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Pediatric Otolaryngology

(326) Nasal Airway Pressure Injuries in the Neonate: Grading Systems

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Alexander E. Graf, MD

    Resident
    Suny Downstate Health Sciences University
    Brooklyn, New York, United States

    • Co-Author(s)

  • SB

    Simon A. Bellido, BA

    Medical Student
    SUNY Downstate Health Sciences University
    Brooklyn, NY, United States

  • CV

    Chellapriya Vythinathan, MD

    SUNY Downstate Health Sciences University, USA

  • JG

    Jigar Govind, MD

    Resident (PGY-1)
    SUNY Downstate Medical Center
    Brooklyn, New York, United States

  • LF

    Lawrence Fordjour, MD

    Clinical Associate Professor of Pediatrics
    SUNY Downstate Health Sciences University
    Brooklyn, New York, United States

  • Sydney C. Butts, MD

    Interim Chair and Associate Professor, Chief-Facial Plastic and Reconstructive Surgery
    SUNY Downstate Health Sciences University
    Brooklyn, New York, United States

    • Senior Author(s)

  • AP

    Ann Plum, MD

    Assistant Professor
    SUNY Downstate Health Sciences University
    Brooklyn, New York, United States

Disclosure(s):
Alexander E. Graf, MD: No relevant relationships to disclose.
Simon Bellido, BA: No relevant relationships to disclose.
Sydney C. Butts, MD: No relevant relationships to disclose.


Introduction: Although neonates treated with Continuous Positive Airway Pressure (CPAP), High Flow Nasal Cannula (HFNC), and other forms of non-invasive ventilation (NIV) for respiratory support are at risk for nasal pressure injury and subsequent nasal deformity, efforts to standardize reporting of these injuries are limited. Nasal injury classification systems should be sensitive and specific for optimal communication and management.

Methods: A systematic review of the literature was conducted (July 2022) to identify the classification systems used for evaluating and describing nasal pressure injuries from NIV. Databases (PubMed, Embase, and Web of science) were queried for scientific papers published after 2000 that reported nasal injury with NIV usage in neonates. Methodology from Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) was employed. Primary outcome was grading system usage.

Results: 705 titles and abstracts were screened, of which 83 papers met inclusion criteria. The majority of studies included were Randomized Clinical Trials (52%), followed by cohort studies, case series, and other types. Nasal injury was reported using dichotomous reporting (yes/no) in 30 studies (36%), or using descriptive measures (mild/moderate/severe) in 8 studies (10%). The remaining studies reported injuries using the scale by Fischer et al 2010, which is a three-stage classification system (13 studies, 16%), the National Pressure Ulcer Advisory Panel (NPUAP) scale (8 studies, 10%), institution-specific scales (11 studies, 13%), and scales adopted from prior publications (6 studies, 7%). While 21 studies (25%) reported on specific nasal anatomic subsite injury, only 2 studies (2%) employed nasal endoscopy for injury assessment.

Conclusions: Wide heterogeneity in nasal pressure injury reporting and evaluation exists across specialties, institutions, and literature. Implementation of a standardized classification system will improve care coordination, allow for better comparison of results across studies, and advance prevention and treatment of nasal pressure injuries.