Nasal septum injury in preterm infants using nasal prongs

Bonfim, Suely de Fátima Santos Freire; Vasconcelos, Maria Gorete Lucena de; Sousa, Nayara Francisca Cabral de; Silva, Daiana Vieira Câmara da; Leal, Luciana Pedrosa

doi:10.1590/0104-1169.3451.2486

Cited by 32 publications

(47 citation statements)

References 16 publications

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“…However, binasal prongs are associated with complications such as increased resistance to gas flow, peri‐nasal leak, and nasal trauma . Observational studies have reported nasal injury in 62.9‐68.1% of preterm infants on non‐invasive ventilation with nasal prongs . The high incidence of nasal injuries associated with nasal prongs have led to the emergence of newer generation anatomically shaped nasal masks, designed using 3D facial scanning.…”

Section: Introductionmentioning

confidence: 99%

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

Jasani

Ismail

Rao

et al. 2018

Pediatric Pulmonology

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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.

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Section: Introductionmentioning

confidence: 99%

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

Jasani

Ismail

Rao

et al. 2018

Pediatric Pulmonology

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“…Another study evaluated the incidence of lesions, specifically of the nasal septum in preterm infants caused by the use of nasal prongs. The study identified a large number of newborns developed lesions and the with a significance for the length of device usage time (Bonfim, Vasconcelos, Sousa, Silva, & Leal, 2014).…”

Section: Discussionmentioning

confidence: 99%

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

Faria

Ferreira

Felix

et al. 2019

Journal of Clinical Nursing

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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.

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“…Mantener un cuidado especial sobre la posición del recién nacido evita el uso de accesorios para la oxigenación. Con el solo cambio de posición y rotando la cabeza de manera alterna, se mantiene permeable la vía aérea y disminuye la severidad de las lesiones del tabique nasal [1,29].…”

Section: Discussionunclassified

“…Se evidencia que existe menor riesgo de desplazamiento de prongs con el uso de placas de hidrocoloide, el gel silicón [9,20,29], así como el protector cutáneo, a n de evitar la fricción directa de las prongs con la columela y el tabique. De esta manera, es visible el cuidado individual del neonato y cómo es un arte conjugar la ciencia con el sentido cotidiano del profesional de enfermería en benecio del confort del neonato [19,24,28].…”

Section: Discussionunclassified

“…Mantener las fosas nasales limpias y lubricadas disminuye el grado de lesión [7,25,29]. Ese hecho deja claro que los asuntos relacionados con el costo-benecio deberían ser reevaluados en centros de estudio que utilizan prongs; sin embargo, las dicultades observadas entorpecen el cuidado cientíco y lo convierten en desafío para encontrar concepciones actualizadas de la práctica que respondan a las intervenciones derivadas de los avances cientícos y tecnológicos [9,24,26].…”

Section: Discussionunclassified

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Intervenciones de enfermería en neonatos con presión positiva continua

Reza

Mejía-Flores

Pérez³

et al. 2018

Investg. Enferm. Imagen Desarollo.

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Objetivo: describir las intervenciones de enfermería en neonatos con presión positiva continua con prongs, hospitalizados en una unidad neonatal mexicana. Métodos: corte transversal en una muestra no aleatoria por conveniencia, conformada por veinticinco enfermeras que tenían bajo sus cuidados a recién nacidos con sistema de presión positiva con prongs. La recolección de datos fue realizada con un cuestionario autoplicado. El análisis fue descriptivo, y se obtuvieron medidas de tendencia central de las variables cuantitativas que mostraron una distribución normal. Las variables cualitativas se describen con valores relativos. Se respetaron aspectos éticos según la reglamentación vigente mexicana. Resultados: participaron veinticinco enfermeras con grado académico: el 88% con licenciatura y solo el 24% especialistas neonatólogas. Los neonatos usan la presión positiva continua: el 52% de 3 a 5 días; el 20% de 6 a 7 días y el 28% de 8 a 12 días. El nivel de lesión nasal y los resultados con prongs, mediante el cuidado constante de la enfermera sobre la aparición de estas, evidenciaron que el 60% de los neonatos presentó lesión leve; el 36%, moderada, y el 4%, severa. Conclusiones: las intervenciones de cuidado del neonato deben dirigirse a minimizar las lesiones de piel y tabique nasal para contribuir con las normas internacionales de seguridad del neonato.

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Nasal septum injury in preterm infants using nasal prongs

Cited by 32 publications

References 16 publications

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

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

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

Intervenciones de enfermería en neonatos con presión positiva continua

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