Effect of Protective Nasal Dressing on the Incidence and Severity of Nasal Injury in Preterm Infants Receiving Continuous Positive Airway Pressure: A Randomized Controlled Trial

Abstract

Background: Continuous positive airway pressure-associated nasal injury persists as one of the most prevalent complications observed among preterm infants receiving non-invasive respiratory support in neonatal intensive care units. This study aims to evaluate the effect of the hydrocolloid protective nasal dressing on nasal injury for premature infants undergoing continuous positive airway pressure.

Subjects and Methods: A randomized controlled trial was conducted during three months, from 14 February to 16 May 2026, in the neonatal intensive care units of two teaching hospitals affiliated with the Maysan Health Department in Iraq. 80 preterm infants with gestational ages between 26 and 36 weeks who required at a minimum 72 hours of CPAP intervention were consecutively recruited and randomly allocated into intervention and control groups. Infants in the intervention group received a hydrocolloid protective nasal dressing along with routine care, whereas the control group received routine care only. Nasal injury was assessed using the nasal injury assessment score chart over a 72-hour follow-up period.

Results: Infants receiving hydrocolloid protective dressing showed a significantly reduced incidence and severity of nasal injury related to CPAP at 27.5% compared with 100% in the control group. The intervention also delayed the onset and progression of tissue injury, while maintaining skin integrity throughout the intervention period. No cases of CPAP failure requiring airway intubation were observed in each group.

Conclusions: The nasal protective dressing evaluated in this study is a safe and effective intervention for reducing the incidence of nasal injuries among preterm infants receiving continuous positive airway pressure.