Incidence and the nature of nasal soft tissue injury during non-invasive respiratory support in newborns and its predisposing factors. A retrospective cohort study

Non-invasive respiratory support is the preferred method for treating respiratory problems in newborns. Whilst having significant advantages, non-invasive methods also have their own complications associated with trauma to the nasal soft tissues such as erythema, ecchymosis, edema, necrosis in the area of the columella and nasal septum and vestibular stenosis as well as long-term consequences in the form of deformation of the nose and nasal septum. However, research studies aimed at determining the incidence and the nature of these injuries are very few. The purpose of this research was to determine the incidence and the nature of damage to the nasal soft tissues in newborns as a result of non-invasive respiratory support and its predisposing factors. Materials and methods used: a single-center retrospective cohort study of 558 newborns who were admitted at the Yekaterinburg Clinical Perinatal Center (Yekaterinburg, Sverdlovsk Oblast, Russia) during 12 months in 2022 and received non-invasive respiratory support: continuous positive airway pressure (CPAP), low flow nasal cannula (LFNC), was conducted with 176 (31.5%) full-term (≥370 weeks of gestation) and 382 (68.5%) premature (˂370 weeks)/190 (34%) with low body weight, 84 (15%) with very low body weight and 47 (8.4%) with extremely low body weight. Thus, the incidence and the nature of injuries to the nasal soft tissues were determined during non-invasive respiratory support in the observed pediatric patients. Results: the incidence of nasal injuries was ca. 10% in the entire patient cohort. No injuries were recorded in full-term infants. Among premature infants, injuries occurred in 84% of cases with a gestational age (GA) of 240 to 276 weeks, 35% with GA of 280 to 296 weeks, below 5% with GA of 300 to 336 weeks and 1.8% with GA 340 to 366 weeks. Therefore, in the groups of children with GA 240 to 276 and 280 to 296 weeks the nasal injury was most common because it was 84% of all cases of nasal injuries registered during these two particular gestational periods with 100% of grades 2 and 3 injuries and 100% of injuries to the nasal passages. The duration of any type of non-invasive respiratory therapy statistically significantly increased the incidence of any grade of injury. The use of LFNC statistically significantly increased the risk of damage to the nasal passages (OR 2.492; 95% CI 1.576-3.942). Conclusion: nasal injuries and injuries to nasal passages during non-invasive respiratory therapy can occur in up to 10% of cases. The main predisposing factors are low birth weight, low GA and long duration of any type of non-invasive respiratory therapy.