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Study Assesses Complications Associated With Nasal Ventilation in Newborns CHICAGO -- March 15, 2010 -- More than 10% of newborns who receive oxygenation and ventilation using nasal continuous positive airway pressure (CPAP) in the neonatal intensive care unit (NICU) may experience complications inside or outside the nose, according to a study published in the March issue of Archives of Otolaryngology-Head & Neck Surgery. Nasal CPAP is a good alternative for many newborns because it avoids complications associated with long-term use of tracheal tubes, including subglottic stenosis. However, some reports have linked CPAP devices to nasal complications. To investigate the potential effects, Kris R. Jatana, MD, Ohio State University Medical Center and Nationwide Children’s Hospital, Columbus, Ohio, and colleagues studied 100 patients aged younger than 1 year who received at least 7 days of nasal CPAP or oxygen supplementation with cannula in the NICU in 2007 or 2008. All patients underwent an external examination of the nose and then nasal endoscopy to identify any internal complications. Nasal complications were observed in 12 of the 91 patients (13.2%) with at least 7 days of nasal CPAP use, whereas no complications were seen in the 9 patients with only nasal cannula use. Complications inside the nose included ulceration in 6 of 182 nasal cavities (3.3%), granulation or the formation of healing tissue in 3 nasal cavities (1.6%), and vestibular stenosis in 4 nasal cavities (2.2%). The primary external complication was columellar necrosis, or tissue death at the end of the nasal septum, which was observed in 5 of 91 patients (5.5%). “Once this occurs, it is difficult to repair surgically, and adverse cosmetic results may ensue,” the authors wrote. “In our series, columellar necrosis was found as early as 10 days after placement of nasal CPAP, but columellar necrosis has been reported as early as after only 3 days of nasal CPAP use in very-low-birthweight infants.” All nasal complications from CPAP were associated with lower Apgar scores at 1 and 5 minutes after birth. “Nasal CPAP is gaining popularity as a preferred means of ventilatory support in the NICU, and its potential complications will be encountered more frequently,” the authors wrote. “Close surveillance for potential complications should be considered during nasal CPAP use.” SOURCE: Archives of Otolaryngology-Head & Neck Surgery E-mail this page to a friend or colleague! To print, use this version