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


METHODS
Cross-sectional study.


METHODS
Tertiary care children's hospital.


METHODS
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.


METHODS
External nasal examination and anterior nasal endoscopy with photographic documentation.


METHODS
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.
Jatana
Kris R
KR
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Nationwide Children's Hospital, Columbus, 43212, USA. Kris.Jatana@osumc.edu
Oplatek
Agnes
A
Stein
Melanie
M
Phillips
Gary
G
Kang
D Richard
DR
Elmaraghy
Charles A
CA
D001034:Apgar Score; D003251:Constriction, Pathologic; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D004724:Endoscopy; D005260:Female; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D009296:Nasal Cavity / Q000473:pathology*; D009336:Necrosis; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects* / Q000295:instrumentation; D010781:Photography; D010808:Physical Examination; D014456:Ulcer / Q000473:pathology