An integrative review of neonatal nasal injuries from nasal CPAP in low-resource settings

Abstract

Nasal continuous positive airway pressure (nCPAP) is a strongly recommended intervention for the care of premature neonates worldwide; however, it is often associated with a range of nasal injuries. Characteristics and prevention strategies of nCPAP associated injuries are not well characterized for low-resource settings. A literature search of Embase, MEDLINE, PubMed, and Google Scholar was conducted for peer-reviewed English-language studies published between January 1, 2013, and September 12, 2025. Search terms included combinations of “neonates,” “CPAP,” “non -invasive ventilation,” and “nasal injury.” Titles and abstracts were screened, and relevant data were extracted and synthesized. No formal risk-of-bias assessment was performed. Of the 97 manuscripts screened, 72 were relevant to the research question and therefore included in this review. The reported incidence of nasal injuries varied widely. Risk factors included improper interface sizing, prolonged therapy, and inadequate monitoring. Preventive strategies included correct interface application, protective barriers or lubricants, structured nursing bundles, frequent skin assessment, and staff training. Low-cost measures, such as proper prong sizing, skin monitoring, stabilization of the interface, and standardized protocols, are feasible in low-resource settings. In conclusion, affordable, context-appropriate interventions may reduce nCPAP-related nasal injuries. Further research is needed to evaluate effectiveness and scalability in low-resource settings.