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Nasal injury in preterm infants receiving non-invasive respiratory support: a systematic review
  1. Dilini I Imbulana1,2,
  2. Brett J Manley1,2,3,
  3. Jennifer A Dawson1,2,3,
  4. Peter G Davis1,2,3,
  5. Louise S Owen1,2,3
  1. 1 Newborn Research Centre, The Royal Women’s Hospital, Melbourne, Victoria, Australia
  2. 2 Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
  3. 3 Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
  1. Correspondence to Dilini I Imbulana, Newborn Research Centre, The Royal Women’s Hospital, 20 Flemington Rd, Melbourne, VIC 3052, Australia; dilini.imbulana{at}


Objective Binasal prongs are the most commonly used interface for the delivery of nasal positive airway pressure (CPAP) to preterm infants. However, they are associated with pressure-related nasal injury, which causes pain and discomfort. Nasal injury may necessitate a change in interface and occasionally damage is severe enough to require surgical repair. We aim to determine the incidence and risk factors for nasal injury in preterm infants, and to provide clinicians with strategies to effectively prevent and treat it.

Design We conducted a systematic search of databases including MEDLINE (PubMed including the Cochrane Library), EMBASE, CINAHL and Scopus. Included studies enrolled human preterm infants and were published prior to 20 February 2017.

Results Forty-five studies were identified, including 14 ra ndomised controlled trials, 10 observational studies, two cohort studies, eight case reports and 11 reviews. The incidence of nasal injury in preterm infants ranged from 20–100%. Infants born <30 weeks’ gestation are at highest risk. Strategies shown to reduce nasal injury included: nasal barrier dressings (2 studies, n=244, risk ratio (RD) −0.12, 95%, CI − 0.20 to −0.04), nasal high flow therapy as an alternative to binasal prong CPAP (7 studies, n=1570, risk difference (RD) −0.14, 95% CI −0.17 to −0.10), and nasal masks rather than binasal prongs (5 studies, n=544, RR 0.80, 95% CI 0.64 to 1.00).

Conclusions and relevance Nasal injury is common in preterm infants born <30 weeks’ gestational age receiving CPAP via binasal prongs. Larger randomised trials are required to fully evaluate strategies to reduce nasal injury.

  • Preterm infant
  • non-invasive respiratory support
  • nasal injury
  • injury prevention
  • nursing care

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  • Contributors DII and BJM performed the systematic search. All authors reviewed full-text articles for inclusion. DII prepared the first draft of the paper; this and all subsequent drafts were reviewed and revised by all authors. All authors approved the final version submitted.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. The article type has been changed from Leading article to Original article.

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