Nasal continuous positive airway pressure with head cap fixation as a contributing factor to extensive scalp necrosis in a preterm neonate with early-onset sepsis and scalp hematoma

BACKGROUND: Nasal continuous positive airway pressure (CPAP) is widely used in the treatment and prevention of respiratory distress in preterm neonates, with only few severe adverse skin effects reported. CASE PRESENTATION: A preterm neonate was born at 34 + 1 weeks of gestation, birth weight 1860 g, and presented with early-onset sepsis (EOS) and scalp hematoma. He developed respiratory distress day 2 after birth. Antibiotics, nasal CPAP and other supportive treatment were initiated. A scalp hematoma in the occipital region was complicated by nasal CPAP cap pressure leading to an extensive scalp necrosis equaling 6% of the total body surface. Debridement and skin grafting were performed day 11, and 51, respectively. The boy survived with good healing of the skin graft. CONCLUSION: The nasal CPAP head cap contributed to the development of severe, but potentially preventable, scalp necrosis in a preterm with birth-related scalp skin injury and EOS.