Effects of Nasal Continuous Positive Airway Pressure and Cannula Use in the Neonatal Intensive Care Unit Setting

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 I year, who received at least 7 clays 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 9 L patients (13.2%) with at least 7 clays 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%). Intanasal 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 I (P=.02) and 5 (P=.06) minutes. Conclusions: External or internal complications of nasal CPAP call be relatively frequent (13.2%) and call 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.