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A comparison of nasal trauma in preterm infants extubated to either heated humidified high-flow nasal cannulae or nasal continuous positive airway pressure

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Abstract

The objectives of this study were (1) to devise a nasal trauma score for preterm infants receiving non-invasive respiratory support, (2) to compare the incidence of nasal trauma in preterm infants <32 weeks gestation randomised to either nasal continuous positive airway pressure (NCPAP) or heated humidified high-Flow nasal cannulae (HHHFNC), in the first 7 days post-extubation and (3) to assess the effect of two different nasal dressings in those assigned to NCPAP. We randomly assigned preterm ventilated infants to receive Vapotherm® HHHFNC or NCPAP post-extubation. Infants receiving HHHFNC were treated with Sticky Whiskers® and infants receiving NCPAP received either Sticky Whiskers® or Cannualaide® nasal dressings. Bedside nursing staff scored six sites on each infant’s nose for erythema, bleeding or ulceration. Scores were recorded three times daily for the first 7 days post-extubation. The sum of these 21 scores was used as the summary measure of nasal trauma. The mean nasal trauma score for infants assigned HHHFNC was 2.8 (SD 5.7) compared to 11.7 for NCPAP (SD 10.4), p < 0.001. There was no difference in mean trauma score between infants on NCPAP assigned Sticky Whiskers® 14.4 (SD 12.5) or Cannualaide® 9.5 (SD 7.3), p = 0.06. Conclusion: HHHFNC resulted in significantly less nasal trauma in the first 7 days post-extubation than NCPAP and was most significant in infants <28 weeks of gestation. The use of protective dressings was not associated with decreased nasal trauma for infants on NCPAP.

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Abbreviations

HHHFNC:

Heated humidified high-flow nasal cannulae

NCPAP:

Nasal continuous positive airway pressure

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Acknowledgments

This study was supported by a grant from the Medical Research Foundation for Women and Babies, Melbourne, Australia. The granting body had no involvement in study design, collection, analysis or interpretation of data, the writing of the report or the decision to submit the paper for publication. We would like to thank G Walsh RN, the Staff Neonatologists, Mercy Hospital for Women, Melbourne, Australia, and Dr J Dawson, Royal Womens’ Hospital, Melbourne, Australia.

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The authors declare they have no conflict of interest.

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Correspondence to C. L. Collins.

Appendix

Appendix

Table 2 Nasal trauma score chart

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Collins, C.L., Barfield, C., Horne, R.S.C. et al. A comparison of nasal trauma in preterm infants extubated to either heated humidified high-flow nasal cannulae or nasal continuous positive airway pressure. Eur J Pediatr 173, 181–186 (2014). https://doi.org/10.1007/s00431-013-2139-8

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