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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 Dawson1,3,2,
  4. Peter G Davis1,3,2,
  5. Louise S Owen1,3,2
  1. 1Newborn Research Centre, The Royal Women’s Hospital, Melbourne, VIC, Australia
  2. 2Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
  3. 3Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
  1. Correspondence to Dilini I Imbulana, Newborn Research Centre, The Royal Women’s Hospital, 20 Flemington Rd, Parkville, VIC 3052, Australia; dilini.imbulana{at}

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Over the last 40 years, there has been an increased use of nasal continuous positive airway pressure (CPAP), which is the ‘gold standard’ form of non-invasive respiratory support to treat preterm infants.1 For effective delivery of nasal CPAP, tight fitting binasal prongs are required to maintain a constant airway pressure. However, the force applied to the delicate tissues of the nares and nasal septum can compromise skin integrity and cause nasal injury.2 3

Preserving the skin and mucosal membranes in preterm infants is important to protect against infection, and to avoid discomfort and nasal deformities. Due to immaturity, the nose of preterm infants can easily be injured, by even a short application of a nasal device.4

Nasal injury may cause pain and discomfort, necessitate change in respiratory therapy and sometimes require surgical intervention.5 6 Several sequelae have been reported, including hyperaemia, nasal snubbing and flaring (upturned nose and enlarged nares), scab formation and areas of necrosis.2 3

Proposed interventions for reducing nasal injury during nasal CPAP therapy include alternating using the binasal prongs with using a nasal mask, and using a nasal barrier dressing between the nares and binasal prongs.7 8 Nasal high flow (nHF) therapy, which uses smaller prongs, may be used as an alternative respiratory support mode to avoid injury. An alternative option discussed in the literature is the application of ointment before or after the occurrence of nasal injury.9

We conducted a systematic review to determine the incidence and risk factors for nasal injury in preterm infants, and the effectiveness of strategies to prevent and treat it.


This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.10 Randomised trials of interventions to prevent or treat nasal injury were identified and analysed using …

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