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Incidence and Risk Factors of Nasal Pressure Injuries in Neonates Receiving Noninvasive Ventilation
Blgeis Elgadra1, Lina Abdullah2, Hafsa Alsharif2,3
1Department of Medical Education, Sidra Medicine, Doha P.O. Box 26999, Qatar.
Journal of Clinical Medicine
|January 28, 2026
Summary
Nasal pressure injuries from non-invasive ventilation (NIV) are common in neonates, mostly mild and early. Recurrence, septal involvement, and prolonged ventilation increase severe injury risk, necessitating improved monitoring and interface management.
Area of Science:
- Neonatal Intensive Care
- Pediatric Pulmonology
- Medical Device Complications
Background:
- Nasal pressure injuries are a frequent complication of non-invasive ventilation (NIV) in neonates.
- Limited data exists on injury severity, timing, and predictors of progression in large neonatal cohorts.
- This study addresses the need for comprehensive data on nasal pressure injuries in neonates receiving NIV.
Purpose of the Study:
- To assess the incidence and characteristics of nasal pressure injuries in neonates undergoing NIV.
- To identify risk factors associated with the development and progression of these injuries.
- To determine independent predictors of moderate-to-severe nasal pressure injuries in a large tertiary neonatal intensive care unit (NICU) population.
Main Methods:
- Retrospective observational study of infants with nasal pressure injuries during NIV from March 2018 to November 2022.
- Injury severity classified using the Fischer classification.
- Analysis of demographic, perinatal, respiratory, and device-related factors; multivariable logistic regression used to identify predictors of moderate-to-severe injury.
Main Results:
- 237 nasal injury episodes occurred in 226 infants (0.406 per 100 device-days).
- 81% of injuries were mild (Stage I), while 19% were moderate-to-severe (Stage II-III).
- Independent predictors of moderate-to-severe injury included previous nasal injury (aOR 6.25), septal involvement (aOR 2.98), and prolonged positive pressure ventilation at birth (aOR 1.23 per minute).
Conclusions:
- While most nasal pressure injuries during NIV are mild and occur early, recurrence and septal involvement significantly elevate the risk of severe injury.
- Prolonged resuscitative ventilation is also a key risk factor for severe outcomes.
- Enhanced surveillance, monitoring of septal pressure points, and proactive interface management are crucial for minimizing nasal morbidity in neonates on NIV.
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