Proactive Nursing Care for Prevention and Management of MDRPI in Preterm Infants Receiving Non-invasive Ventilation: A Case Study
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Abstract
Preterm infants are at high risk of developing medical device-related pressure
injuries (MDRPIs) because of immature skin integrity and prolonged use of non-
invasive respiratory support. MDRPIs may lead to infection, prolonged
hospitalization, scarring, and reduced quality of life. This article aims to present
a case study of proactive evidence-based nursing care for the prevention and
management of MDRPIs in a preterm infant. The case involved a male preterm
infant born at 29+1 weeks’ gestation with a birth weight of 976 g who was
diagnosed with respiratory distress syndrome and received non-invasive positive
pressure ventilation (NIPPV). Upon admission, the risk of skin injury was assessed
based on the principles of the Neonatal Skin Risk Assessment Scale (NSRAS),
together with systematic skin assessment. On the third day of hospitalization,
non-blanchable erythema was observed on the nasal bridge, consistent with a
stage 1 MDRPI. Nursing interventions included increased frequency of skin
assessment and interface rotation, application of prophylactic dressings, and
adjustment of device fixation to reduce pressure and friction. Following
continuous proactive nursing care, the erythema improved within 72 hours and
completely resolved by day 10 without progression of the lesion or secondary
infection. Skin integrity was maintained throughout the period of NIV support.
Proactive nursing care integrating evidence-based practice with risk assessment,
continuous surveillance, appropriate device management, and prophylactic skin
protection played a crucial role in reducing the severity of MDRPIs and enhancing
patient safety among critically ill preterm infants.
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