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.

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.

BACKGROUND: A spontaneous breathing trial (SBT) is commonly used to determine extubation readiness in patients receiving mechanical ventilation. However, the physiological impact of such a trial in preterm infants has not been well described. This study aimed to investigate the effects of a 3-min SBT on the cardiorespiratory stability of these infants. METHODS: A retrospective analysis of prospectively collected data was done for infants < 37 weeks gestational age who were extubated after a successful 3-min SBT. Heart rate, S pO 2 , breathing frequency, exhaled tidal volume, and Silverman Andersen Respiratory Severity Score (SA-RSS) to assess work of breathing, before and at the end of the SBT, were recorded and compared using nonparametric paired Mann-Whitney tests. A secondary analysis was done between extubation success (ie, 72 h without the need for re-intubation) and failure groups. Differences were considered statistically significant if P < .05. RESULTS: A total of 90 SBTs were performed in 70 premature infants; 65 had a successful SBT, and 5 failed the SBT. Of the 65 infants who had a successful SBT and were extubated, 6 failed extubation (9.2%). Subjects had a median (interquartile range [IQR]) gestational age of 30 (27-33) weeks at birth, a birthweight of 1,240 (860-1,790) g, and weight at extubation of 1,790 (1,440-2,500) g. Cardiorespiratory stability was noted by a significant decrease in median (IQR) exhaled tidal volume (6.4 [4.9-8.4] mL/kg vs 5.2 (3.8-6.6] mL/kg, P < .001), a significant increase in mean 6 SD breathing frequency (45.1 6 11.4 vs 52.6 6 14.4 breaths/min, P < .001), and a significant median (IQR) increase in work of breathing (SA-RSS of 1 [1-2] vs 2 [1-3], P < .001) at the end of the SBT. Respiratory instability was more remarkable in the success group. CONCLUSIONS: In preterm infants receiving prolonged mechanical ventilation, the performance of a 3-min SBT was associated with increased respiratory instability while still leading to a 10% extubation failure rate. Therefore, the routine use of SBTs to assess extubation readiness in this population is not recommended until there are clear standards and definitions, as well as good accuracy to identify failures.

Monitoring CO2 levels in intubated neonates is highly relevant in the face of complications associated with altered CO2 levels. Thus, this review aims to present the scientific evidence in the literature regarding the correlation between arterial carbon dioxide measured by non-invasive methods in newborns submitted to invasive mechanical ventilation. The search was carried out from January 2020 to January 2021, in the Scopus, Medline, The Cochrane Library, Web of Science, CINAHL and Embase databases. Also, a manual search of the references of included studies was performed. The main descriptors used were: “capnography,” “premature infant,” “blood gas analysis,” and “mechanical ventilation.” As a result, 221 articles were identified, and 18 were included in this review. A total of 789 newborns were evaluated, with gestational age between 22.8 and 42.2 weeks and birth weight between 332 and 4790 g. Capnometry was the most widely used non-invasive method. In general, the correlation and agreement between the methods evaluated in the studies were strong/high. The birth weight did not influence the results. The gestational age of fewer than 37 weeks implied, in its majority, a moderate correlation and agreement. Therefore, we can conclude that there was a predominance of a strong correlation between arterial blood gases and non-invasive methods, although there are variations found in the literature. Even so, the results were promising and may provide valuable data for future studies, which are necessary to consolidate non-invasive methods as a reliable and viable alternative to arterial blood gasometry.

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 AE 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 ¼ 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 ¼ 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.

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