{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:27:35Z","timestamp":1789705655083,"version":"4.0.1"},"reference-count":30,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objective: Nasal pressure injuries following non-invasive ventilation (NIV) have remained a common complication. Available evidence on injury severity characteristics, timing, and predictors of progression to moderate\u2013severe injury, especially in large cohorts, is limited. The objective was to assess the incidence, characteristics and risk factors for nasal pressure injuries among neonates on NIV in a large tertiary neonatal intensive care unit (NICU). Methods: This retrospective observational study recruited all infants who experienced nasal pressure injury while on NIV from March 2018 to November 2022. The severity of the injury was categorized by the Fischer classification. Demographics, perinatal, respiratory, and device-related factors were examined. Multivariable logistic regression revealed independent predictors of moderate to severe injury. Results: There were 237 nasal injury episodes in 226 infants (0.406 per 100 device-days), considering 17,004 NICU admissions and 58,363 NIV device-days. Most injuries were mild (Stage I 81%) while 19% were moderate\u2013severe (Stage II\u2013III). Early injuries (\u22643 days after NIV) were present in 83.5% of patients and were often related to the nasal bridge. In particular, late-onset injuries (&gt;3 days) were more likely in infants with previous injury, exposure to postnatal steroids, longer prior intubation, or septal involvement. Moreover, multivariable analysis identified three specific independent predictors of moderate\u2013severe injury previous nasal injury (aOR 6.25, 95% CI 1.11\u201335.35), septal or combined bridge\/septum involvement (aOR 2.98, 95% CI 1.04\u20138.43), and prolonged period of positive pressure ventilation at birth (aOR 1.23 per minute, 95% CI 1.04\u20131.45). Conclusions: Most nasal pressure injuries seen during NIV are mild and early; however, recurrence, septal involvement, and prolonged resuscitative ventilation markedly increase the risk of severe injury. Improving surveillance on early NIV use, monitoring of septal pressure points, and proactive interventions with interface management will aid in minimizing preventable nasal morbidity.<\/jats:p>","DOI":"10.3390\/jcm15020615","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T14:57:25Z","timestamp":1768229845000},"page":"615","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Incidence and Risk Factors of Nasal Pressure Injuries in Neonates Receiving Noninvasive Ventilation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3568-0877","authenticated-orcid":false,"given":"Blgeis","family":"Elgadra","sequence":"first","affiliation":[{"name":"Department of Medical Education, Sidra Medicine, Doha P.O. Box 26999, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1964-5813","authenticated-orcid":false,"given":"Lina","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafsa","family":"Alsharif","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar"},{"name":"Department of Critical Care Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman","family":"Dirar","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit (NICU), Women\u2019s Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Estalilla","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit (NICU), Women\u2019s Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quennie","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit (NICU), Women\u2019s Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habeebah","family":"Fazlullah","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit (NICU), Women\u2019s Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9023-7950","authenticated-orcid":false,"given":"Jojo","family":"Furigay","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit (NICU), Women\u2019s Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roderick","family":"Pedron","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit (NICU), Women\u2019s Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal","family":"Kanth","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit (NICU), Women\u2019s Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2627-4806","authenticated-orcid":false,"given":"Mohammad A. A.","family":"Bayoumi","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit (NICU), Women\u2019s Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9158-2696","authenticated-orcid":false,"given":"Ashraf","family":"Gad","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit (NICU), Women\u2019s Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar"},{"name":"Weill-Cornell Medicine-Qatar, Doha P.O. Box 24144, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1159\/000528914","article-title":"European consensus guidelines on the management of respiratory distress syndrome: 2022 update","volume":"120","author":"Sweet","year":"2023","journal-title":"Neonatology"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network, Finer, N.N., Carlo, W.A., Walsh, M.C., Rich, W., and Gantz, M.G. (2010). Early CPAP versus Surfactant in Extremely Preterm Infants. N. Engl. J. Med., 362, 1970\u20131979.","DOI":"10.1056\/NEJMoa0911783"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ramaswamy, V.V., Devi, R., and Kumar, G. (2023). Non-invasive ventilation in neonates: A review of current literature. Front. 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