Effects of nasal continuous positive airway pressure and cannula use in the neonatal intensive care unit setting

Abstract

Objective: To investigate the effects of nasal continuous positive airway pressure (CPAP) and cannula use in the neonatal intensive care unit.

Design: Cross-sectional study.

Setting: Tertiary care children's hospital.

Patients: One hundred patients (200 nasal cavities), younger than 1 year, who received at least 7 days of nasal CPAP (n = 91) or cannula supplementation (n = 9) in the neonatal intensive care unit.

Interventions: External nasal examination and anterior nasal endoscopy with photographic documentation.

Main outcome measures: The incidence and characteristics of internal and external nasal findings of patients with nasal CPAP or cannula use.

Results: Nasal complications were seen in 12 of the 91 patients (13.2%) with at least 7 days of nasal CPAP exposure, while no complications were seen in the 9 patients with nasal cannula use alone. The external nasal finding of columellar necrosis, seen in 5 patients (5.5%), occurred as early as 10 days after nasal CPAP use. Incidence of intranasal findings attributed to CPAP use, in the 182 nostrils examined, included ulceration in 6 nasal cavities (3.3%), granulation in 3 nasal cavities (1.6%), and vestibular stenosis in 4 nasal cavities (2.2%). Intranasal complications were seen as early as 8 to 9 days after nasal CPAP administration. Nasal complications from CPAP were associated with lower Apgar scores at 1 (P = .02) and 5 (P = .06) minutes.

Conclusions: External or internal complications of nasal CPAP can be relatively frequent (13.2%) and can occur early, and patients with lower Apgar scores may be at higher risk. Close surveillance for potential complications should be considered during nasal CPAP use.

Figure 1

Internal review of the neonatal intensive care unit (NICU) at our institution. An increasing trend in the frequency of nasal continuous positive airway pressure (CPAP) use among patients in the NICU is seen from 2002 to 2008.

Figure 2

Cross-sectional study design. NICU indicates neonatal intensive care unit.

Figure 3

Anterior nasal endoscopy images demonstrate normal findings (A), ulceration (B), granulation (C), and vestibular stenosis (D and E).

Figure 4

External nasal examination images demonstrate early (A) and late (B) columellar necrosis (arrowheads). The necrosis occurred 10 and 12 days after initiation of nasal continuous positive airway pressure use.