Nasal cutaneous impact of non-invasive respiratory support for extremely preterm neonates: a descriptive, prospective, multicenter study

Abstract

The purpose of this study was to examine the prevalence and characteristics of nasal skin trauma under non-invasive ventilation for very preterm neonates. Secondary objectives were to identify risk factors of lesion occurrence and progression. This study is a descriptive, prospective, multicenter study, ancillary to the SEPREVEN study, from November 2015 to 2017 in 12 neonatal intensive care units in France. Very premature infants born before 32 weeks of gestation, receiving non-invasive ventilation in the first 7 days of life or in the 7 days after the first extubation were included. For the main outcome measure, a document named "Nasal status score" was collected daily for a total of 7 days: type of interface, nasal protection, localization and stage of lesion, and ventilatory effects. We included 806 children (median birth age 29 weeks of gestation). Nasal skin trauma was recorded in 51% of cases, sometimes as early as day one; 80% were of low severity. A few traumas (4%) became severe and only 34% resolved. Lesions were associated with the absence of antenatal corticosteroid therapy and low gestational age (p < 0.05). With nasal continuous positive airway pressure, the use of a mask and alternating mask and cannula were associated with fewer lesions than the use of a cannula alone (p < 0.01). Skin protection reduced the risk of injury (40.2% vs 51.2% with no protection, p < 0.05).

Conclusion: The high frequency of nasal trauma under non-invasive ventilation in extremely preterm neonates calls for their early and systematic monitoring and better prevention.

What is known: • In premature babies < 36 weeks of gestation who receive non-invasive ventilation, the incidence of nasal injury varies from 20 to 100%, with risk factors being low gestational age (< 32 weeks of gestation) and low birth weight (< 1500 g).

What is new: • In our study, approximately 50% of premature babies born before 32 weeks of gestation had a nasal lesion; most (80%) were benign, some (16%) moderate and more rarely (4%) severe. Nasal lesions mostly appeared on the first day of nCPAP and were of low severity grade. Antenatal corticosteroids and local skin protection were protective against lesions.

Keywords: NICU; Nasal injury; Neonate; Preterm; Respiratory support.