Nasal pressure injuries among newborns caused by nasal CPAP: An incidence study

Aim: To assess the incidence and severity of nasal pressure injuries caused by nasal CPAP nasal masks and binasal prongs. Methods: Single NICU observational study among infants who required nCPAP, using the Nasal Injury Assessment Score Chart (NIASC). Results: In 90.7% (N = 118) skin injuries were observed. Eleven infants had no skin injury, 68 mild, 26 moderate and 13 severe. The severity of the injury was categorized into groups; group I (NIASC <5) and II (NIASC ≥5). In Group I the median gestational age was 30 + 6 (IQR 25.1–41.2) vs 27 + 0 (IQR 24.0–32.1) in group II, birthweight 1395 g (IQR 520–3964) vs 860 g (IQR 500–1739) and nCPAP duration 5 days (IQR 1–53) vs 28 days (IQR 5–71). Females and an increase in gestational age and birthweight were associated with a decrease in odds to develop skin injuries (OR = 0.154, 95%CI 0.028–0.837, p = 0.030; OR = 0.97, 95%CI 0.947–0.987, p = 0.001; OR = 0.999, 95%CI 0.998–1.0, p = 0.002). Conclusion and discussion: The incidence of nasal pressure injuries caused by nCPAP is high. However, comparison with other studies remains difficult due to the variety in definitions and observation scales used. Further measures to predict, identify, stage, and prevent nasal pressure injuries among preterm infants should be considered.