Necrosis of the columella associated with nasal continuous positive airway pressure in a preterm infant.

Dear Editors, We present a case of nasal injury secondary to nasal continuous positive airway pressure in a 28-week-preterm infant, hospitalised in the neonatal intensive care unit of our hospital. After having applied a nasal continuous positive airway pressure (NCPAP) device at 4 weeks of birth, the infant showed a loss of cutaneous substance at the level of nasal columella with partial exposure of the underlying cartilaginous structures (Figure 1). NCPAP is a non-invasive form of ventilation that is becoming increasingly popular as a method of respiratory support in the newborn and, more recently, as a primary mode of respiratory support for preterm infants with respiratory insufficiency (1). In our patient, the use of the NCPAP device was absolutely necessary: when we moved it away from the nares of the infant, there was a sudden decrease in PO2. One of the complications of NCPAP application is nasal injury, ranging from oedema to columella necrosis, which may occur with all types of nasal prongs and NCPAP devices (24). The major underlying mechanism of nasal injury related to NCPAP appears to be the pressure generated on the columella by the prongs. Current available interfaces are too rigid, oversized or too heavy for smaller infants. Increased pressure on the columella causes diminished circulation of blood flow. This subsequently impairs tissue perfusion and leads to ischaemia along with tissue damage. Persistent erythema, dermal injury, oedema, induration and finally an ulcer can