title: A comparative effectiveness study of continuous positive airway pressure-related skin breakdown when using different nasal interfaces in the extremely low birth weight neonate.
abstract: A three group prospective randomized experimental design was conducted to identify differences in frequency and severity of nasal injuries when comparing various interfaces used during continuous positive airway pressure (CPAP) and identified risk factors associated with injury. Seventy-eight neonates <1500 g were randomized into three groups: continuous nasal prongs; continuous nasal mask; or alternating mask/prongs. Repeated measures ANOVA with Bonferroni correction demonstrated that significantly less skin injury was detected in the rotation interface group when compared to both mask and prong groups. In the final stepwise regression model (F = 11.51; R(2) = 0.221; p = 0.006) significant predictors of skin injury included number of days on nasal CPAP (p < 0.001) and current mean post menstrual age (p = 0. 006). Reduced nasal injury was demonstrated using rotating mask/prong nasal interfaces. Future best practices must include precise selection of device size, developmental and CPAP device positioning with focused skin assessment including rapid intervention for skin injury.
authors.affiliation: Neonatal Nurse Practitioner, Children's Hospital of the King's Daughters, Norfolk, Virginia 23507. Electronic address: kathynewnam@cox.net.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Newnam
authors.affiliation: School of Nursing, University of Connecticut, Storrs, CT 06269-2026; Connecticut Children's Medical Center, Hartford, CT 06106. Electronic address: Jacqueline.mcgrath@uconn.edu.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: McGrath
authors.affiliation: School of Nursing, Virginia Commonwealth University, Richmond, Virginia 23298-0567. Electronic address: jsalyer@vcu.edu.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Salyer
authors.affiliation: South University, Richmond, Virginia. Electronic address: tsestes@southuniversity.edu.
authors.forename: Tracy
authors.initials: T
authors.lastname: Estes
authors.affiliation: Virginia Commonwealth University, School of Nursing, PO Box 980567, Richmond, Virginia 23298-0567. Electronic address: njallo@vcu.edu.
authors.forename: Nancy
authors.initials: N
authors.lastname: Jallo
authors.affiliation: Division of Neonatal Medicine, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia 23507. Electronic address: Thomas.bass@chkd.org.
authors.forename: W Thomas
authors.initials: WT
authors.lastname: Bass
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D009666:Nose / Q000293:injuries*; D011446:Prospective Studies; D012307:Risk Factors; D012867:Skin / Q000293:injuries*
keywords: Nasal CPAP of the neonate; Nasal trauma; Pressure ulcer; Preterm infant nasal skin breakdown; Skin breakdown during nasal CPAP