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The Pressure Is On!

Neonatal Skin and Nasal Continuous Positive Airway Pressure

Ottinger, Daniele DNP, NNP-BC; Hicks, Jamie MSN, NNP-BC; Wilson, Sarah MSN, NNP-BC; Sperber, Kim MSN, NNP-BC; Power, Keely MSN, NNP-BC

Section Editor(s): Schierholz, Elizabeth

doi: 10.1097/ANC.0000000000000348
Case of the Month

Background: Premature infants have an increased risk for developing skin breakdown. Perceivably noninvasive interventions may have detrimental effects on the infant's skin.

Purpose: This case presentation describes an extreme case of nasal breakdown associated with nasal continuous positive airway pressure (nCPAP).

Methods: Highlighted is the vital importance of proper placement, along with appropriate apparatus size, in the efforts to prevent skin breakdown. Ensuring that pressure points are avoided is imperative to prevent nCPAP-related injuries, along with treating the area in the event of skin denudation. A literature search was conducted to determine best practice options to prevent these injuries.

Findings: There is little information in the literature to guide treatment and prevention of this type of breakdown.

Implications for Practice: Avoidance of pressure in a localized area is the most commonly found recommendation.

Implications for Research: There are extensive opportunities for adding to our current knowledge in terms of prevention and treatment of skin breakdown associated with device utilization in the neonatal intensive care unit, especially with the increasing use of nCPAP.

Neonatal Intensive Care Unit, University of Virginia Health System, Charlottesville.

Correspondence: Daniele Ottinger, DNP, NNP-BC, Neonatal Intensive Care Unit, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903 (

The authors declare no conflicts of interest

© 2016 by The National Association of Neonatal Nurses