Nasopharyngeal ventilation: an answer to the conundrum of severe nasal injury in a neonate.

A term neonate with a stormy perinatal course, requiring prolonged mechanical ventilation, due to congenital pneumonia, complicated by secondary pulmonary arterial hypertension and prolonged non-invasive respiratory support, presented to us in the fourth week of postnatal age, with the challenge of difficulty in weaning from respiratory support. The neonate was noted to have a severe injury of the nasal bridge and septum, excessive purulent nasal secretions and crusting leading to recurrent nasal block. This precluded the usage of nasal masks or prongs in the neonate and led to episodes of worsening distress necessitating recurrent handling for clearance of the nasal debris. To curb this vicious cycle of nasal injury and inflammation, a nasopharyngeal tube was employed to allow adequate ventilation, while enabling effective healing of the injured nasal areas. This simple intervention of nasopharyngeal ventilation allowed early weaning from respiratory support and successful discharge of the neonate.