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Updated: May 20, 2025

Continuous Telemetric In Utero Tracheal Pressure Measurements in Fetal Lambs
Published on: December 22, 2023
Reducing device-related pressure injuries in high-risk neonates receiving nasal continuous positive airway pressure:
Margaret Broom1,2, Alison L Kent3,4, Tejasvi Chaudhari5,3
1Neonatal Department, Canberra Hospital, Garran, Australian Capital Territory, Australia margaret.broom@act.gov.au.
Objective:
Neonates requiring Non-InVasive respiratory Support (NIVS) are at high risk of device-related pressure injury (DRPI), with incidence rates of 20%-60% in extremely premature infants. Over a 4-year period, our team undertook a Quality Improvement Project to review aspects of the clinical management of NIVS: types of interfaces, introduction of hydrocolloid dressing and the development and implementation of nasal injury care plan (NICP) to reduce DRPI in high-risk neonates.
Design:
A prospective descriptive study was completed in three stages: trial of nCPAP interfaces, preintroduction NICP (2016-2018), post-NICP (2018-2020) and (2021-2022) to measure sustainability of implementation. Data included: gestational age (GA), birth weight, NIVS days, incidence, grade and day of DRPI. Statistical analysis of incidence rate ratio was completed between pre and postgroups.
Setting:
Australian neonatal intensive care unit.
Patients:
All neonates ≤32 weeks requiring nCPAP.
Interventions:
Evaluation of types of interfaces, introduction of hydrocolloid dressing and the development and implementation of NICPMain outcome measures: incidence and severity of DRPI.
Results:
Total DRPI recorded in all CPAP babies pre/post NICP were (59/659 (9.0%), 26/574 (4.5%), p=0.0032, respectively). Analysis showed DRPI incidence rates per 1000 NIVS days ((10.6, 5.5), p=0.0001, respectively). 75 (88%) of DRPI occurred in the ≤32 week group of neonates requiring NIVS. Review of babies ≤32 weeks across the three intervals showed significant improvement with time (55 (19%); 27 (13%); 19 (9%), p=0.0001).
Conclusions:
Preferred nCPAP interface, nasal dressing and NICP have reduced the incidence and severity of DRPI in the NICU.
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