Effects of nasal continuous positive airway pressure and cannula use in the neonatal intensive care unit setting

Arch Otolaryngol Head Neck Surg. 2010 Mar;136(3):287-91. doi: 10.1001/archoto.2010.15.


Objective: To investigate the effects of nasal continuous positive airway pressure (CPAP) and cannula use in the neonatal intensive care unit.

Design: Cross-sectional study.

Setting: Tertiary care children's hospital.

Patients: One hundred patients (200 nasal cavities), younger than 1 year, who received at least 7 days of nasal CPAP (n = 91) or cannula supplementation (n = 9) in the neonatal intensive care unit.

Interventions: External nasal examination and anterior nasal endoscopy with photographic documentation.

Main outcome measures: The incidence and characteristics of internal and external nasal findings of patients with nasal CPAP or cannula use.

Results: Nasal complications were seen in 12 of the 91 patients (13.2%) with at least 7 days of nasal CPAP exposure, while no complications were seen in the 9 patients with nasal cannula use alone. The external nasal finding of columellar necrosis, seen in 5 patients (5.5%), occurred as early as 10 days after nasal CPAP use. Incidence of intranasal findings attributed to CPAP use, in the 182 nostrils examined, included ulceration in 6 nasal cavities (3.3%), granulation in 3 nasal cavities (1.6%), and vestibular stenosis in 4 nasal cavities (2.2%). Intranasal complications were seen as early as 8 to 9 days after nasal CPAP administration. Nasal complications from CPAP were associated with lower Apgar scores at 1 (P = .02) and 5 (P = .06) minutes.

Conclusions: External or internal complications of nasal CPAP can be relatively frequent (13.2%) and can occur early, and patients with lower Apgar scores may be at higher risk. Close surveillance for potential complications should be considered during nasal CPAP use.

MeSH terms

  • Apgar Score
  • Constriction, Pathologic
  • Continuous Positive Airway Pressure / adverse effects*
  • Cross-Sectional Studies
  • Endoscopy*
  • Female
  • Granulation Tissue / pathology
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Male
  • Nasal Cavity / pathology*
  • Necrosis
  • Oxygen Inhalation Therapy / adverse effects*
  • Oxygen Inhalation Therapy / instrumentation
  • Photography
  • Physical Examination*
  • Ulcer / pathology