Nasal Trauma in Neonates receiving CPAP And its Prevention in tertiary care hospital.

Abstract

Objectives: This study was done to evaluate the frequency and severity of nasal trauma secondary to nasal continuous positive airway pressure (NCPAP) in neonates and different methods to reduce the nasal septum injury via CPAP

Methods: This is a prospective study carried out in the Neonatal Care Unit (NCU) of LAL DED maternity hospital associated with department of pediatrics Government Medical College, Srinagar, Kashmir. The study included newborns that underwent NCPAP with prongs on admission and those receiving NCPAP after weaning from ventilator, from 1st January 2016  - 1st jan 2017. Neonates noses were monitored from the first day of NCPAP treatment until its weaning. Nasal trauma was reported into Three Grades: (I) Erythema/pressure indentation (II) superficial Erosion and (III) Septal necrosis.

Results:-258 newborns were included in study, 136 males and 122 females. All enrolled newborn received CPAP. Babies were randomly allocated to different groups in which no barrier and different barriers were applied. Randomization of
group of infants who received no barrier(group 0) and different barriers( group 1,2,&3) was done by systematic allocation, in which first newborn was randomly designated to no barrier group 0 on particular day of admission ,and subsequently alternating with other three groups i.e group 1,group 2, group 3. The mean gestational age, birth weight and CPAP days in each group is 31wk (GA28-35 wks),1200 gms(0.7kg-1.8kg) & 5 days(3-10days) respectively. Incidence of Septal  necrosis was 26.7% in the babies that had ‘No barrier applied at septal hudson prongs interface (Group0), which was significantly more (p<0.001) when compared with other three groups, within which its incidence was 2.8% in Cotton applied at septal and hudson prongs interface with glycerine (Group1), 7.1% in Danaplast applied at interface(Group2) and 0.0% in Cotton soaked with normal saline(Group3) respectively. In Group 0 nasal septal injury Grade 1 is (35%),grade 2 (35%),and grade 3(30.0%), in Group 1, grade 1 septal injury is (84%), grade 2(12.7%) & grade 3(2.8%),In Group 2 grade 1 is (65.7%),grade2(30.0%),grade3 (4.3%) and Group3 grade1(80.7%),grade2(19.3%) and Grade3 (0.0%)

Conclusions: Nasal trauma is a frequent complication of NCPAP, especially in preterm babies and babies requiring nasal prongs for longer duration. And can be prevented by applying a barrier as in group 1,2 &3 in our study shows statistically significant decreased in severe nasal septal injury. JMS 2017;20(2):96-100