Summary of the best evidence for the prevention of nasal injury in preterm infants with nasal noninvasive ventilation

Background: Due to immaturity, the nose of preterm infants can easily be injured, by even a short application of a nasal device. However, 20% to 60% of preterm infants suffer nasal damage while using nasal continuous positive airway pressure (NCPAP) due to weak skin tissue, prolonged use of nasal device, and improper nursing practices, leading to increased risk of infection and decreased compliance and tolerance. In this study, we retrieved, obtained and integrated the related evidences of prevention of nasal injury in premature infants with nasal noninvasive ventilation to provide reference for clinical practice. Methods: We searched the relevant guidelines, expert consensus, evidence summaries and systematic reviews in the databases and guideline websites of the National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), the Agency for Health care Research and Quality (AHRQ), Guidelines International Network (GIN), the World Health Organization (WHO) guideline websites, Registered Nurses' Association of Ontario (RANO), Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), European Pressure Ulcer Advisory Panel (EPUAP), Yi Maitong, British Medical Journal best-practice, Cochrane Library, UpToDate, Embase, PubMed, China National Knowledge Infrastructure (CNKI), Wanfang. The search was limited to the time of library establishment to February 2023. Results: In total, 16 articles were included, including six guidelines, three expert consensuses, two evidence summaries and five systematic reviews. Twenty-eight pieces of evidence were summarized from six aspects: risk assessment, ventilation and connection, skin protection, skin assessment, training and support, and continuous quality improvement. Conclusions: This study summarized the best evidence for the prevention of nasal injury in premature infants through nasal noninvasive ventilation. It is suggested that nurses should consider the actual clinical situation when applying the suggestions from the evidence, formulate corresponding nursing measures, and reduce the occurrence of nasal injury in premature infants.