Prevention of Pressure Injuries During Nasal Continuous Positive Airway Pressure in Newborns: A Non-pharmacological Intervention Trial

Background: Nasal continuous positive airway pressure (NCPAP) is the gold standard for the treatment of respiratory distress syndrome. However, the main risks associated with NCPAP use are pressure injuries, infection at the device site and related complications, which can affect long-term outcomes. Preventing pressure injuries should therefore be a priority in nursing care. Aim: To evaluate the effectiveness of nursing interventions to reduce the incidence of nasal pressure injuries during NCPAP in newborns admitted to the neonatal intensive care unit (NICU). Study Design: A non-pharmacological intervention trial was conducted in an Italian university-tertiary NICU. A total of 596 newborns receiving NCPAP support without ongoing nasal pressure injury were enrolled between December 2019 and April 2022. Preventive strategies, including periodic alternation and repositioning of the interface and regular skin assessment, were applied based on newborns' risk factors and compared with a historical control group from 2018. Outcomes included the incidence of pressure injuries, patient characteristics and postnatal morbidities. Results: Five hundred and ninety-six newborns were included in the study (316 in the control group and 280 in the intervention group). The rate of nasal injury was reduced by 0.0009/day (95% CI, 0.004–0.003) in the intervention group compared to the control group. In both groups, newborns who developed pressure injury had a significantly lower gestational age and birth weight and required longer NCPAP support and NICU stay. No significant differences in clinical and demographic characteristics were found between the groups; however, newborns in the intervention group had on average a lower gestational age and birth weight, longer NCPAP treatment and NICU stay. Gestational age was a significant risk factor for the development of pressure injury (HR: 0.696, p < 0.001). We observed a non-statistically significant reduction in the severity of the injuries in the intervention group (21.1%) compared to the control group (38.5%). Conclusions: We suggest adopting protective strategies against pressure injuries in newborns treated with NCPAP. Nurse training may contribute to reducing the incidence of NCPAP-related pressure injuries. Relevance to Clinical Practice: Combining specific and type-adapted interventions with nurse training can reduce the incidence and severity of NCPAP-related injuries in infants, thereby improving care quality in NICUs. Trial Registration: www.clinicaltrials.gov (Identifier: NCT04293601).