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Wang L, Zuo D, Sun L. Transient neonatal hyperpigmentation of the proximal nail fold in a Chinese infant: a case report. J Int Med Res 2022; 50:3000605211067748. [PMID: 35023378 PMCID: PMC8785318 DOI: 10.1177/03000605211067748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cutaneous alterations are common in neonates and usually occur in the first few days of life. Most of these are transient and benign, appearing as physiological responses to birth. Skin pigmentation disorders are considered transitory dermatoses of newborn infants. Nail pigmentation manifests as asymptomatic brown to bluish-black skin pigmentation over the fingers and toes in newborns. Hyperpigmentation of the distal phalanx of both hands and feet is commonly found in dark-skinned newborns, but it is rare in fair-skinned newborns and East Asian populations. We herein describe a Chinese infant with transient neonatal hyperpigmentation of the proximal nail fold.
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Affiliation(s)
- Lu Wang
- Department of Dermatology, Sichuan Provincial Maternity and Child Health Care Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Daming Zuo
- Department of Dermatology, the Fifth Affiliated Hospital, 70570Southern Medical University, Southern Medical University, Guangzhou, Guangdong, China
| | - Ledong Sun
- Department of Dermatology, the Fifth Affiliated Hospital, 70570Southern Medical University, Southern Medical University, Guangzhou, Guangdong, China
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Multichannel esophageal signals to monitor respiratory rate in preterm infants. Pediatr Res 2022; 91:572-580. [PMID: 34601494 PMCID: PMC8487228 DOI: 10.1038/s41390-021-01748-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/29/2021] [Accepted: 09/05/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Apnea of prematurity cannot be reliably measured with current monitoring techniques. Instead, indirect parameters such as oxygen desaturation or bradycardia are captured. We propose a Kalman filter-based detection of respiration activity and hence apnea using multichannel esophageal signals in neonatal intensive care unit patients. METHODS We performed a single-center observational study with moderately preterm infants. Commercially available nasogastric feeding tubes containing multiple electrodes were used to capture signals with customized software. Multichannel esophageal raw signals were manually annotated, processed using extended Kalman filter, and compared with standard monitoring data including chest impedance to measure respiration activity. RESULTS Out of a total of 405.4 h captured signals in 13 infants, 100 episodes of drop in oxygen saturation or heart rate were examined. Median (interquartile range) difference in respiratory rate was 0.04 (-2.45 to 1.48)/min between esophageal measurements annotated manually and with Kalman filter and -3.51 (-7.05 to -1.33)/min when compared to standard monitoring, suggesting an underestimation of respiratory rate when using the latter. CONCLUSIONS Kalman filter-based estimation of respiratory activity using multichannel esophageal signals is safe and feasible and results in respiratory rate closer to visual annotation than that derived from chest impedance of standard monitoring.
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Ramos MCM, Veríssimo MDLÓR, Velasco MVR. Análisis del rótulo y características de los jabones utilizados en la piel del recién nacido. J Wound Care 2022; 31:10-21. [PMID: 36789927 DOI: 10.12968/jowc.2022.31.latam_sup_5.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Objetivo: Analizar la información del rótulo, y las características físicas y fisicoquímicas de los jabones usados en recién nacidos (RN). Método: Estudio cuantitativo y descriptivo de 17 jabones comercializados en San Pablo, Brasil. Se analizó la información del rótulo (tensioactivos, pruebas de seguridad y descripción del valor de pH), y las características físicas (color y fragancia) y fisicoquímicas (valor de pH) del producto; las dos últimas, en laboratorio. Resultados: Se identificaron 27 tipos de tensioactivos: 70,3% (n=19) aniónicos, 18,5% (n=5) anfóteros y 11,1% (n=3) no iónicos. El 37% (n=10) tuvo un potencial moderado de irritación. En cuanto a las pruebas de seguridad, la mayoría de las formulaciones (94,1%) citó “dermatológicamente probado”. Sólo 42% citó “oftalmológicamente probado”. La translucidez estuvo presente en 23,5% (n=4) de los jabones. Todas las formulaciones presentaron fragancia. El promedio más alto de valor de pH fue de jabones en barra tradicionales (9,94 DE 0,81). Conclusión: Las formulaciones analizadas indicaron un potencial de irritación bajo o moderado. Cuatro jabones líquidos y uno en barra combinados tuvieron valores cercanos a los del pH de la piel del RN, y mostraron ser adecuados para la homeostasis de la barrera cutánea. Aunque las formulaciones citaron “dermatológicamente probado”, no todas citaron “oftalmológicamente probado”. Este estudio proporciona elementos para seleccionar un jabón adecuado para el RN.
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Affiliation(s)
- Mily C Moreno Ramos
- Programa de Posgrado en Enfermería (PPGE), Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Maria de La Ó Ramallo Veríssimo
- Departamento de Enfermagem Materno-Infantil e Psiquiátrica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Maria V Robles Velasco
- Departamento de Farmácia, Facultad de Ciencias Farmaceúticas, Universidade de São Paulo, San Pablo, Brasil
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Prado NCDC, Lima DMD, Silva ABPD, Mercês BMO, Menezes HFD, Silva RARD. ELABORATION AND VALIDATION OF A TERMINOLOGY SUBSET FOR NEWBORNS WITH CENTRAL VENOUS CATHETERS. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2020-0649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to elaborate and validate the content of a terminology subset of the International Classification for Nursing Practice, in light of Betty Neuman's theoretical model, for newborns with a Peripherally Inserted Central Catheter. Method: a methodological study carried out according to the guidelines of the Brazilian method for developing International Classification for Nursing Practice terminology subsets, through the following stages: 1) Identification of clinical findings relevant to the Nursing practice; 2) Cross-mapping of the findings identified with the International Classification for Nursing Practice terms, version 2019/2020; 3) Elaboration of the Nursing diagnoses, outcomes and interventions statements, based on Betty Neuman's theoretical model; 4) Validation of the statements' content by expert nurses, using the Delphi Technique in two rounds. The Content Validity Index was used for data analysis, where the statements with Content Validity Index values ≥ 0.80 were validated. Results: 86 clinical findings were identified, allowing for the development and validation of a terminology subset of the International Classification for Nursing Practice, composed of 31 diagnoses/outcomes, categorized according to the levels of intra-personal (3.03%), inter-personal (3.03%) and extra-personal (93.93%) stressors, as well as of 154 Nursing interventions. Conclusion: the elaboration and validation of a terminology subset of the International Classification for Nursing Practice for newborns with a Peripherally Inserted Central Catheter offers support for better targeted provision of care and for quality assistance.
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de Souza IMF, Vitral GLN, Caliari MV, Reis ZSN. Association between the chronology of gestation and the morphometrical skin characteristics at childbirth: a development of predictive model. BMJ Health Care Inform 2021; 28:bmjhci-2021-100476. [PMID: 34876452 PMCID: PMC8655593 DOI: 10.1136/bmjhci-2021-100476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/10/2021] [Indexed: 12/11/2022] Open
Abstract
Objective The structural maturation of the skin is considered a potential marker of pregnancy dating. This study investigated the correlation between the morphometrical skin characteristics with the pregnancy chronology to propose models for predicting gestational age. Methods A cross-sectional analysis selected 35 corpses of newborns. The biopsy was performed up to 48 hours after death in the periumbilical abdomen, palm and sole regions. Pregnancy chronology was based on the obstetric ultrasound before 14 weeks. The dimensions of the skin layers, area of glands and connective fibrous tissue were measured with imaging software support. Univariate and multivariate regression models on morphometric values were used to predict gestational age. Results Gestational age at birth ranged from 20.3 to 41.2 weeks. Seventy-one skin specimens resulted in the analysis of 1183 digital histological images. The correlation between skin thickness and gestational age was positive and strong in both regions of the body. The highest univariate correlation between gestational age and skin thickness was using the epidermal layer dimensions, in palm (r=0.867, p<0.001). The multivariate modelling with the thickness of the abdominal epidermis, the dermis and the area of the sebaceous glands adjusted had the highest correlation with gestational age (r=0.99, p<0.001). Conclusion The thickness of the protective epidermal barrier is, in itself, a potential marker of pregnancy dating. However, sets of values obtained from skin morphometry enhanced the estimation of the gestational age. Such findings may support non-invasive image approaches to estimate pregnancy dating with various clinical applications.
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Affiliation(s)
| | | | - Marcelo Vidigal Caliari
- Department of General Pathology, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Interrelationships between Skin Structure, Function, and Microbiome of Pregnant Females and Their Newborns: Study Protocol for a Prospective Cohort Study. Dermatol Res Pract 2021; 2021:4163705. [PMID: 34840564 PMCID: PMC8612799 DOI: 10.1155/2021/4163705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Pregnancy leads to several skin changes, but evidence about structural and functional skin changes is scarce. Findings on skin structure and function in children in their first year reveal rapid skin maturation, but evidence indicates that in particular, water holding and transport mechanisms are different from adults. Important questions include whether maternal cutaneous properties predict infant skin condition, and if so, how. This is especially relevant for the skin's microbiome because it closely interacts with the host and is assumed to play a role in many skin diseases. Therefore, the study objective is to explore characteristics of skin and hair of pregnant women and their newborns during pregnancy and in the first six months after delivery and their associations. Methods The study has an observational longitudinal design. We are recruiting pregnant females between 18 and 45 years using advertisement campaigns in waiting areas of gynecologists and hospital's outpatient services. A final sample size of n = 100 women is the target. We perform noninvasive, standardized skin, hair, and skin microbiome measurements. We establish the baseline visit during pregnancy until at the latest four weeks before delivery. We schedule follow-up visits four weeks and six months after birth for mothers and their newborns. We will calculate descriptive statistical methods using frequencies and associations over time depending on scale levels of the measurements. Discussion. The majority of previous studies that have investigated infants' skin microbiome and its associations used cross-sectional designs and focused on selected characteristics in small samples. In our longitudinal study, we will characterize a broad range of individual and environmental characteristics of mothers and their newborns to evaluate interrelationships with skin parameters and their changes over time. Considering the combination of these multiple variables and levels will allow for a deeper understanding of the complex interrelationship of the newborn's skin maturation. This trial is registered with ClinicalTrials.gov (Identifier: NCT04759924).
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Kwak SS, Yoo S, Avila R, Chung HU, Jeong H, Liu C, Vogl JL, Kim J, Yoon HJ, Park Y, Ryu H, Lee G, Kim J, Koo J, Oh YS, Kim S, Xu S, Zhao Z, Xie Z, Huang Y, Rogers JA. Skin-Integrated Devices with Soft, Holey Architectures for Wireless Physiological Monitoring, With Applications in the Neonatal Intensive Care Unit. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2103974. [PMID: 34510572 DOI: 10.1002/adma.202103974] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/28/2021] [Indexed: 06/13/2023]
Abstract
Continuous monitoring of vital signs is an essential aspect of operations in neonatal and pediatric intensive care units (NICUs and PICUs), of particular importance to extremely premature and/or critically ill patients. Current approaches require multiple sensors taped to the skin and connected via hard-wired interfaces to external data acquisition electronics. The adhesives can cause iatrogenic injuries to fragile, underdeveloped skin, and the wires can complicate even the most routine tasks in patient care. Here, materials strategies and design concepts are introduced that significantly improve these platforms through the use of optimized materials, open (i.e., "holey") layouts and precurved designs. These schemes 1) reduce the stresses at the skin interface, 2) facilitate release of interfacial moisture from transepidermal water loss, 3) allow visual inspection of the skin for rashes or other forms of irritation, 4) enable triggered reduction of adhesion to reduce the probability for injuries that can result from device removal. A combination of systematic benchtop testing and computational modeling identifies the essential mechanisms and key considerations. Demonstrations on adult volunteers and on a neonate in an operating NICUs illustrate a broad range of capabilities in continuous, clinical-grade monitoring of conventional vital signs, and unconventional indicators of health status.
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Affiliation(s)
- Sung Soo Kwak
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Seonggwang Yoo
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Raudel Avila
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | | | - Hyoyoung Jeong
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Claire Liu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Jamie L Vogl
- Division of Pediatric Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Joohee Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Hong-Joon Yoon
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Yoonseok Park
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Hanjun Ryu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Geumbee Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Jihye Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Jahyun Koo
- School of Biomedical Engineering, Korea University, Seoul, 02841, Republic of Korea
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, 02841, Republic of Korea
| | - Yong Suk Oh
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Sungbong Kim
- Department of Materials Science and Engineering, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
- Sibel Health, Niles, IL, 60714, USA
- Department of Dermatology, Division of Dermatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Zichen Zhao
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, 116024, China
- Ningbo Institute of Dalian University of Technology, Ningbo, 315016, China
| | - Zhaoqian Xie
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, 116024, China
- Ningbo Institute of Dalian University of Technology, Ningbo, 315016, China
| | - Yonggang Huang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Chemistry, Northwestern University, Evanston, IL, 60208, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, 60208, USA
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Viability-Resolved Metagenomics Reveals Antagonistic Colonization Dynamics of Staphylococcus epidermidis Strains on Preterm Infant Skin. mSphere 2021; 6:e0053821. [PMID: 34523979 PMCID: PMC8550141 DOI: 10.1128/msphere.00538-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Preterm infants are at increased risk of infections caused by coagulase-negative staphylococci (CoNS) that colonize skin. Technical barriers in sequencing low-microbial-biomass skin swabs from preterm infants hinder attempts to gain a strain-level understanding of CoNS colonization dynamics within their developing skin microbiome. Here, the microbiome of five skin sites and available stool was studied from four preterm infants hospitalized over their first 2 months of life. We used propidium monoazide treatment of samples to enrich for the viable microbiome and metagenomic shotgun sequencing to resolve species and strains. The microbiome of different skin sites overlapped with each other, was dominated by the CoNS species Staphylococcus epidermidis and Staphylococcus capitis, and was distinct from stool. Species diversity on skin increased over time despite antibiotic exposure. Evidence of antagonism between the most common S. epidermidis strains, ST2 and ST59, included negative relationships for species correlation networks and in situ replication rates and that ST2 colonized skin earlier but was often replaced by ST59 over time. Experiments done with reference isolates showed that ST2 produced more biofilm than ST59 on plastic surfaces, which was reduced in mixed culture. We also discovered that a rare S. epidermidis strain, ST5, grew rapidly in stool in association with Stenotrophomonas maltophilia from a suspected episode of infection. Viability treatment of samples and moderate throughput shotgun sequencing provides strain-level information about CoNS colonization dynamics of preterm infant skin that ultimately might be exploited to prevent infections. IMPORTANCE The skin is a habitat for microbes that commonly infect preterm infants, but the use of sequencing for fine-scale study of the microbial communities of skin that develop in these infants has been limited by technical barriers. We treated skin swabs of preterm infants with a photoreactive dye that eliminates DNA from nonviable microbes and then sequenced the remaining DNA. We found that two strains of the most common species, Staphylococcus epidermidis, showed an antagonistic relationship on skin by cooccurring with different species, replicating fastest in different samples, and dominating skin sites at different times. Representatives of these strains also differed in their ability to stick to plastic surfaces—an important pathogenicity trait of this species. Our study shows the feasibility of gaining detailed information about strain colonization dynamics from this difficult-to-sequence body site of preterm infants, which might be used to guide novel approaches to prevent infections.
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Early development of the skin microbiome: therapeutic opportunities. Pediatr Res 2021; 90:731-737. [PMID: 32919387 PMCID: PMC7952468 DOI: 10.1038/s41390-020-01146-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/23/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023]
Abstract
As human skin hosts a diverse microbiota in health and disease, there is an emerging consensus that dysregulated interactions between host and microbiome may contribute to chronic inflammatory disease of the skin. Neonatal skin is a unique habitat, structurally similar to the adult but with a different profile of metabolic substrates, environmental stressors, and immune activity. The surface is colonized within moments of birth with a bias toward maternal strains. Initial colonists are outcompeted as environmental exposures increase and host skin matures. Nonetheless, early life microbial acquisitions may have long-lasting effects on health through modulation of host immunity and competitive interactions between bacteria. Microbial ecology and its influence on health have been of interest to dermatologists for >50 years, and an explosion of recent interest in the microbiome has prompted ongoing investigations of several microbial therapeutics for dermatological disease. In this review, we consider how recent insight into the host and microbial factors driving development of the skin microbiome in early life offers new opportunities for therapeutic intervention. IMPACT: Advancement in understanding molecular mechanisms of bacterial competition opens new avenues of investigation into dermatological disease. Primary development of the skin microbiome is determined by immunological features of the cutaneous habitat. Understanding coordinated microbial and immunological development in the pediatric patient requires a multidisciplinary synthesis of primary literature.
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60
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Natsis N, Soeprono F, Nelson A, Barrio VR, Tom WL. Diffuse Geometric Erosions on the Skin of a Premature Infant, Fraternal Twin Unaffected. Pediatr Rev 2021; 42:118-121. [PMID: 34470890 DOI: 10.1542/pir.2019-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Nicola Natsis
- School of Medicine, University of California, San Diego, San Diego, CA.,Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA.,Department of Dermatology, University of California, San Diego, San Diego, CA
| | - Fred Soeprono
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA.,Department of Dermatology, University of California, San Diego, San Diego, CA
| | - Aislyn Nelson
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA.,Department of Dermatology, University of California, San Diego, San Diego, CA
| | - Victoria R Barrio
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA.,Department of Dermatology, University of California, San Diego, San Diego, CA
| | - Wynnis L Tom
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA.,Department of Dermatology, University of California, San Diego, San Diego, CA
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Munoz N, Posthauer ME. Nutrition strategies for pressure injury management: Implementing the 2019 International Clinical Practice Guideline. Nutr Clin Pract 2021; 37:567-582. [PMID: 34462964 DOI: 10.1002/ncp.10762] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Nutrition is an important component in the prevention and treatment of pressure injuries (PIs). The skin is the largest organ of the body, and macronutrients and micronutrients in specific amounts are required to maintain and repair body tissues. The European Pressure Ulcer Advisory Panel, the National Pressure Injury Advisory Panel, and the Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: 2019 Clinical Practice Guideline includes nutrition recommendations for PI management. This manuscript identifies the key nutrients required for wound healing, reviews the evidence in the 2019 nutrition recommendations, and translates the recommendations provided into key points to be incorporated into policy and practice that impact patient outcomes.
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Affiliation(s)
- Nancy Munoz
- VA Southern Nevada Healthcare System, North Las Vegas, Nevada, USA
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Kim KM, White JS, Max W, Chapman SA, Muench U. Evaluation of Clinical and Economic Outcomes Following Implementation of a Medicare Pay-for-Performance Program for Surgical Procedures. JAMA Netw Open 2021; 4:e2121115. [PMID: 34406402 PMCID: PMC8374611 DOI: 10.1001/jamanetworkopen.2021.21115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Surgical complications increase hospital costs by approximately $20 000 per admission and extend hospital stays by 9.7 days. Improving surgical care quality and reducing costs is needed for patients undergoing surgery, health care professionals, hospitals, and payers. OBJECTIVE To evaluate the association of the Hospital-Acquired Conditions Present on Admission (HAC-POA) program, a mandated national pay-for-performance program by the Centers for Medicare & Medicaid Services, with surgical care quality and costs. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study of Medicare inpatient surgical care stays from October 2004 through September 2017 in the US was conducted. The National Inpatient Sample and a propensity score-weighted difference-in-differences analysis of hospital stays with associated primary surgical procedures was used to compare changes in outcomes for the intervention and control procedures before and after HAC-POA program implementation. The sample consisted of 1 317 262 inpatient surgical episodes representing 1 198 665 stays for targeted procedures and 118 597 stays for nontargeted procedures. Analyses were performed between November 1, 2020, and May 7, 2021. EXPOSURES Implementation of the HAC-POA program for the intervention procedures included in this study (fiscal year 2009). MAIN OUTCOMES AND MEASURES Incidence of surgical site infections and deep vein thrombosis, length of stay, in-hospital mortality, and hospital costs. Analyses were adjusted for patient and hospital characteristics and indicators for procedure type, hospital, and year. RESULTS In our propensity score-weighted sample, the intervention procedures group comprised 1 047 351 (88.5%) individuals who were White and 742 734 (60.6%) women; mean (SD) age was 75 (6.9) years. The control procedures group included 94 715 (88.0%) individuals who were White, and 65 436 (60.6%) women; mean (SD) age was 75 (7.1) years. After HAC-POA implementation, the incidence of surgical site infections in targeted procedures decreased by 0.3 percentage points (95% CI, -0.5 to -0.1 percentage points; P = .02) compared with nontargeted procedures. The program was associated with a reduction in length of stay by 0.5 days (95% CI, -0.6 to -0.4 days; P < .001) and hospital costs by 8.1% (95% CI, -10.2% to -6.1%; P < .001). No significant changes in deep vein thrombosis incidence and mortality were noted. CONCLUSIONS AND RELEVANCE The findings of this study suggest that the HAC-POA program is associated with small decreases in surgical site infection and length of stay and moderate decreases in hospital costs for patients enrolled in Medicare. Policy makers may consider these findings when evaluating the continuation and expansion of this program for other surgical procedures, and payers may want to consider adopting a similar policy.
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Affiliation(s)
- Kyung Mi Kim
- Clinical Excellence Research Center, Stanford University School of Medicine, Palo Alto, California
- Department of Social and Behavioral Sciences, University of California School of Nursing, San Francisco
| | - Justin S. White
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Epidemiology & Biostatistics, University of California School of Medicine, San Francisco
| | - Wendy Max
- Department of Social and Behavioral Sciences, University of California School of Nursing, San Francisco
- Institute for Health & Aging, University of California, San Francisco
| | - Susan A. Chapman
- Department of Social and Behavioral Sciences, University of California School of Nursing, San Francisco
| | - Ulrike Muench
- Department of Social and Behavioral Sciences, University of California School of Nursing, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
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Kang SY, Um JY, Chung BY, Kim JC, Park CW, Kim HO. Differential Diagnosis and Treatment of Itching in Children and Adolescents. Biomedicines 2021; 9:biomedicines9080919. [PMID: 34440123 PMCID: PMC8389554 DOI: 10.3390/biomedicines9080919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 12/13/2022] Open
Abstract
Itching is prevalent in children with skin disorders and associated with effects on their mood, quality of life, and social functioning. Surprisingly, there are no data on childhood prevalence of pruritus in the general population. The aim of this article is to explore the epidemiology, clinical manifestation, and treatment for itch (pruritus) in the pediatric population (from infancy to adolescence), and to be helpful to primary care physicians who assess and diagnose pediatric patients with itching. In this study, we searched for specific keywords using PubMed and MEDLINE (Ovid) and, then, refined the retrieved searches for each cause and treatment. As a result of reviewing the literature, atopic dermatitis was shown to be the most common cause of itching, especially during infancy and through preschool. Not only skin disorders but also systemic diseases, drugs, and postburn states can predispose an individual to itching in childhood. There are traditional and newly developed treatment modalities for itching in pediatric patients. However, because the pharmacokinetics and pharmacodynamics of childhood are different from those of adults, the medications for itching have to be applied carefully for these age groups. There are many areas to be elucidated regarding the prevalence and objective assessment of pruritus in pediatric patients. Moreover, the safety profiles of medications in the pediatric population need to be better understood. Further studies to investigate itching in childhood are warranted.
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Amer Y, Bridges C, Marathe K. Epidemiology, Pathophysiology, and Management Strategies of Neonatal Wound Care. Neoreviews 2021; 22:e452-e460. [PMID: 34210809 DOI: 10.1542/neo.22-7-e452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Guidelines for neonatal skin care are scarce, and there is no consensus on the best management practices for neonatal skin breakdown. This review presents the pathology and phases of wound healing, reasons for neonatal skin fragility, and approaches to recognition of commonly encountered neonatal wounds. This review also provides general strategies for neonatal wound prevention, care, dressing, and management to avoid further damage to the fragile neonatal skin. The importance and role of retaining moisture in expediting wound healing is discussed, as well as updated classifications on how to grade and assess pressure ulcers and the role of negative pressure wound therapy and silver dressings. Lastly, this review discusses prevention and treatment options for surgical wounds, intravenous extravasation wounds, congenital wounds, and thermal injuries, in addition to how to differentiate these wounds from the common diaper dermatitis and contact dermatitis.
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Affiliation(s)
- Yomna Amer
- School of Medicine, University of Louisville, Louisville, KY
| | - Catherine Bridges
- Department of Dermatology, University of Cincinnati, Cincinnati, OH.,Department of Dermatology, Cincinnati Children's Hospital, Cincinnati, OH
| | - Kalyani Marathe
- Department of Dermatology, Cincinnati Children's Hospital, Cincinnati, OH
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Pithadia DJ, Kerns ML, Golden WC, Balagula Y, Glick SA, Huang A, Natsis NE, Tom WL, Cohen BA. Heterogeneous cutaneous findings associated with intrauterine HSV infection: A case series and literature review. Pediatr Dermatol 2021; 38:831-841. [PMID: 34227161 DOI: 10.1111/pde.14682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Herpes simplex virus (HSV) infection acquired in utero may present with non-vesicular dermatologic findings in affected newborns, which may pose a diagnostic dilemma. We aimed to describe and assess the range of non-vesiculobullous skin lesions that neonates with intrauterine HSV infection may manifest at birth. METHODS We collected a multicenter case series and conducted a literature review of neonates with intrauterine HSV infection presenting with non-vesiculobullous cutaneous lesions. RESULTS Twenty-two cases were reviewed, including six managed clinically by members of our team and 16 identified in the literature. Four (18%) were associated with twin pregnancies, and thirteen (59%) cases occurred in premature infants. Only four (18%) mothers had a documented history of HSV infection. Twelve (55%) cases resulted in poor outcomes, including long-term neurologic sequelae or death. Cutaneous manifestations included erosions, ulcerations, crusted papules or plaques, calcinosis cutis, excoriations, macules (erythematous, hypopigmented, or hyperpigmented), cutaneous atrophy, contractures, and bruising. About one-third of neonates developed new-onset vesicular lesions within a week of birth; in each of these cases, accurate diagnosis and therapy were delayed until appearance of vesicles. CONCLUSIONS The range of dermatologic findings associated with intrauterine HSV is extremely broad, and the various morphologies present at birth likely reflect different stages of the ongoing evolution of an HSV infection that began in utero. Clinicians should have a low threshold for HSV testing in premature neonates born with atypical cutaneous lesions, since early detection and treatment of HSV may reduce morbidity and mortality from systemic complications.
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Affiliation(s)
- Deeti J Pithadia
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle L Kerns
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William C Golden
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sharon A Glick
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Amy Huang
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Nicola E Natsis
- Department of Dermatology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Wynnis L Tom
- Department of Dermatology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Bernard A Cohen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Park M, Park S, Jung WH. Skin Commensal Fungus Malassezia and Its Lipases. J Microbiol Biotechnol 2021; 31:637-644. [PMID: 33526754 PMCID: PMC9705927 DOI: 10.4014/jmb.2012.12048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/11/2021] [Accepted: 01/25/2021] [Indexed: 12/15/2022]
Abstract
Malassezia is the most abundant genus in the fungal microflora found on human skin, and it is associated with various skin diseases. Among the 18 different species of Malassezia that have been identified to date, M. restricta and M. globosa are the most predominant fungal species found on human skin. Several studies have suggested a possible link between Malassezia and skin disorders. However, our knowledge on the physiology and pathogenesis of Malassezia in human body is still limited. Malassezia is unable to synthesize fatty acids; hence, it uptakes external fatty acids as a nutrient source for survival, a characteristic compensated by the secretion of lipases and degradation of sebum to produce and uptake external fatty acids. Although it has been reported that the activity of secreted lipases may contribute to pathogenesis of Malassezia, majority of the data were indirect evidences; therefore, enzymes' role in the pathogenesis of Malassezia infections is still largely unknown. This review focuses on the recent advances on Malassezia in the context of an emerging interest for lipases and summarizes the existing knowledge on Malassezia, diseases associated with the fungus, and the role of the reported lipases in its physiology and pathogenesis.
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Affiliation(s)
- Minji Park
- Department of Systems Biotechnology, Chung-Ang University, Anseong 17546, Republic of Korea
| | - Sungmin Park
- Department of Systems Biotechnology, Chung-Ang University, Anseong 17546, Republic of Korea
| | - Won Hee Jung
- Department of Systems Biotechnology, Chung-Ang University, Anseong 17546, Republic of Korea,Corresponding author Phone: +82-31-670-3068 Fax: +82-31-675-1381 E-mail:
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Teklay S, Balai E, Patel L. The Complexity of Managing a Burned Irreducible Umbilical Hernia in an Adult. Cureus 2021; 13:e14030. [PMID: 33898118 PMCID: PMC8059485 DOI: 10.7759/cureus.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We present a case of a 65-year-old male with a longstanding non-symptomatic irreducible umbilical hernia who presented with a three-day-old full-thickness thermal burn to the hernia. The burn was sustained while operating a metal drop forger, where the patient was repeatedly exposed to 30-second bursts of heat from the furnace, with temperature exceeding 1350°C. He estimated he had this exposure approximately 48 times during an 8-hour shift, giving him a total of 24 minutes cumulative exposure to the heat. The patient reported that he normally wore an abdominal binder under his heat-resistant apron to temporarily flatten and protect his hernia. On the day of the injury, he had not been wearing this binder. The patient was initially unaware that he had sustained a burn; upon delayed presentation to the hospital, he had cellulitis surrounding a 0.25% total body surface area (TBSA) full-thickness burn. Contrast-enhanced CT abdomen demonstrated an umbilical hernia with a neck diameter of 2.3cm, with breach of the hernia fascia but no communication between the bowel and burnt tissue. After discussion between Plastic Surgery and General Surgery teams the decision was made to manage the burn non-operatively with daily flamazine dressings and empirical antibiotics for the cellulitis. Once this area had healed, elective mesh repair of the umbilical hernia was carried out. This is the first adult case of a full-thickness burn overlying an umbilical hernia to be reported in the literature. The case highlights both an unusual aetiology and a rare injury, as well as the multi-disciplinary teamwork required to manage it successfully.
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Affiliation(s)
- Samuel Teklay
- Plastic Surgery, Queen Elizabeth Hospital, Birmingham, GBR
| | - Edward Balai
- Plastic Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR
| | - Lopa Patel
- Plastic Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR
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Talianu MT, Dinu-Pîrvu CE, Ghica MV, Anuţa V, Jinga V, Popa L. Foray into Concepts of Design and Evaluation of Microemulsions as a Modern Approach for Topical Applications in Acne Pathology. NANOMATERIALS (BASEL, SWITZERLAND) 2020; 10:E2292. [PMID: 33228156 PMCID: PMC7699607 DOI: 10.3390/nano10112292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 01/19/2023]
Abstract
With a fascinating complexity, governed by multiple physiological processes, the skin is considered a mantle with protective functions which during lifetime are frequently impaired, triggering dermatologic disorders. As one of the most prevalent dermatologic conditions worldwide, characterized by a complex pathogenesis and a high recurrence, acne can affect the patient's quality of life. Smart topical vehicles represent a good option in the treatment of a versatile skin condition. By surpassing the stratum corneum known for diffusional resistance, a superior topical bioavailability can be obtained at the affected place. In this direction, the literature study presents microemulsions as a part of a condensed group of modern formulations. Microemulsions are appreciated for their superior profile in matters of drug delivery, especially for challenging substances with hydrophilic or lipophilic structures. Formulated as transparent and thermodynamically stable systems, using simplified methods of preparation, microemulsions have a simple and clear appearance. Their unique structures can be explained as a function of the formulation parameters which were found to be the mainstay of a targeted therapy.
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Affiliation(s)
- Marina-Theodora Talianu
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 020950 Bucharest, Romania; (M.-T.T.); (C.-E.D.-P.); (V.A.); (L.P.)
| | - Cristina-Elena Dinu-Pîrvu
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 020950 Bucharest, Romania; (M.-T.T.); (C.-E.D.-P.); (V.A.); (L.P.)
| | - Mihaela Violeta Ghica
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 020950 Bucharest, Romania; (M.-T.T.); (C.-E.D.-P.); (V.A.); (L.P.)
| | - Valentina Anuţa
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 020950 Bucharest, Romania; (M.-T.T.); (C.-E.D.-P.); (V.A.); (L.P.)
| | - Viorel Jinga
- Department of Clinical Sciences, no.3, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Lăcrămioara Popa
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 020950 Bucharest, Romania; (M.-T.T.); (C.-E.D.-P.); (V.A.); (L.P.)
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Kim J, Lee JW, Kim DY. Analysis of Characteristics of Peripheral Arterial Ischemia in Premature Babies and Effects of Nitroglycerin Patch Application. CHILD HEALTH NURSING RESEARCH 2020; 26:434-444. [PMID: 35004487 PMCID: PMC8650864 DOI: 10.4094/chnr.2020.26.4.434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 11/06/2022] Open
Abstract
Purpose: The aim of this retrospective study was to analyze the characteristics of peripheral arterial ischemia and tissue necrosis in premature babies, as well as the effects of nitroglycerin.Methods: In total, 513 newborns were enrolled who were admitted to the neonatal intensive care unit with a gestational age of 34 weeks or younger. Data were collected on general personal and clinical information, peripheral arterial ischemia, and nitroglycerin patch application in the premature infants. The collected data were analyzed using the x<sup>2</sup> test, t-test, Mann-Whitney U test, logistic regression.Results: Thirty-six (7.0%) infants had peripheral arterial ischemia, while 477 (93.0%) infants did not. Lower gestational age (x<sup>2</sup>=35.97, p<.001), lower birth weight (x<sup>2</sup>=29.40, p<.001), lower blood pressure (x<sup>2</sup>=23.10, p<.001), and insertion of an umbilical artery catheter (p<.001) were significantly associated with the occurrence of peripheral arterial ischemia. Among the preterm infants in whom nitroglycerin patches were applied, 30 (83.3%) premature infants without necrosis improved without complications, 4 (11.1%) showed hypotension, and 2 (5.6%) showed skin damage.Conclusion: Based on a review of our experiences with nitroglycerin patches, we recommend closely observing skin color and using nitroglycerin patches on the skin to help improve flow in premature infants with peripheral arterial ischemia.
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Affiliation(s)
- Jeongeun Kim
- Registered Nurse, Neonatal Intensive Care Unit, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jin Won Lee
- Registered Nurse, Neonatal Intensive Care Unit, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Dong Yeon Kim
- Unit Manager, Hematology Intensive Care Unit, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
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Investigating the Efficacy of Hydrocolloid Dressing for Preventing Nasotracheal Tube-Related Pressure Injury in the PICU. Pediatr Crit Care Med 2020; 21:e752-e758. [PMID: 32740180 DOI: 10.1097/pcc.0000000000002494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the efficacy of hydrocolloid dressing in reducing the occurrence rate and severity of nasotracheal tube-related pressure injury. DESIGN Randomized controlled trial. SETTING A PICU in a tertiary medical center in southern China. PATIENTS Pediatric patients received invasive mechanical ventilation via nasotracheal tubes. INTERVENTIONS The hydrocolloid dressing was cut into an optimal square size, which should cover the area from the nasal columella to the ala. MEASUREMENTS AND MAIN RESULTS Eligible participants were randomly allocated to the control group and the experimental group. The participants in the experimental group received hydrocolloid dressing to protect nasal skin from the beginning of nasotracheal intubation, while the participants in the control group received the current care procedure (without hydrocolloid dressing) unless pressure injuries occurred. The hydrocolloid dressing was changed daily to assess the nasal skin. The pressure injury staging system that was redefined and updated by the National Pressure Ulcer Advisory Panel in 2016 was used. The mean duration of nasotracheal intubation was 150.10 ± 117.09 hours in the experimental group and 161.75 ± 120.72 hours in the control group. Forty-five participants had nasotracheal tube-related pressure injuries in control group, whereas 26 patients had in experimental group (72.6% vs 43.3%; absolute difference, 29.3%, 95% CI, 12.5-46%; p = 0.001). The median survival times of the nasal skin integrity were 95.5 hours in the control group and 219.5 hours in the experimental group (p < 0.001). CONCLUSIONS Hydrocolloid dressing can not only reduce the occurrence rate of nasotracheal tube-related pressure injury in the child with long-term nasotracheal intubation but also improve the endurance of the nasal skin significantly.
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71
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Camillo Ribeiro DDF, Barros FS, Fernandes BL, Nakato AM, Nohama P. Hydrocolloid versus silicone gel for the prevention of nasal injury in newborns submitted to noninvasive ventilation: A randomized clinical trial. Heliyon 2020; 6:e04366. [PMID: 32642588 PMCID: PMC7334427 DOI: 10.1016/j.heliyon.2020.e04366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/20/2020] [Accepted: 06/25/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose To compare the effectiveness of the hydrocolloid and the silicone gel on the nasal protection of the newborns (NBs) during the use of noninvasive ventilation (NIV). Materials and methods Thirty-three NBs were selected. They were randomly divided into three groups of 11 NBs, according to the type of nasal protection used: hydrocolloid, thick silicone gel, and thin silicone gel. The stage of the nasal injury and need for exchanging nasal protection were assessed before the connection to the NIV and every 24 h until the physician's authorization for NIV's suspension. Results The mean gestational age was 32.03 ± 3.93 weeks, and the median birth weight was 1760 g (750–3535 g). The incidence of nasal injury using hydrocolloid, thick silicone gel, and a thin silicone gel group was 36.36%, 81.81%, and 72.72%, respectively (p = 0.06). Regarding the injury stage, there was no statistical significance between the three study groups. The hydrocolloid protection type had the best adhesion (p = 0.03) on the NBs' skin. Conclusions Although this study was conducted by local practice patterns, the results showed that the hydrocolloid could be the best choice to prevent the nasal septum base injury in the NB submitted to NIV.
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Affiliation(s)
- Débora de Fátima Camillo Ribeiro
- Neonatal Services, Waldemar Monastier Hospital, Rua XV de Novembro 3701, Bom Jesus, Campo Largo, Paraná, Brazil.,Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Avenida Sete de Setembro 3165, Rebouças, Curitiba, Paraná, Brazil.,Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Prado Velho, Curitiba, Paraná, Brazil
| | - Frieda Saicla Barros
- Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Avenida Sete de Setembro 3165, Rebouças, Curitiba, Paraná, Brazil
| | - Beatriz Luci Fernandes
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Prado Velho, Curitiba, Paraná, Brazil
| | - Adriane Muller Nakato
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Prado Velho, Curitiba, Paraná, Brazil
| | - Percy Nohama
- Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Avenida Sete de Setembro 3165, Rebouças, Curitiba, Paraná, Brazil.,Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Prado Velho, Curitiba, Paraná, Brazil
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Sampah MES, Hackam DJ. Dysregulated Mucosal Immunity and Associated Pathogeneses in Preterm Neonates. Front Immunol 2020; 11:899. [PMID: 32499778 PMCID: PMC7243348 DOI: 10.3389/fimmu.2020.00899] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/17/2020] [Indexed: 12/12/2022] Open
Abstract
Many functions of the immune system are impaired in neonates, allowing vulnerability to serious bacterial, viral and fungal infections which would otherwise not be pathogenic to mature individuals. This vulnerability is exacerbated in compromised newborns such as premature neonates and those who have undergone surgery or who require care in an intensive care unit. Higher susceptibility of preterm neonates to infections is associated with delayed immune system maturation, with deficiencies present in both the innate and adaptive immune components. Here, we review recent insights into early life immunity, and highlight features associated with compromised newborns, given the challenges of studying neonatal immunity in compromised neonates due to the transient nature of this period of life, and logistical and ethical obstacles posed by undertaking studies newborns and infants. Finally, we highlight how the unique immunological characteristics of the premature host play key roles in the pathogenesis of diseases that are unique to this population, including necrotizing enterocolitis and the associated sequalae of lung and brain injury.
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Affiliation(s)
- Maame Efua S Sampah
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David J Hackam
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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73
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Ahn YM, Lee SM, Cho JA. Development of a Nursing Guideline for Improving Skin Integrity in High-Risk Infants. J Contin Educ Nurs 2020; 51:238-244. [PMID: 32347961 DOI: 10.3928/00220124-20200415-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 11/04/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND High-risk infants are highly susceptible to skin impairment caused by invasive procedures, radiant warmers, and phototherapy, in addition to their intrinsic vulnerability. This leads to a vicious cycle that aggravates the risk of skin infections. Concerns have been raised that neonatal nurses may lack knowledge regarding feasible guidelines to improve skin integrity of high-risk newborns. METHOD A clinical guideline was developed for neonatal skin care practices based on skin physiology, and its educational effects on the knowledge and confidence of neonatal nurses was evaluated. A booklet was developed on skin care practice guidelines divided into topics determined through a nationwide survey. RESULTS Using a quasi-experimental design with 46 neonatal nurses, education with this booklet improved nurses' knowledge of skin care practices but not their confidence. CONCLUSION These findings highlight the importance of implementing a tailored systematic program rather than a single educational session on skin care in high-risk infants for neonatal nurses. [J Contin Educ Nurs. 2020;51(5):238-244.].
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Chung HU, Rwei AY, Hourlier-Fargette A, Xu S, Lee K, Dunne EC, Xie Z, Liu C, Carlini A, Kim DH, Ryu D, Kulikova E, Cao J, Odland IC, Fields KB, Hopkins B, Banks A, Ogle C, Grande D, Park JB, Kim J, Irie M, Jang H, Lee J, Park Y, Kim J, Jo HH, Hahm H, Avila R, Xu Y, Namkoong M, Kwak JW, Suen E, Paulus MA, Kim RJ, Parsons BV, Human KA, Kim SS, Patel M, Reuther W, Kim HS, Lee SH, Leedle JD, Yun Y, Rigali S, Son T, Jung I, Arafa H, Soundararajan VR, Ollech A, Shukla A, Bradley A, Schau M, Rand CM, Marsillio LE, Harris ZL, Huang Y, Hamvas A, Paller AS, Weese-Mayer DE, Lee JY, Rogers JA. Skin-interfaced biosensors for advanced wireless physiological monitoring in neonatal and pediatric intensive-care units. Nat Med 2020; 26:418-429. [PMID: 32161411 PMCID: PMC7315772 DOI: 10.1038/s41591-020-0792-9] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
Standard of care management in neonatal and pediatric intensive care units (NICUs and PICUs) involve continuous monitoring of vital signs with hard-wired devices that adhere to the skin and, in certain instances, include catheter-loaded pressure sensors that insert into the arteries. These protocols involve risks for complications and impediments to clinical care and skin-to-skin contact between parent and child. Here we present a wireless, non-invasive technology that not only offers measurement equivalency to these management standards but also supports a range of important additional features (without limitations or shortcomings of existing approaches), supported by data from pilot clinical studies in the neonatal intensive care unit (NICU) and pediatric ICU (PICU). The combined capabilities of these platforms extend beyond clinical quality measurements of vital signs (heart rate, respiration rate, temperature and blood oxygenation) to include novel modalities for (1) tracking movements and changes in body orientation, (2) quantifying the physiological benefits of skin-to-skin care (e.g. Kangaroo care) for neonates, (3) capturing acoustic signatures of cardiac activity by directly measuring mechanical vibrations generated through the skin on the chest, (4) recording vocal biomarkers associated with tonality and temporal characteristics of crying impervious to confounding ambient noise, and (5) monitoring a reliable surrogate for systolic blood pressure. The results have potential to significantly enhance the quality of neonatal and pediatric critical care.
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Affiliation(s)
- Ha Uk Chung
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Alina Y Rwei
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Aurélie Hourlier-Fargette
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Shuai Xu
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - KunHyuck Lee
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Emma C Dunne
- Division of Pediatric Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Zhaoqian Xie
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Claire Liu
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Andrea Carlini
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Dong Hyun Kim
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Dennis Ryu
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Sibel Inc, Evanston, IL, USA
| | | | | | - Ian C Odland
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Kelsey B Fields
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Brad Hopkins
- Division of Pediatric Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Anthony Banks
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Christopher Ogle
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Dominic Grande
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Jun Bin Park
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Jongwon Kim
- Photo-Electronic Hybrids Research Center, Korea Institute of Science and Technology (KIST), Seoul, South Korea.,Department of Mechanical Engineering, Kyung Hee University, Yongin, Republic of Korea
| | - Masahiro Irie
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Hokyung Jang
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Yerim Park
- Department of Computer Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jungwoo Kim
- Department of Computer Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Han Heul Jo
- Department of Computer Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Hyoungjo Hahm
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Raudel Avila
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.,Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA
| | - Yeshou Xu
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.,Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA.,Key Laboratory of C&PC Structures of the Ministry of Education, Southeast University, Nanjing, China
| | - Myeong Namkoong
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Jean Won Kwak
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Emily Suen
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
| | - Max A Paulus
- Department of Biology, Northwestern University, Evanston, IL, USA
| | - Robin J Kim
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Blake V Parsons
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Kelia A Human
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Seung Sik Kim
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Manish Patel
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Sibel Inc, Evanston, IL, USA.,University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - William Reuther
- Department of Graphic Design and Industrial Design at North Carolina State University, Raleigh, NC, USA
| | - Hyun Soo Kim
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Sung Hoon Lee
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Yeojeong Yun
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Taeyoung Son
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Inhwa Jung
- Department of Mechanical Engineering, Kyung Hee University, Yongin, Republic of Korea
| | - Hany Arafa
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Vinaya R Soundararajan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ayelet Ollech
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Avani Shukla
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Allison Bradley
- Division of Pediatric Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Molly Schau
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Casey M Rand
- Division of Pediatric Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lauren E Marsillio
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Division of Pediatric Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Zena L Harris
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Division of Pediatric Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Yonggang Huang
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.,Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA
| | - Aaron Hamvas
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amy S Paller
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Debra E Weese-Mayer
- Division of Pediatric Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. .,Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. .,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Jong Yoon Lee
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA. .,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA. .,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Sibel Inc, Evanston, IL, USA.
| | - John A Rogers
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA. .,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA. .,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA. .,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA. .,Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA. .,Department of Chemistry, Northwestern University, Evanston, IL, USA. .,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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75
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Pereira KD, Shaigany K, Zur KB, Jenks CM, Preciado DA, Hamdi O, Banker K, Briddell JW, Isaiah A. Tracheostomy in the Extremely Premature Neonate: A Multi-Institutional Study. Otolaryngol Head Neck Surg 2020; 162:559-565. [PMID: 32093576 DOI: 10.1177/0194599820905528] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE (1) To describe characteristics associated with tracheostomy placement and (2) to describe associated in-hospital morbidity in extremely premature infants. STUDY DESIGN Pooled retrospective analysis of charts. SETTING Academic children's hospitals. SUBJECTS AND METHODS The patient records of premature infants (23-28 weeks gestational age) who underwent tracheostomy between January 1, 2012, and December 31, 2017, were reviewed from 4 academic children's hospitals. Demographics, procedural morbidity, feeding, respiratory, and neurodevelopmental outcomes at the time of transfer from the neonatal intensive care unit (NICU) were obtained. The contribution of baseline characteristics to mortality, neurodevelopmental, and feeding outcomes was also assessed. RESULTS The charts of 119 infants were included. The mean gestational age was 25.5 (95% confidence interval, 25.2-25.7) weeks. The mean birth weight was 712 (671-752) g. Approximately 50% was African American. The principal comorbidity was chronic lung disease (92.4%). Overall, 60.5% of the infants had at least 1 complication. At the time of transfer, most remained mechanically ventilated (94%) and dependent on a feeding tube (90%). Necrotizing enterocolitis increased the risk of feeding impairment (P = .002) and death (P = .03). CONCLUSIONS Tracheostomy in the extremely premature neonate is primarily performed for chronic lung disease. Complications occur frequently, with skin breakdown being the most common. Placement of a tracheostomy does not seem to mitigate the systemic morbidity associated with extreme prematurity.
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Affiliation(s)
- Kevin D Pereira
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine and University of Maryland Children's Hospital, Baltimore, Maryland, USA
| | - Kevin Shaigany
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine and University of Maryland Children's Hospital, Baltimore, Maryland, USA
| | - Karen B Zur
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Carolyn M Jenks
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Diego A Preciado
- Department of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Children's National Medical Center, Washington, DC, USA
| | - Osama Hamdi
- Howard University College of Medicine, Washington, DC, USA
| | - Karen Banker
- Division of Otolaryngology, Nemours/A. I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Jenna W Briddell
- Deptartment of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA.,Nemours/A. I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine and University of Maryland Children's Hospital, Baltimore, Maryland, USA
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76
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Examining Factors That Contribute to Delayed Wound Healing in Children with Tracheostomy Wounds. Adv Skin Wound Care 2020; 33:1-4. [PMID: 32032107 DOI: 10.1097/01.asw.0000653156.13611.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify variables that may contribute to delayed wound healing times in pediatric patients with tracheostomy wounds. DESIGN Researchers identified 134 charts spanning January 2013 to June 2017; 95 charts met the inclusion criteria. The study examined Pressure Ulcer Scale for Healing (PUSH) scores, pressure injury staging, and albumin levels. SETTING Arkansas Children's Hospital. PATIENTS Patients (birth to 18 years) who developed or were admitted with a wound caused by a tracheostomy device. MAIN OUTCOME MEASURE Time in days to wound closure. MAIN RESULTS There was a moderate positive correlation between albumin and days to healing (r = 0.432, n = 22, P = .045) with higher albumin levels associated with shorter healing times. The PUSH scores and pressure injury stage were significant in explaining 14.1% of variance in days to healing (F77,2 = 7.458; P < .001). CONCLUSIONS Wound healing appears to be multifactorial in nature in the pediatric population; albumin levels, pressure injury stage, and PUSH scores are all positively correlated with healing times. Further research is needed to investigate the contribution of race to healing time predication for the pediatric population.
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77
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Law RM, Ngo MA, Maibach HI. Twenty Clinically Pertinent Factors/Observations for Percutaneous Absorption in Humans. Am J Clin Dermatol 2020; 21:85-95. [PMID: 31677110 DOI: 10.1007/s40257-019-00480-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
At least 20 clinically relevant factors affect percutaneous absorption of drugs and chemicals: relevant physico-chemical properties, vehicle/formulation, drug exposure conditions (dose, duration, surface area, exposure frequency), skin appendages (hair follicles, glands) as sub-anatomical pathways, skin application sites (regional variation in penetration), population variability (premature, infants, and aged), skin surface conditions (hydration, temperature, pH), skin health and integrity (trauma, skin diseases), substantivity and binding to different skin components, systemic distribution and systemic toxicity, stratum corneum exfoliation, washing-off and washing-in, rubbing/massaging, transfer to others (human to human and hard surface to human), volatility, metabolic biotransformation/cutaneous metabolism, photochemical transformation and photosensitivity, excretion pharmacokinetics, lateral spread, and chemical method of determining percutaneous absorption.
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Affiliation(s)
- Rebecca M Law
- School of Pharmacy, Memorial University of Newfoundland, H3440, 300 Prince Phillip Dr., St. John's, NL, A1B 3V6, Canada.
- Department of Dermatology, UCSF School of Medicine, N461 2340 Sutter Street, San Francisco, CA, 94115, USA.
| | - Mai A Ngo
- California Department of Toxic Substances Control, 8800 Cal Center Drive, Sacramento, CA, 95826, USA
| | - Howard I Maibach
- Department of Dermatology, UCSF School of Medicine, N461 2340 Sutter Street, San Francisco, CA, 94115, USA
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78
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Marques-Mejías MA, Tomás-Pérez M, Vilà-Nadal G, Quirce S. Acute urticaria in the pediatric emergency department: Management and possible triggers. Ann Allergy Asthma Immunol 2020; 124:396-397. [PMID: 31981615 DOI: 10.1016/j.anai.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/18/2019] [Accepted: 01/13/2020] [Indexed: 01/11/2023]
Affiliation(s)
- M Andreína Marques-Mejías
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain; Servicio de Alergia, Hospital Universitario La Paz, Madrid, Spain.
| | - Margarita Tomás-Pérez
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain; Department of Allergy, Hospital La Paz Institute for Health Research (IDIPAZ), Madrid, Spain
| | - Gemma Vilà-Nadal
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain; Department of Allergy, Hospital La Paz Institute for Health Research (IDIPAZ), Madrid, Spain
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79
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Silva MJFD, Rodrigues AM, Vieira IRS, Neves GDA, Menezes RR, Gonçalves EDGDR, Pires MCC. Development and characterization of a babassu nut oil-based moisturizing cosmetic emulsion with a high sun protection factor. RSC Adv 2020; 10:26268-26276. [PMID: 35519748 PMCID: PMC9055432 DOI: 10.1039/d0ra00647e] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/23/2020] [Accepted: 06/16/2020] [Indexed: 12/03/2022] Open
Abstract
A stable moisturizing cosmetic emulsion was developed from babassu nut oil and high concentrations of sunscreens. Babassu nut oil was chosen because within the laboratory time-scale, this vegetable oil showed stable physicochemical properties (relative density, acidity index, and refracted index) and a good ratio between lauric and myristic fatty acids. The presence of these saturated fatty acids can confer specific activities to the cosmetic emulsion, such as antiviral, bactericidal, and anti-inflammatory activity. The prepared cosmetic emulsion, even after the centrifugation test (3000 rpm for 15 min), showed a creamy appearance with stable light-yellow coloration and the typical odor of babassu nut oil-based products. In the accelerated stability assays (pH, viscosity, and globule homogeneity), the cosmetic emulsion was kept at different temperatures (2.0 ± 0.2 °C (TG), 25 ± 2 °C (TA), and 40 ± 2 °C (TE)) and time durations (24 hours (t0), 7 days (t7), 15 days (t15), and 30 days (t30)). Finally, developed the cosmetic emulsion was investigated for occlusive properties and in vitro sun protection factor (SPF). Both were measured at room temperature and did not change significantly under the experimental conditions employed. The maximum experimental value measured in the in vitro occlusive test was equal to 34.2 ± 2.8, and the SPF was 39 ± 1.6 (t0) and 38 ± 2.9 (t30). In agreement with European and Brazilian legislations, the obtained babassu oil-based cosmetic emulsion is classified to have a high sun protection factor. A stable moisturizing cosmetic emulsion was developed from babassu nut oil and high concentrations of sunscreens.![]()
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Affiliation(s)
| | - Alisson Mendes Rodrigues
- Universidade Federal de Campina Grande
- Centro de Ciências e Tecnologia
- Unidade Acadêmica de Engenharia de Materiais
- Campina Grande
- Brazil
| | - Italo Rennan Sousa Vieira
- Universidade do Estado do Rio de Janeiro
- Instituto de Química
- Pavilhão Reitor Haroldo Lisboa da Cunha
- Rio de Janeiro
- Brazil
| | - Gelmires de Araújo Neves
- Universidade Federal de Campina Grande
- Centro de Ciências e Tecnologia
- Unidade Acadêmica de Engenharia de Materiais
- Campina Grande
- Brazil
| | - Romualdo Rodrigues Menezes
- Universidade Federal de Campina Grande
- Centro de Ciências e Tecnologia
- Unidade Acadêmica de Engenharia de Materiais
- Campina Grande
- Brazil
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80
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Iribarne-Durán LM, Artacho-Cordón F, Peña-Caballero M, Molina-Molina JM, Jiménez-Díaz I, Vela-Soria F, Serrano L, Hurtado JA, Fernández MF, Freire C, Olea N. Presence of Bisphenol A and Parabens in a Neonatal Intensive Care Unit: An Exploratory Study of Potential Sources of Exposure. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:117004. [PMID: 31774309 PMCID: PMC6927498 DOI: 10.1289/ehp5564] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Newborns in neonatal intensive care units (NICUs) are in contact with a variety of medical products whose production might include synthetic chemicals with hormonal activity. OBJECTIVES Our aim was to assess the content of bisphenol A (BPA) and parabens (PBs) and the hormone-like activities of a subset of medical products commonly used in NICUs in prolonged intimate contact with NICU newborns. METHODS Fifty-two NICU items were analyzed, determining the concentrations of BPA and PBs [methyl- (MeP), ethyl- (EtP), propyl- (PrP), and butylparaben (BuP)] and using the E-Screen and PALM-luciferase assays to measure the in vitro (anti-)estrogenic and (anti-)androgenic activity, respectively, of the extracts. Items found to have elevated BPA/PB content or hormone-like activities were further extracted using leaching methodologies. RESULTS BPA was found in three-fifths and PBs in four-fifths of tested NICU items, and ∼25% and ∼10% of extracts evidenced estrogenic and anti-androgenic activity, respectively. The highest BPA content was found in the three-way stopcock (>7.000 ng/g), followed by patterned transparent film dressing, gastro-duodenal feeding tubes, sterile gloves, single-lumen umbilical catheters, and intravenous (IV) infusion extension sets (concentrations ranged from 100 to 700 ng/g BPA). A total PB concentration (∑PBs) >100 ng/g was observed in several items, including light therapy protection glasses, patterned transparent film dressing, winged IV catheters, IV infusion extension sets, and textile tape. The highest estrogenic activity [>450 pM estradiol equivalent (E2eq)] was found in small dummy nipples, three-way stopcocks, and patterned transparent film dressing and the highest anti-androgenic activity [>5 mM procymidone equivalent units per gram (Proceq/g)] in small dummy nipples and three-way stopcocks. DISCUSSION According to these findings, neonates might be exposed to multiple sources of BPA and PBs in NICUs via inhalation, dermal, oral, and IV/parenteral routes. There is a need to address the future health implications for these extremely vulnerable patients and to adopt precautionary preventive measures as a matter of urgency. https://doi.org/10.1289/EHP5564.
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Affiliation(s)
| | - Francisco Artacho-Cordón
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Radiology and Physical Medicine Department, University of Granada, Granada, Spain
| | | | - José M Molina-Molina
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | - Laura Serrano
- Neonatal Intensive Care Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | - José A Hurtado
- Neonatal Intensive Care Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | - Mariana F Fernández
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Radiology and Physical Medicine Department, University of Granada, Granada, Spain
| | - Carmen Freire
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Nicolás Olea
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Radiology and Physical Medicine Department, University of Granada, Granada, Spain
- San Cecilio University Hospital, Granada, Spain
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81
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de Faria MF, Ferreira MBG, Felix MMDS, Calegari IB, Barbosa MH. Factors associated with skin and mucosal lesions caused by medical devices in newborns: Observational study. J Clin Nurs 2019; 28:3807-3816. [PMID: 31323697 DOI: 10.1111/jocn.14998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 01/24/2023]
Abstract
AIM AND OBJECTIVE To identify the occurrence of skin and mucosal lesions and factors related to the use of medical devices in newborns admitted to a neonatal intensive care unit. BACKGROUND The use of medical devices increases the risk of injury in newborns due to the immaturity and fragility of their skin and mucosa. DESIGN Observational and longitudinal study. METHODS The study included 85 newborns admitted to in a neonatal intensive care unit from a public teaching hospital. Data were collected from February-August 2018. For the evaluation, the Neonatal Skin Condition Score was used, as well as an instrument covering sociodemographic and clinical variables, medical devices in use and materials for skin protection. The study followed the recommendations STROBE. Simple frequency, measures of central tendency and variability, Pearson's correlation coefficient and multiple linear regression analysis were used for data analysis. RESULTS Of the n = 85 newborns evaluated, n = 62 (72.9%) presented skin or mucosal lesions caused using medical devices, excoriations being the most observed n = 55 (64.7%), and n = 32 (37.6%) had 1-3 lesions. As the number of devices increased, so did the number of lesions. On the other hand, the age of the newborn and the number of lesions were inversely proportional. CONCLUSION Most participants, n = 62 (72.9%), had skin or mucosal lesions associated with medical devices. The number of medical devices used and the age of the newborn were predictors for this occurrence. RELEVANCE TO CLINICAL PRACTICE The results show that it is fundamental that nurses know the factors that can interfere in the skin and mucosa conditions and, thus, promote the implementation of injury prevention measures in newborns, supporting safe and quality care.
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82
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Tielemans C, Voegeli D. Silicone-based adhesive removers for preventing peristomal skin complications caused by mechanical trauma. ACTA ACUST UNITED AC 2019. [DOI: 10.12968/gasn.2019.17.sup9.s22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Peristomal skin complications (PSCs) are reported by 77% of people with a stoma, with a serious impact on their quality of life, as well as on healthcare resources. PSCs are usually caused by irritant contact dermatitis from stoma effluent or skin stripping from mechanical trauma to the stratum corneum caused by removal of the ostomy appliance. The risk of mechanical trauma is higher in neonates, young infants and older adults, who have more fragile, friable skin. The incidence and impact of PSCs can be reduced with an appropriate appliance change routine. Mechanical trauma is reduced by minimising the frequency of appliance changes and using an adhesive remover wipe or spray. In adults with a stoma, silicone-based solvents are considered the first choice, as they are skin-friendly and sting-free, and they release the adhesive from the skin quickly and evaporate within seconds, without leaving a residue. However, for neonates, wipes and specialist paediatric oil-based adhesive removers are advised instead. The efficacy of adhesive removers, and silicone-based solvents in particular, at maintaining skin integrity and reducing discomfort has been reported by both stoma care nurses and people with a stoma.
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Affiliation(s)
- Chantal Tielemans
- President of the Flemish Association for Enterostomal Therapists, Belgium
| | - David Voegeli
- Professor of Nursing, Faculty of Health and Wellbeing, University of Winchester, Winchester, UK
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83
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Zhu T, Liu X, Kong FQ, Duan YY, Yee AL, Kim M, Galzote C, Gilbert JA, Quan ZX. Age and Mothers: Potent Influences of Children's Skin Microbiota. J Invest Dermatol 2019; 139:2497-2505.e6. [PMID: 31420081 DOI: 10.1016/j.jid.2019.05.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/25/2019] [Accepted: 05/05/2019] [Indexed: 12/31/2022]
Abstract
The evolution of a child's skin microbiome is associated with the development of the immune system and skin environment. As only few studies have analyzed the microbiota in young children, we investigated changes in the skin microbiota of children (158 subjects; ≤10 years old) and compared the microbiota structures between children and their mothers using 16S rRNA gene amplicon sequencing. Sample location and age were the primary factors determining a child's skin bacterial composition, which differed significantly among the face, ventral forearm, and calf. Relative abundances of Streptococcus and Granulicatella were negatively correlated with age, and the alpha diversity at all body sites examined increased during the first 10 years of life, especially on the face. The facial bacterial composition of 10-year-old children was strongly associated with delivery mode at birth. Among mother-child pairs (50 pairs), the relative abundances of most bacterial genera in children were more similar to those of their own mothers than those of unrelated women. The data indicated that age and site were significantly associated with microbial composition and that maternal factors determine the child's microbiome. Further research is needed to characterize the effects of maturation of the infant microbiome on health in adulthood.
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Affiliation(s)
- Ting Zhu
- Ministry of Education Key Laboratory for Biodiversity Science and Ecological Engineering, Institute of Biodiversity Science, School of Life Sciences, Fudan University, Shanghai, China
| | - Xing Liu
- Ministry of Education Key Laboratory for Biodiversity Science and Ecological Engineering, Institute of Biodiversity Science, School of Life Sciences, Fudan University, Shanghai, China
| | - Fan-Qi Kong
- AP Skin Testing Center, Johnson & Johnson China, Shanghai, China
| | - Yuan-Yuan Duan
- AP Skin Testing Center, Johnson & Johnson China, Shanghai, China
| | - Alyson L Yee
- Interdisciplinary Scientist Training Program, University of Chicago, Chicago, Illinois, USA; Microbiome Center, University of Chicago, Chicago, Illinois, USA; Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Madeline Kim
- Microbiome Center, University of Chicago, Chicago, Illinois, USA; Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Carlos Galzote
- Johnson & Johnson International (Singapore) Pte, Singapore, Singapore
| | - Jack A Gilbert
- Department of Pediatrics and Scripps Institution of Oceanography, University of California, San Diego, San Diego, California, USA
| | - Zhe-Xue Quan
- Ministry of Education Key Laboratory for Biodiversity Science and Ecological Engineering, Institute of Biodiversity Science, School of Life Sciences, Fudan University, Shanghai, China.
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Neumann K, Thomas JP, Voelter C, Dazert S. A new adhesive bone conduction hearing system effectively treats conductive hearing loss in children. Int J Pediatr Otorhinolaryngol 2019; 122:117-125. [PMID: 31004837 DOI: 10.1016/j.ijporl.2019.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 03/01/2019] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Bone conduction hearing devices integrated in softbands (BCDSs) are frequently not well accepted by children with conductive hearing loss due to pressure on the head, sweating, or cosmetic stigma. A non-surgical hearing system (ADHEAR) uses a new bone conduction concept consisting of an audio processor connected to an adhesive adapter fixed behind the ear. This study is the first to evaluate the audiological and clinical outcome of this novel system, comparing it with conventional BCDSs in a short- and mid-term follow-up in children under 10 years of age. METHODS The ADHEAR was compared to a BCDS in 10 children with conductive hearing loss (age: 0.7-9.7 years). Aided and unaided pure tone/behavioral observational audiometry and, if applicable, speech audiometry in quiet and noise were performed initially with both devices and after 8 weeks with the ADHEAR alone. The subjective hearing gain and usage of the new hearing system, as well as patients' and parents' satisfaction were assessed using questionnaires. RESULTS The functional gain with the ADHEAR averaged over 0.5, 1, 2, and 4 kHz exceeded that of the conventional BCDS (35.6 dB ± 15.1 vs. 29.9 dB ± 14.6, p = .001, n = 9 ears). Speech perception in quiet and noise (n = 8) improved in the aided situation similarly for both hearing devices. The parents of 8 of 10 children evaluated the ADHEAR system as being useful. Minor wearing problems occurred occasionally. Eight children continued using the ADHEAR after the study, one received an active middle ear implant and one continued to use a BCDS. CONCLUSION The ADHEAR system is a promising solution for children with conductive hearing loss or chronically draining ears.
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Affiliation(s)
- Katrin Neumann
- Division of Phoniatrics and Pediatric Audiology, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany; Cochlear Implant Center, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany.
| | - Jan Peter Thomas
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christiane Voelter
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany; Cochlear Implant Center, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
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85
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Broom M, Dunk AM, E Mohamed AL. Predicting Neonatal Skin Injury: The First Step to Reducing Skin Injuries in Neonates. Health Serv Insights 2019; 12:1178632919845630. [PMID: 31236011 PMCID: PMC6572893 DOI: 10.1177/1178632919845630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/28/2019] [Indexed: 11/17/2022] Open
Abstract
Background Skin injuries remain common in neonates admitted to neonatal intensive care units. While predicting neonates at risk of skin injury may assist in reducing the incidence of injury, currently there is limited evidence on which tool may be superior. Methods A prospective study was completed during November-December 2016 to evaluate the predictive value of the Skin Risk Assessment and Management Tool (SRAMT). Comparisons were made between SRAMT and Neonatal/Infant Braden-Q Scale (BQS) as well as staff's capacity to predict a neonate's risk of skin injury. Data collected included gestation, weight, day of assessment, injury types, causation, medical devices in situ and risk scores. Results In total, 248 assessments were completed with 38% (93) recorded skin injuries. Median (interquartile range) gestation and weight at assessment were 36.7 (26.86-56.86) weeks and 2.44 (0.99-4.06) kg, respectively. Receiver operating characteristic curve analysis showed the SRAMT had AUC (SE) of 0.94 (0.02) compared with 0.82 (0.03) for BQS (0.011, P < .001). The SRAMT and BQS had sensitivity of [(90.0 (80.5-95.9), 72.86 (60.9-82.8)] and specificity [(88.46 (81.7-93.4), 79.23 (71.2-85.8)], respectively. Conclusion In this study, the SRAMT's capacity to predict neonates at risk of injury was higher than the Neonatal BQS and staff. Predicting injuries remains complex and often multifactorial.
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Affiliation(s)
- Margaret Broom
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital and Health Services, Canberra, ACT, Australia.,Synergy: Nursing and Midwifery Research Centre, UC and ACT Health, University of Canberra, Canberra, ACT, Australia
| | - Ann Marie Dunk
- Synergy: Nursing and Midwifery Research Centre, UC and ACT Health, University of Canberra, Canberra, ACT, Australia.,Tissue Viability Unit, Canberra Hospital, University of Canberra, Canberra, ACT, Australia
| | - Abdel-Latif E Mohamed
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital and Health Services, Canberra, ACT, Australia.,Men, Women and Children's Health, The Medical School, College of Health and Medicine, Australian National University, Acton, ACT, Australia
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86
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Hughes-Formella B, Wunderlich O, Williams R, Fernández J, Kim YZ, Wigger-Alberti W, Pecquet S, Moodycliffe A. Comparison of Skin Structural and Functional Parameters in Well-Nourished and Moderately Undernourished Infants. Skin Pharmacol Physiol 2019; 32:212-223. [PMID: 31167217 DOI: 10.1159/000499434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/05/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Little is known about the impact of nutrition on the development of skin structure and function in infants. METHODS We investigated epidermal, dermal, and subcutis parameters of aged-matched well-nourished and moderately undernourished infants in this single-center, cross-sectional, noninterventional study using noninvasive methods (skin caliper, 20-MHz sonography, transepidermal water loss, skin pH, and corneometry). Plasma fatty acids were determined as an indicator of nutritional differences. 310 infants from different age groups, i.e., 1 week, 4 weeks, and 6, 9, 12, 24, and 36 months were included. Approximately half of each age group was well-nourished (WHO reference values weight-for-height/length Zscore: -0.75 ≤ Z ≤ 0.75) and the other half was moderately undernourished (-3 ≤ Z < -2). RESULTS Structural maturational differences in the deeper dermis and subcutis regions of the skin and subtle functional changes in the epidermis were observed in moderately undernourished infants without notable clinical symptoms. Reduced skin barrier function or skin hydration were not observed in the undernourished infants, and skin pH shifted to more acidic values in this group. CONCLUSION These findings reveal a greater impact of moderate undernutrition on the development of the dermis and subcutis and suggest that critical epidermal functions such as skin barrier and pH are mostly maintained.
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Affiliation(s)
| | | | | | - Josefina Fernández
- El Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Yun Zyong Kim
- El Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic
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O'Brien F, Clapham D, Krysiak K, Batchelor H, Field P, Caivano G, Pertile M, Nunn A, Tuleu C. Making Medicines Baby Size: The Challenges in Bridging the Formulation Gap in Neonatal Medicine. Int J Mol Sci 2019; 20:E2688. [PMID: 31159216 PMCID: PMC6600135 DOI: 10.3390/ijms20112688] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022] Open
Abstract
The development of age-appropriate formulations should focus on dosage forms that can deliver variable yet accurate doses that are safe and acceptable to the child, are matched to his/her development and ability, and avoid medication errors. However, in the past decade, the medication needs of neonates have largely been neglected. The aim of this review is to expand on what differentiates the needs of preterm and term neonates from those of the older paediatric subsets, in terms of environment of care, ability to measure and administer the dose (from the perspective of the patient and carer, the routes of administration, the device and the product), neonatal biopharmaceutics and regulatory challenges. This review offers insight into those challenges posed by the formulation of medicinal products for neonatal patients in order to support the development of clinically relevant products.
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Affiliation(s)
- Fiona O'Brien
- School of Pharmacy, Royal College of Surgeons in Ireland, 111 St Stephens Green Dublin 2, Ireland.
| | | | - Kamelia Krysiak
- School of Pharmacy, Royal College of Surgeons in Ireland, 111 St Stephens Green Dublin 2, Ireland.
| | - Hannah Batchelor
- College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Peter Field
- University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK.
| | - Grazia Caivano
- Chiesi Farmaceutici S.p.A. Largo Francesco Belloli 11/A-43122 Parma, Italy.
| | - Marisa Pertile
- Chiesi Farmaceutici S.p.A. Largo Francesco Belloli 11/A-43122 Parma, Italy.
| | - Anthony Nunn
- Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool L8 7SS, UK.
| | - Catherine Tuleu
- University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK.
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88
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de-Souza IMF, Vitral GLN, Reis ZSN. Skin thickness dimensions in histological section measurement during late-fetal and neonatal developmental period: A systematic review. Skin Res Technol 2019; 25:793-800. [PMID: 31119813 PMCID: PMC6900000 DOI: 10.1111/srt.12719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/28/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The development and maturation of the skin is a process that occurs during the gestation and neonatal period. Histological skin biopsy studies are relevant to improve knowledge on the skin protective barrier during the perinatal period. The thin skin of preterm newborns is unable to maintain homeostasis, thermal regulation through the skin, and is susceptible to infections. This study systematically reviewed the evidence regarding histological thickness dimensions of the skin and its layers during the late-fetal and neonatal period. METHODS PubMed, Scopus, BVS, and e SciELO library databases, with no limits in the period of analysis or idiom. Eligibility criteria were as follows: studies describing the thickness of the entire skin or its layers during late-fetal life or the neonatal period; human being; skin biopsy analysis; and any scientific report. Two independent reviewers screened the search and extracted the following standard data: fetal or neonatal age of assessment, biopsy site, technique used for preparation and staining of histological slides, measurement techniques, and values of skin thickness. RESULTS Fifty-nine studies were screened, and eleven were identified from other sources. We recognized six studies that met the criteria for inclusion for proper extraction. Expressive differences between sites for sampling, methods of slide preparation, and number of layers measured made the thicknesses values summarization difficult. There were no reliable dimensions reported on this tissue. CONCLUSION Despite the importance of studying the human skin barrier, these findings confirmed limited evidence on skin thickness dimensions obtained by histology.
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Affiliation(s)
| | - Gabriela Luiza Nogueira Vitral
- Postgraduate Program in Pediatrics and Adolescence, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Zilma Silveira Nogueira Reis
- Postgraduate Program in Women's Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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89
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Chen SN, Wang PH, Hsieh MF, Tsai HW, Lin LT, Tsui KH. Maternal pregnancy-induced hypertension increases the subsequent risk of neonatal candidiasis: A nationwide population-based cohort study. Taiwan J Obstet Gynecol 2019; 58:261-265. [PMID: 30910150 DOI: 10.1016/j.tjog.2019.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Neonatal candidiasis is a leading infectious cause of significant morbidity and mortality in premature birth mainly due to impaired physical barriers and immature immune system of fetus. Maternal pregnancy-induced hypertension (PIH) has been reported to be able to disturb the neonatal immune system, which could cause the increased possibility of neonatal infection. Therefore, we hypothesized that maternal PIH may increase the risk of neonatal candidiasis. The aim of this study was to evaluate whether PIH increased the risk of neonatal candidiasis and identify the predictive risk factors. MATERIALS AND METHODS Patients with newly diagnosed PIH between January 1, 2000, and December 31, 2013 were selected from the Taiwan National Health Insurance Research Database (NHIRD). For each patient in the PIH cohort, 4 subjects without PIH, matched for age and year of delivery, were randomly selected as the comparison cohort. A Cox proportional regression model was used to estimate the risks of neonatal candidiasis in both cohorts. RESULTS Among the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and 116,052 matched controls were identified. Patients with PIH had a higher incidence of neonatal candidiasis than did those without PIH. According to the multivariate analysis, PIH (odds ratio [OR] = 2.08, 95% confidence interval [CI] = 1.11-3.19, p < 0.0228), single parity (OR = 1.91, 95% CI = 1.00-3.65, p < 0.0499), and preterm birth (OR = 3.57, 95% CI = 1.84-6.93, p = 0.0002) were independent risk factors for the development of neonatal candidiasis. CONCLUSION Patients who had a history of PIH was associated with an increased risk of having infants who develop neonatal candidiasis compared with those without PIH. Additionally, preterm birth was an independent risk factor for the development of neonatal candidiasis.
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Affiliation(s)
- San-Nung Chen
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Fang Hsieh
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsiao-Wen Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan; Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan; Department of Pharmacy and Graduate Institute of Pharmaceutical Technology, Tajen University, Pingtung County, Taiwan.
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90
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Vongsa R, Rodriguez K, Koenig D, Cunningham C. Benefits of Using an Appropriately Formulated Wipe to Clean Diapered Skin of Preterm Infants. Glob Pediatr Health 2019; 6:2333794X19829186. [PMID: 30815515 PMCID: PMC6381433 DOI: 10.1177/2333794x19829186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022] Open
Abstract
The skin of premature infants is underdeveloped rendering it more prone to break down and irritation. Therefore, special care is needed to protect premature skin and ensure it is not adversely affected. Many health care professionals advise using just water and cloth to clean diapered skin after a bowel movement despite evidence that shows improved infant skin health with the use of modern appropriately formulated baby wipes. This article describes the unique physiology of premature infant skin, reviews clinical evidence comparing use of baby wipes to water and cloth, and describes attributes of appropriately formulated baby wipes.
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91
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Duarah S, Sharma M, Wen J. Recent advances in microneedle-based drug delivery: Special emphasis on its use in paediatric population. Eur J Pharm Biopharm 2019; 136:48-69. [DOI: 10.1016/j.ejpb.2019.01.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/24/2018] [Accepted: 01/07/2019] [Indexed: 12/12/2022]
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Baier C, Pirr S, Ziesing S, Ebadi E, Hansen G, Bohnhorst B, Bange FC. Prospective surveillance of bacterial colonization and primary sepsis: findings of a tertiary neonatal intensive and intermediate care unit. J Hosp Infect 2019; 102:325-331. [PMID: 30716339 DOI: 10.1016/j.jhin.2019.01.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Preterm infants and critically ill neonates are predisposed to nosocomial infections as sepsis. Moreover, these infants acquire commensal bacteria, which might become potentially harmful. On-ward transmission of these bacteria can cause outbreaks. AIM To report the findings of a prospective surveillance of bacterial colonization and primary sepsis in preterm infants and neonates. METHODS The results of the surveillance of bacterial colonization of the gut and the respiratory tract, targeting meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and Gram-negative bacteria from November 2016 to March 2018 were analysed. Bacterial colonization was compared to surveillance of sepsis. FINDINGS Six-hundred and seventy-one patients were admitted and 87.0 % (N=584) of the patients were screened; 48.3% (N=282) of the patients screened were colonized with at least one of the bacteria included in the screening; 26.2% of them (N=74) had multi-drug-resistant strains. A total of 534 bacterial isolates were found. The most frequently found species were Escherichia coli, Enterobacter cloacae, Klebsiella oxytoca and Klebsiella pneumoniae. Three MRSA but no VRE were detected. The surveillance detected a K. pneumoniae cluster involving nine patients. There were 23 blood-culture-confirmed sepsis episodes; 60.9% (N=14) were caused by staphylococci. Gram-negative bacteria (one Klebsiella aerogenes and two E. cloacae) caused three sepsis episodes which were preceded by colonization with the respective isolates. CONCLUSIONS Surveillance of colonization provided a comprehensive overview of species and antibiotic resistance patterns. It allowed early detection of a colonization cluster. Knowledge of colonization and surveillance of sepsis is useful for guiding infection control measures and antibiotic treatment.
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Affiliation(s)
- C Baier
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.
| | - S Pirr
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - S Ziesing
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - E Ebadi
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - G Hansen
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - B Bohnhorst
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - F-C Bange
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
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Nagori A, Dhingra LS, Bhatnagar A, Lodha R, Sethi T. Predicting Hemodynamic Shock from Thermal Images using Machine Learning. Sci Rep 2019; 9:91. [PMID: 30643187 PMCID: PMC6331545 DOI: 10.1038/s41598-018-36586-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/24/2018] [Indexed: 12/12/2022] Open
Abstract
Proactive detection of hemodynamic shock can prevent organ failure and save lives. Thermal imaging is a non-invasive, non-contact modality to capture body surface temperature with the potential to reveal underlying perfusion disturbance in shock. In this study, we automate early detection and prediction of shock using machine learning upon thermal images obtained in a pediatric intensive care unit of a tertiary care hospital. 539 images were recorded out of which 253 had concomitant measurement of continuous intra-arterial blood pressure, the gold standard for shock monitoring. Histogram of oriented gradient features were used for machine learning based region-of-interest segmentation that achieved 96% agreement with a human expert. The segmented center-to-periphery difference along with pulse rate was used in longitudinal prediction of shock at 0, 3, 6 and 12 hours using a generalized linear mixed-effects model. The model achieved a mean area under the receiver operating characteristic curve of 75% at 0 hours (classification), 77% at 3 hours (prediction) and 69% at 12 hours (prediction) respectively. Since hemodynamic shock associated with critical illness and infectious epidemics such as Dengue is often fatal, our model demonstrates an affordable, non-invasive, non-contact and tele-diagnostic decision support system for its reliable detection and prediction.
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Affiliation(s)
- Aditya Nagori
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, 110007, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Lovedeep Singh Dhingra
- All India Institute of Medical Sciences, Department of Pediatrics, New Delhi, 110029, India
| | - Ambika Bhatnagar
- All India Institute of Medical Sciences, Department of Pediatrics, New Delhi, 110029, India
| | - Rakesh Lodha
- All India Institute of Medical Sciences, Department of Pediatrics, New Delhi, 110029, India
| | - Tavpritesh Sethi
- All India Institute of Medical Sciences, Department of Pediatrics, New Delhi, 110029, India.
- Indraprastha Institute of Information Technology Delhi, 110020, Delhi, India.
- Stanford University, School of Medicine, Stanford, 94305, CA, USA.
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Abstract
Dermatophyte infections are exceedingly rare in neonates, possibly due to the thin stratum corneum and high sebum content of neonatal skin. Only a handful of cases of tinea faciei have been reported in neonates, with the majority of reports occuring in India. Here, we report what to our knowledge is the earliest reported presentation of tinea faciei in the United States. We also provide a brief literature review of other reported cases of tinea faciei in neonates less than 30 days of age.
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Affiliation(s)
- Amena Alkeswani
- School of Medicine, University of Alabama Birmingham, Birmingham, Alabama
| | - James Robert Duncan
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama
| | - Amy Theos
- Department of Dermatology, Children's of Alabama, Birmingham, Alabama
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95
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Dermatology today and tomorrow: from symptom control to targeted therapy. J Eur Acad Dermatol Venereol 2018; 33 Suppl 1:3-36. [DOI: 10.1111/jdv.15335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023]
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McNichol LL, Ayello EA, Phearman LA, Pezzella PA, Culver EA. Incontinence-Associated Dermatitis: State of the Science and Knowledge Translation. Adv Skin Wound Care 2018; 31:502-513. [DOI: 10.1097/01.asw.0000546234.12260.61] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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97
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Neonatal and Pediatric Pressure Injuries Secondary to Limb Splinting for Intravascular Access: Case Series and Literature Review. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.java.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Aim: This review aims to present a case series on pressure injury (PI) formation secondary to limb-splinting for preservation of peripheral intravascular catheter (PIVC) access in neonatal and pediatric patients. A literature review was undertaken to analyze the existing knowledge base on this phenomenon.
Background: Medical devices and attachments are considered a risk factor for PI development in neonates, infants, and children. Three cases of PI formation caused by contact with limb boards used to preserve PIVC access were identified in an Australian tertiary pediatric facility during 2016.
Methods: A literature search was conducted during December 2017 using the Cumulative Index of Nursing and Allied Health, Excerpta Medica database, MEDLINE, PubMed, and the Cochrane Library. Keywords used were pressure injury(ies), pressure ulcer, pressure ulcers, decubitus ulcer, and decubitus ulcers. Articles were excluded if published before 2006, patients were adolescents or adults, and if injuries were not caused by PIVC-associated limb-splinting. Patients included in the case series were identified through screening of admissions in one ward of a tertiary paediatric hospital.
Results: Five low-quality studies were included in the literature review. Three children were included in the case series. Each child acquired a PI subsequent to limb-splinting and taping adjacent to a PIVC. Hydration, nutritional state, and oxygenation did not appear to contribute to PI development in these cases.
Conclusions: There is a gap in the evidence base pertaining to PIVC splinting and its involvement with PI formation in neonates, infants, and children. The existing literature provides low-quality evidence this problem exists; thus, further research is recommended.
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98
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Younge NE, Araújo-Pérez F, Brandon D, Seed PC. Early-life skin microbiota in hospitalized preterm and full-term infants. MICROBIOME 2018; 6:98. [PMID: 29855335 PMCID: PMC5984431 DOI: 10.1186/s40168-018-0486-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 05/18/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The infant skin microbiota may serve as a reservoir of bacteria that contribute to neonatal infections and stimulate local and systemic immune development. The objectives of our study were to characterize the skin microbiota of preterm and full-term infants during their birth hospitalization and describe its relationship to the microbiota of other body sites and the hospital environment. RESULTS We conducted a cross-sectional study of 129 infants, including 40 preterm and 89 full-term infants. Samples were collected from five sites: the forehead and posterior auricular scalp (skin upper body); the periumbilical region, inguinal folds, and upper thighs (skin lower body); the oral cavity; the infant's immediate environment; and stool. Staphylococcus, Streptococcus, Enterococcus, and enteric Gram-negative bacteria including Escherichia and Enterobacter dominated the skin microbiota. The preterm infant microbiota at multiple sites had lower alpha diversity and greater enrichment with Staphylococcus and Escherichia than the microbiota of comparable sites in full-term infants. The community structure was highly variable among individuals but differed significantly by body site, postnatal age, and gestational age. Source tracking indicated that each body site both contributed to and received microbiota from other body sites and the hospital environment. CONCLUSION The skin microbiota of preterm and full-term infants varied across individuals, by body site, and by the infant's developmental stage. The skin harbored many organisms that are common pathogens in hospitalized infants. Bacterial source tracking suggests that microbiota are commonly exchanged across body sites and the hospital environment as microbial communities mature in infancy.
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Affiliation(s)
| | - Félix Araújo-Pérez
- Department of Pediatrics, Northwestern University, 310 E. Superior, Morton 4-685, Chicago, IL 60611 USA
| | - Debra Brandon
- Department of Pediatrics, Duke University, Durham, NC USA
- Duke University School of Nursing, Durham, NC USA
| | - Patrick C. Seed
- Department of Pediatrics, Northwestern University, 310 E. Superior, Morton 4-685, Chicago, IL 60611 USA
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Vitral GLN, Aguiar RAPL, de Souza IMF, Rego MAS, Guimarães RN, Reis ZSN. Skin thickness as a potential marker of gestational age at birth despite different fetal growth profiles: A feasibility study. PLoS One 2018; 13:e0196542. [PMID: 29698511 PMCID: PMC5919437 DOI: 10.1371/journal.pone.0196542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/14/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND New methodologies to estimate gestational age (GA) at birth are demanded to face the limited access to obstetric ultrasonography and imprecision of postnatal scores. The study analyzed the correlation between neonatal skin thickness and pregnancy duration. Secondarily, it investigated the influence of fetal growth profiles on tissue layer dimensions. METHODS AND FINDINGS In a feasibility study, 222 infants selected at a term-to-preterm ratio of 1:1 were assessed. Reliable information on GA was based on the early ultrasonography-based reference. The thicknesses of the epidermal and dermal skin layers were examined using high-frequency ultrasonography. We scanned the skin over the forearm and foot plantar surface of the newborns. A multivariate regression model was adjusted to determine the correlation of GA with skin layer dimensions. The best model to correlate skin thickness with GA was fitted using the epidermal layer on the forearm site, adjusted to cofactors, as follows: Gestational age (weeks) = -28.0 + 12.8 Ln (Thickness) - 4.4 Incubator staying; R2 = 0.604 (P<0.001). In this model, the constant value for the standard of fetal growth was statistically null. The dermal layer thickness on the forearm and plantar surfaces had a negative moderate linear correlation with GA (R = -0.370, P<0.001 and R = -0.421, P<0.001, respectively). The univariate statistical analyses revealed the influence of underweight and overweight profiles on neonatal skin thickness at birth. Of the 222 infants, 53 (23.9%) had inappropriate fetal growths expected for their GA. Epidermal thickness was not fetal growth standard dependent as follows: 172.2 (19.8) μm for adequate for GA, 171.4 (20.6) μm for SGA, and 177.7 (15.2) μm for LGA (P = 0.525, mean [SD] on the forearm). CONCLUSIONS The analysis highlights a new opportunity to relate GA at birth to neonatal skin layer thickness. As this parameter was not influenced by the standard of fetal growth, skin maturity can contribute to clinical applications.
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Affiliation(s)
- Gabriela Luiza Nogueira Vitral
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Regina Amélia P. Lopes Aguiar
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ingrid Michelle Fonseca de Souza
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Albertina Santiago Rego
- Department of Pediatrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rodney Nascimento Guimarães
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Zilma Silveira Nogueira Reis
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Abstract
More than 80% of the global population depends on traditional medicine for their basic primary health care needs. Africa has a well-established history of botanicals use. These include a vast array of compounds that can be used to treat various skin-related conditions. The rationale for the use of traditional medicine in skincare stems from the physical effects these compounds have on skin, such as the ability to control bleeding and speed up wound healing, as well as the potential to treat burns and other disorders of pigmentation. Most African traditional healers employ decoctions and infusion methods in medicinal plant preparations; the former entails boiling of the whole or parts of the plant in water or other solvents to extract the active ingredients. Infusions involve immersion of the plant in hot or cold water for some time, followed by topically application to the affected skin area. The cosmetic skincare products are formulated to protect, enhance, and preserve the skin in its healthiest state to maintain its barrier function, thus protecting the human body. This review examines a number of botanicals that are used across Africa and the phytochemical actives that are responsible for skincare.
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Affiliation(s)
- Ncoza C Dlova
- Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Moses A Ollengo
- Department of Chemistry, Dedan Kimathi University of Technology, Nyeri, Kenya
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