title: An integrative review of skin breakdown in the preterm infant associated with nasal continuous positive airway pressure.
abstract: OBJECTIVE
  To identify factors associated with skin injury during nasal continuous positive airway pressure (NCPAP) and describe differences in frequency, severity, and type of skin injuries when comparing nasal interfaces used during NCPAP in the preterm infant.
  
  
  METHODS
  Scientific databases were searched using provided key terms and yielded 113 articles.
  
  
  METHODS
  Forty-six articles were included in this integrative review: six case studies, 22 with identified aim of examining skin and nasal injury during NCPAP; 18 included skin care considerations during NCPAP.
  
  
  METHODS
  Studies were categorized into four themes: types of nasal injuries; associated risk factors that increase incidence of injury; differences between NCPAP devices and/or nasal interface and corresponding rate and severity of nasal injury; and recommended prevention strategies to reduce iatrogenic cutaneous injury.
  
  
  RESULTS
  Skin injury was a common theme during neonatal NCPAP with skin breakdown rates of 20% to 60%. Increased skin injury risk was associated with smaller infant size, gestational age, and duration of therapy. Nursing care strategies to improve skin integrity during NCPAP had little supportive evidence. Nursing practice is varied with reportedly little standardized care during NCPAP therapy. Recommendations for specific care strategies to reduce skin injury during NCPAP were supported by limited experimental studies.
  
  
  CONCLUSIONS
  Risk factors during NCPAP include nasal injury and trauma secondary to tight-fitting nasal interfaces necessary to provide continuous distending pressure for respiratory stability. Identifying strategies to reduce skin breakdown will support noninvasive treatment success, reduce reintubation rates, reduce sepsis, reduce patient discomfort, and improve developmental outcomes during NCPAP use.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Newnam
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: McGrath
authors.forename: Tracy
authors.initials: T
authors.lastname: Estes
authors.forename: Nancy
authors.initials: N
authors.lastname: Jallo
authors.forename: Jeanne
authors.initials: J
authors.lastname: Salyer
authors.forename: W Thomas
authors.initials: WT
authors.lastname: Bass
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D009297:Nasal Mucosa / Q000293:injuries; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000628:therapy*; D018570:Risk Assessment; D012867:Skin / Q000293:injuries*; D012871:Skin Diseases / Q000209:etiology / Q000503:physiopathology*; D016896:Treatment Outcome
keywords: CPAP; nasal CPAP of the neonate; nasal prongs, skin care and pressure ulcer; nasal trauma; noninvasive respiratory management of the preterm; preterm infant nasal skin breakdown; respiratory devices of the newborn; respiratory pressure sources of the preterm infant