What Can I Use to Maintain Nasal Moisture in Neonates on Oxygen?

Catherine L. Witt, RNC, MS, NNP

Disclosures

June 18, 2004

Question

Have any products been US Food and Drug Administration (FDA)-approved for use in neonates to maintain nasal moisture during prolonged use of nasal continuous positive airway pressure (NCPAP) or high-flow nasal cannula oxygen? There is a moisture gel used on infants to adults, but there is no reference to neonates. Increased bleeding has been an issue despite increased humidity use.

Response from Catherine L. Witt, RNC, MS, NNP

You are right to be cautious with the use of ointments or gels in the neonate. Because neonates' skin is thinner and more permeable, they are at risk of absorbing ingredients through the skin at a higher rate than older infants or adults.

There is no nasal moisturizer approved for use in neonates using NCPAP or oxygen by high-flow cannula. Dryness and breakdown of the nares can be a problem for these infants. Increasing humidity is a first step. You may need to increase the temperature on the humidifier to provide visible humidity in the NCPAP tubing. In addition, increasing the humidity in the infant's environment may help, either in the isolette or by providing mist in a hood or tubing placed near the infant's face.

Also, it is important to use the right size nasal prongs for the infant. A common mistake is to use prongs that are too small, thinking that they will be gentler than larger ones. However, the smaller prongs can advance too far into the nasal passage, eroding the tissue. The prongs should fit comfortably in the nares without distending them, yet provide an adequate seal.[1] Positioning the baby in a prone position, supported with swaddling or blanket rolls, can decrease movement that drags on the device, causing increasing pressure on the nose.[2] The prongs should be attached carefully to avoid upward pressure on the nose, but provide for an adequate seal.

Currently, there is limited research on suctioning from which to determine how frequently the nares should be suctioned with use of the NCPAP or high-flow nasal cannula. Suctioning should be used as necessary to clear secretions, but care should be taken not to suction too vigorously, which may cause trauma to the nasal passages. Excessive suctioning can also lead to edema, exacerbating the problem.

Infants who are very active will benefit from swaddling, careful positioning, and other comfort measures. Sedation with lorazepam (Ativan) or midazolam (Versed) may be necessary to prevent trauma to the nasal passages from excessive movement or activity if other measures are not successful. Vigilant nursing care is essential to achieve successful therapy with the NCPAP or high-flow nasal cannula.

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