The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

EVALUATION OF A NASAL BREAKDOWN SCORING SYSTEM FOR PREMATURE INFANTS REQUIRING CPAP.

B. K. Walsh1, D. Kaufman1, S. Zanelli1, T. Hicks2


Background: Earlier and more prolonged use of nasal continuous positive airway pressure (nCPAP) has increased in neonates at lower birth weight and gestational age. Skin trauma and breakdown is a common complication of this therapy in these infants with immature and fragile skin. Subjective findings of skin breakdown lead to inconsistent management.
Objective: To evaluate an objective scoring system to monitor the skin condition of premature infants who require nCPAP.

Design/Methods: A nasal breakdown scoring system was developed to evaluate the skin integrity of premature infants who require nCPAP support. Five commonly injured nasal areas were defined with each location receiving a severity score ranging from 0 to 3. The scoring system was used during the evaluation of a new CPAP interface (Airlife Infant nCPAP, Cardinal Health, McGaw Park, IL) in our NICU. Scores were determined twice daily by the respiratory therapists.

Results: 49 infants with a median gestational age of 29 weeks (range 23-38 weeks) and a median birth weight of 1185g (range 490-3740g) were evaluated over a 6-month period using this scoring system. The median number of examinations was 6 (range 1-39). 80% of infants had at least one score greater than 1. For infants with abnormal findings, the average score was 1.55 +/- 0.7 (mean/SD) with a median of 1 (range 1-3+). Lesions were evenly distributed within the 5 anatomical predefined areas (16.6% internal nare; 13.7% external nare; 28.2% philtrum; 26% nasal bridge; 15.5% septum).

Conclusions: This nasal breakdown scoring system was helpful in the evaluation of a new nCPAP system. This evaluation also demonstrates the need to improvement current CPAP systems and/or education of their application as 80% of patient had some skin integrity issues. This system can be used for quality improvement of nCPAP support in the neonate. Its role in the management of nasal breakdown while on nCPAP needs to be further assessed.

Nasal Breakdown Scoring System
 0=Normal 1=Pale or Pink/Red 2=Bleeding,Ulcer,Eschar 3=Skin tear Nasal conpression (+ if present)
Internal nare      
External nare      
Philtrum      
Bridge      
Septum      



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