World Water Assessment Program case study, Ruhuna basins, Sri Lanka

River basins / Topography / Soils / Ecology / Climate / Rain / Evapotranspiration / Population / Land use / Surface water / Groundwater / Aquifers / Water quality / Water resources development / Fisheries / Wells / Pumps / Waterborne diseases / Ecosystems / Water use / Hydroelectric schemes / Tanks / Political aspects / Institutions / Legislation / Public investment / Domestic water / Water supply / Financing / Social participation / Risks / Drought / Irrigation water / Sri Lanka / Ruhuna river basins

Irrigation, health and the environment: A literature review with examples from Sri Lanka

Irrigation management / Health / Environment / Water management / Sri Lanka

Nasal injury in preterm infants receiving non-invasive respiratory support: a systematic review

ObjectiveBinasal prongs are the most commonly used interface for the delivery of nasal positive airway pressure (CPAP) to preterm infants. However, they are associated with pressure-related nasal injury, which causes pain and discomfort. Nasal injury may necessitate a change in interface and occasionally damage is severe enough to require surgical repair. We aim to determine the incidence and risk factors for nasal injury in preterm infants, and to provide clinicians with strategies to effectively prevent and treat it.DesignWe conducted a systematic search of databases including MEDLINE (PubMed including the Cochrane Library), EMBASE, CINAHL and Scopus. Included studies enrolled human preterm infants and were published prior to 20 February 2017.ResultsForty-five studies were identified, including 14 ra ndomised controlled trials, 10 observational studies, two cohort studies, eight case reports and 11 reviews. The incidence of nasal injury in preterm infants ranged from 20–100%. Infants born &lt;30 weeks’ gestation are at highest risk. Strategies shown to reduce nasal injury included: nasal barrier dressings (2 studies, n=244, risk ratio (RD) −0.12, 95%, CI − 0.20 to −0.04), nasal high flow therapy as an alternative to binasal prong CPAP (7 studies, n=1570, risk difference (RD) −0.14, 95% CI −0.17 to −0.10), and nasal masks rather than binasal prongs (5 studies, n=544, RR 0.80, 95% CI 0.64 to 1.00).Conclusions and relevanceNasal injury is common in preterm infants born &lt;30 weeks’ gestational age receiving CPAP via binasal prongs. Larger randomised trials are required to fully evaluate strategies to reduce nasal injury.</jats:sec