bubble CPAP 6 cm water. In both groups, stepwise weaning of their respiratory support over 96 hours according to a strict weaning protocol was carried out.

MAIN OUTCOME MEASURES

Time on respiratory support from randomisation to 72 hours off respiratory support or 36 weeks' postmenstrual age. The non-inferiority threshold was set at 15%.

RESULTS

59 infants were randomised to weaning using nHF and 61 using nCPAP. The groups were well balanced in regards to baseline demographics. The restricted mean duration of respiratory support following randomisation for the nCPAP group, using per-protocol analysis was 401 hours (upper boundary, mean plus 0.15, was 461 hours) and 375 hours in the nHF group (upper 95% CI 413 hours). nHF weaning was, therefore, non-inferior to nCPAP weaning at the non-inferiority threshold. There was no significant difference in time to discharge.

CONCLUSION

For infants ready to wean from nCPAP, the CHiPS study found that nHF was non-inferior to discontinuing nCPAP at 5 cm water.

TRIAL REGISTRATION NUMBER

Australia and New Zealand Clinical Trials Registry (ACTRN12615000077561).

Nasal Continuous Positive Airway Pressure and High-Flow Nasal Cannula Today

This study reviews the mechanisms of action and physiologic effects of nasal continuous positive airway pressure (nCPAP) and high-flow nasal cannula (HFNC) in preterm infants with respiratory distress syndrome, discusses the main characteristics of available devices and patients' interfaces, reports on risk of failure and possible adverse effects, and summarizes clinical evidence regarding effectiveness for preventing mechanical ventilation as primary respiratory support or after extubation in the neonatal intensive care unit. nCPAP is preferred to HFNC as primary mode of noninvasive respiratory support in preterm infants with respiratory distress syndrome, whereas HFNC is an effective alternative to nCPAP after extubation.