Early nasal injury resulting from the use of nasal prongs in preterm infants with very low birth weight: a pilot study

Abstract

ObjectiveTo analyze the incidence of early-onset nasal injury in infants with very low birth weight and indication for noninvasive ventilation via nasal prongs. MethodsA prospective case series of infants with gestational age <37 weeks, weight <1.500 g and postnatal age <29 days. The patients were evaluated three times daily from the installation of nasal prongs to the 3rd day of use. The patients' clinical conditions and the device's characteristics and its application were analyzed. The initial analysis was descriptive, indicating the prevalence of nasal injury and factors associated with it. Categorical data were analyzed using the chi-squared test or Fisher's exact test, and numerical data were analyzed using the t-test or the Mann-Whitney test. ResultsEighteen infants were included; 12 (with a gestational age of 29.8±3.1 weeks, birth weight of 1.070±194 g and a Score for Neonatal Acute Physiology - Perinatal Extension (SNAPPE) of 15.4±17.5) developed nasal injuries (injury group), and 6 (with a gestational age of 28.0±1.9 weeks, weight of 1.003±317 g and SNAPPE of 26.2±7.5) showed no nasal injury (uninjured group). The injury group subjects were more often male (75% versus 17%), and their injuries appeared after an average of 18 hours, predominantly during the night (75%). ConclusionThe incidence of nasal injury in preterm infants who experienced noninvasive ventilation via nasal prongs was high, and a study of associated factors may be planned based on this pilot.

Nasal septum injury in preterm infants using nasal prongs

“…In a recent study, it was observed that most of the injuries due to nasal prongs appear at night, when the surveillance at the neonatal intensive care unit probably decreases. Also, the work overload at some times of the day can reduce the surveillance of the infants using this device ( 20 ) . This fact entails the need for qualification and appropriate dimensioning of the nursing staff attending to infants.…”

“…In fact, perhaps, the control of the number of times the devices are sterilized, due to the need to preserve their consistency, which guarantees their softness ( 9 ) , in combination with the compliance with the nursing care protocol to prevent nasal septum injuries in premature infants, may be more associated with the drop in the incidence rates of the injuries that the type of prong used in the treatment. This fact entails the need for sensitization and continuous training of the team to monitor the infants, as well as for the early detection of the injuries and measures to prevent their development and worsening ( 20 ) .…”

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

“…It was based on empirical observations of infants who used NIV, carried out by the intensive care physiotherapist, in addition to the analysis of the data collected and the available literature. 8 , 9 , 11 , 14 , 17 - 25 …”

“…Training and collective involvement in improving the use of the NIV are key components for the optimal performance of this ventilatory support. 22 …”

Biometric measurements of the nasal area of newborns for the development of a nasal protector model: cross-sectional study

“…The length and width of the columella are measures of a prominent structure when the nasal lesion develops. Columella and nasal septum are the main structures associated with nasal lesions correlated with the use of prongs (16) , which is due to their location. The columella extends from the tip of the nose to the lip, medially separating the nostrils.…”