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O'Neil A, Schumacher B, Dorr S, Jarding L. Customized Silicone Foam Dressing Under Noninvasive Ventilation and Skincare Bundle to Reduce Hospital-Acquired Pressure Injuries in Neonates. Neonatal Netw 2024; 43:165-175. [PMID: 38816221 DOI: 10.1891/nn-2023-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
In a sixty-eight-bed level-IV NICU, an increased incidence of hospital-acquired pressure injuries (HAPIs) from noninvasive ventilation (NIV) devices was identified. The aim of this quality improvement project was to decrease HAPIs from NIV by 10%. A literature review and the Plan-Do-Study-Act were implemented. The intervention included a customized silicone foam dressing under NIV, an NIV skincare bundle, and multidisciplinary support. Hospital-acquired pressure injury rates were tracked over 3 years postinterventions. The incidence of HAPIs declined by 20% from 0.2 per 1,000 patient days to 0.05 per 1,000 patient days. Relative risk was 4.6 times greater prior to intervention (p = .04). Continuous positive airway pressure (CPAP) failure was not noted and measured by the percentage of patients on ventilators pre- and postintervention. Customized silicone foam dressings under NIV, NIV skincare bundle, and multidisciplinary team support may decrease HAPIs in neonates without CPAP failure.
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Lorente Flores CM, Zhan Z, Scholten AWJ, Hutten GJ, Vervoorn M, Niemarkt HJ. The Effects of a New Wireless Non-Adhesive Cardiorespiratory Monitoring Device on the Skin Conditions of Preterm Infants. SENSORS (BASEL, SWITZERLAND) 2024; 24:1258. [PMID: 38400415 PMCID: PMC10892062 DOI: 10.3390/s24041258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
AIM The aim of our study was to investigate skin conditions when wearing and removing a novel wireless non-adhesive cardiorespiratory monitoring device for neonates (Bambi-Belt) compared to standard adhesive electrodes. STUDY DESIGN This was a prospective study including preterm neonates requiring cardiorespiratory monitoring. Besides standard electrodes, the infants wore a Bambi Belt for 10 consecutive days. Their skin conditions were assessed using Trans Epidermal Water Loss (TEWL) and the Neonatal Skin Condition Score (NSCS) after daily belt and standard electrode removal. The ∆TEWL was calculated as the difference between the TEWL at the device's location (Bambi-Belt/standard electrode) and the adjacent control skin location, with a higher ∆TEWL indicating skin damage. RESULTS A total of 15 infants (gestational age (GA): 24.1-35.6 wk) were analyzed. The ΔTEWL significantly increased directly after electrode removal (10.95 ± 9.98 g/m2/h) compared to belt removal (5.18 ± 6.71 g/m2/h; F: 8.73, p = 0.004) and after the washout period (3.72 ± 5.46 g/m2/h vs. 1.86 ± 3.35 g/m2/h; F: 2.84, p = 0.09), although the latter did not reach statistical significance. The TEWL was not influenced by prolonged belt wearing. No significant differences in the NSCS score were found between the belt and electrode (OR: 0.69, 95% CI [0.17, 2.88], p = 0.6). CONCLUSION A new wireless non-adhesive device for neonatal cardiorespiratory monitoring was well tolerated in preterm infants and may be less damaging during prolonged wearing.
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Affiliation(s)
- Carmen M. Lorente Flores
- Máxima Medical Center, Department of Neonatology, De Run 4600, 5504 DB Veldhoven, The Netherlands; (C.M.L.F.); (M.V.)
| | - Zhuozhao Zhan
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands;
| | - Anouk W. J. Scholten
- Department of Neonatology, UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands (G.J.H.)
- Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Gerard J. Hutten
- Department of Neonatology, UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands (G.J.H.)
- Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Marieke Vervoorn
- Máxima Medical Center, Department of Neonatology, De Run 4600, 5504 DB Veldhoven, The Netherlands; (C.M.L.F.); (M.V.)
| | - Hendrik J. Niemarkt
- Máxima Medical Center, Department of Neonatology, De Run 4600, 5504 DB Veldhoven, The Netherlands; (C.M.L.F.); (M.V.)
- Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
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August D, Hall S, Marsh N, Coyer F. A scoping review and narrative synthesis of neonatal skin injury severity scales. Nurs Crit Care 2024. [PMID: 38355874 DOI: 10.1111/nicc.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Mechanical force skin injuries are common for critical care patients, especially neonates. Currently, identification and severity assessments of injuries are dependent on clinical experience and/or utilization of severity tools. Compared with adults, neonates sustain skin injuries in different anatomical locations and have decreased layers of healthy tissue (from 0.9 to 1.2 mm) creating questions around direct application of adult injury severity scales reliant on visual assessment. AIMS The aim of this scoping review (ScR) was to investigate severity scales used to report hospital acquired skin injuries for neonates. METHODS This study utilized the 2015 Joanna Briggs Institute methodology for scoping reviews and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews extension. PubMed, CINAHL, COCHRANE Central, Scopus, and the reference lists of included studies were searched for studies published between 2001 and 2023, that included severity scales use within neonatal population. Two authors independently identified studies for full review, data extraction, and quality assessment. RESULTS A systematic database search returned 1163 records. After full test review of 109 studies, 35 studies were included. A majority of studies included were cohort or action research and conducted in the United States of America. Most studies (57%, n = 20) reported skin injuries acquired throughout the body, 14 (40%) of the studies reported the nasal area alone and one study reported no anatomical location. A total of nine severity scales or combination of scales were utilized within studies (n = 31) and four studies did not report a scale. Various versions of scales from the National Pressure Ulcer Advisory Panel (n = 16), European Pressure Ulcer Advisory Panel (n = 8) or Neonatal Skin Condition Score (n = 4) were reported, compared with locally developed classifications/scales (n = 4). Scales were predominantly of ordinal grouping (74%, n = 26) or categorical assessment (14%, n = 5). Only one scale from 2004 was validated for neonates. CONCLUSION Neonatal skin injuries will continue to be reported subjectively until severity scales are consistently applied or other measurements are identified to support assessment. Additionally, without skin injury assessment uniformity, critical examination of effectiveness of skin care treatment practices will have subjective comparison. This review suggests there is a need for consistent skin assessment and severity scales that are valid for the neonatal population and their unique skin considerations.
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Affiliation(s)
- Deanne August
- Department Neonatology, Royal Brisbane and Women's Hospital (Neonatal Unit), Herston, Queensland, Australia
- Royal Brisbane and Women's Hospital (Nursing and Midwifery Research Centre), Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
| | - Stephanie Hall
- Department Neonatology, Royal Brisbane and Women's Hospital (Neonatal Unit), Herston, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Nicole Marsh
- Royal Brisbane and Women's Hospital (Nursing and Midwifery Research Centre), Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Royal Brisbane and Women's Hospital (Intensive Care Services), Herston, Queensland, Australia
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Curcio F, Vaquero Abellán M, Dioni E, de Lima MM, Ez Zinabi O, Romero Saldaña M. Validity and reliability of the italian-Neonatal skin risk assessment scale (i-NSRAS). Intensive Crit Care Nurs 2024; 80:103561. [PMID: 37826961 DOI: 10.1016/j.iccn.2023.103561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/10/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The skin of infants has important anatomical and physiological differences from that of children and adults. Because of skin immaturity, reduced mobility, neurological changes, and the need for medical devices, infants are at high risk for pressure injuries. Specific, validated tools are needed to assess the risk of pressure injuries in this population. OBJECTIVES To assess the psychometric properties of the Italian version of Neonatal Skin Risk Assessment Scale (construct validity, internal consistency and reliability). METHOD A cross-sectional descriptive study was conducted in the neonatal units of the two Italian hospitals. 200 infants were examined 3 times by 54 nurses to assess the risk of pressure injuries. Exploratory and confirmatory factor analysis were performed jointly to assess construct validity. Internal consistency was analyzed using McDonalds omega coefficient and Cronbach's alpha, while intra and interobserver agreement using Intraclass Correlation Coefficients (ICC). RESULTS Exploratory factor analysis confirmed a 2-factor model; the factor "duration and intensity of pressure" explained four subscales (mental state, mobility, activity and nutrition), while "skin immaturity" explained the subscales (general physical condition and skin moisture). Confirmatory factor analysis results indicated good model fits (X2/df = 0.84, p = 0.002, RMSEA = 0, NNFI = 1.01, NFI = 0.98 y CFI = 1 (M1 with MI). The italian-Neonatal Skin Risk Assessment Scale showed a good internal consistency, McDonalds omega coefficient and Cronbach's alpha both 0.86. An excellent intra and inter observer reliability was also observed, ICC 0.99 and 0.98 respectively. CONCLUSION The psychometric characteristics indicate that the italian-Neonatal Skin Risk Assessment Scale is useful, valid and reliable for measuring risk of pressure injuries in the neonatal population. IMPLICATIONS FOR CLINICAL PRACTICE This is the first valid and reliable newborn-specific scale that assesses the presence of medical devices. Its use could enable efficient management of preventive resources, early classification of newborns at risk and assignment of preventive interventions, facilitate the development of risk assessment protocols.
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Affiliation(s)
- Felice Curcio
- Faculty of Medicine and Nursing, Department of Nursing, University of Córdoba, Córdoba, Spain; Faculty of Medicine and Surgery, University of Sassari (UNISS), Sassari, Italy.
| | - Manuel Vaquero Abellán
- Faculty of Medicine and Nursing, Department of Nursing, University of Córdoba, Córdoba, Spain; GC12 Consolidated Group Clinical and Epidemiological Research in Primary Care. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Spain.
| | - Elisabetta Dioni
- Neonatology and Neonatal Intensive Care Unit, Children Hospital, ASST Spedali Civili, Brescia, Italy.
| | | | | | - Manuel Romero Saldaña
- Faculty of Medicine and Nursing, Department of Nursing, University of Córdoba, Córdoba, Spain; GA 16 Associated Group Lifestyles, Innovation and Health, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Faculty of Medicine and Nursing, Department of Nursing, University of Córdoba, Córdoba, Spain.
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Hofman H, Beeckman D, Duljic T, Al Gilani S, Johansson S, Kottner J, Kinnaer LM, Eriksson M. Patients' experiences with the application of medical adhesives to the skin: a qualitative systematic review protocol. BMJ Open 2023; 13:e073546. [PMID: 37344112 DOI: 10.1136/bmjopen-2023-073546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Medical adhesives are adhesives used in medical devices to establish and maintain contact with the body over a period of time (usually by application to the skin) and are widely used in most care settings. Application of medical adhesives to the skin can lead to skin stripping, mild or severe allergic reactions and skin irritation that may manifest as redness, itching or rash. Adhesive-related skin injury can lead to infection, delayed wound healing and an increased risk of scarring. These injuries can cause severe discomfort and pain, and can affect the patient's quality of life. A systematic review summarising patient's experiences on this topic will contribute to informing adhesive producers and policy makers, and guiding further development and improvement of available technologies. METHODS AND ANALYSIS This systematic review protocol is based on the principles of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline. A systematic search will be conducted in CINAHL, EMBASE, MEDLINE and PsycINFO. In addition, manual searches will be performed, reviewing the reference lists of relevant reviews and articles included for quality assessment. Qualitative studies using various methods will be considered for inclusion. Screening of title, abstract and full text will be done by two reviewers. The methodological quality of studies under consideration will be critically assessed by two reviewers using the Joanna Briggs Institute Critical Appraisal Tool for Qualitative Research. Data extraction will be performed independently by two reviewers using a predefined data extraction form. Meta-aggregation will be used to summarise the evidence. ETHICS AND DISSEMINATION No ethical approval or consent is required because no participants will be recruited. This systematic review protocol is published in an open access journal to increase transparency of the research methods used. Results will be disseminated at national and international conferences.
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Affiliation(s)
- Hannelore Hofman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Swedish Centre for Skin and Wound Research (SCENTR), Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Tanja Duljic
- Swedish Centre for Skin and Wound Research (SCENTR), Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Department of Care Science, Malmö University, Malmö, Sweden
| | - Samal Al Gilani
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | | - Jan Kottner
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Institute of Clinical Nursing Science, Charité Center for Health and Human Sciences, Charité Universitätsmedizin, Berlin, Germany
| | - Lise-Marie Kinnaer
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Fassino B, Ferrario S, Sorrentino G, Adamini I, Pesenti N, Fumagalli M, Mosca F, Plevani L. Hospital-acquired skin lesions in the neonatal intensive care unit: A retrospective analysis of temporal trends and quality improvement strategies. J Pediatr Nurs 2023; 70:40-46. [PMID: 36796303 DOI: 10.1016/j.pedn.2023.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Skin lesions in neonatal population are an emerging problem deserving attention from health care professionals. The purpose of this study is to retrospectively assess the incidence of hospital-acquired skin lesions during a 6-year period and to describe the characteristics of infants who developed them. DESIGN AND METHODS This was a retrospective observational study conducted in a university-tertiary care center between 2015 and 2020. A descriptive analysis of the observed skin lesions is presented according to 2 time periods: 1) the implementation phase of a quality improvement program (2015-2019) and 2) the postimplementation phase (2020). RESULTS Our findings showed an apparent increase in the incidence of all reported skin lesions throughout the study period. Pressure injuries were the most frequently reported skin lesions showing an increasing incidence over time which, however, was paralleled by a reduction in their severity. Among pressure injuries, device-related injuries were the most commonly observed (56.6% and 62.5% in the two periods, respectively) with nasal continuous positive airway pressure-related injuries accounting for 71.7% and 56.0% of lesions, respectively, and mainly affecting the nose root. The occipital area was the most frequently involved site in cases of conventional pressure injuries. CONCLUSION Infants admitted to Neonatal Intensive Care Units may be at high risk of developing skin lesions. The adoption of appropriate preventative as well as treatment interventions could be effective in reducing the severity of pressure injuries. PRACTICE IMPLICATIONS The implementation of quality improvement strategies may contribute to prevent skin injuries or lead to their early detection.
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Affiliation(s)
- Barbara Fassino
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy.
| | - Silvia Ferrario
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy.
| | - Gabriele Sorrentino
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy.
| | - Ileana Adamini
- Healthcare Professions Department Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy.
| | - Nicola Pesenti
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy; Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, 20126 Milan, Italy.
| | - Monica Fumagalli
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy; University of Milan, Department of Clinical Sciences and Community Health, via Festa del Perdono 7, 20122 Milan, Italy.
| | - Fabio Mosca
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy; University of Milan, Department of Clinical Sciences and Community Health, via Festa del Perdono 7, 20122 Milan, Italy.
| | - Laura Plevani
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy.
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Jani P, Mishra U, Buchmayer J, Maheshwari R, D'Çruz D, Walker K, Gözen D, Lowe K, Wright A, Marceau J, Culcer M, Priyadarshi A, Kirby A, Moore JE, Oei JL, Shah V, Vaidya U, Khashana A, Godambe S, Cheah FC, Zhou WH, Hu XJ, Satardien M. Global variation in skin injures and skincare practices in extremely preterm infants. World J Pediatr 2023; 19:139-157. [PMID: 36372868 PMCID: PMC9660114 DOI: 10.1007/s12519-022-00625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/19/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Globally, are skincare practices and skin injuries in extremely preterm infants comparable? This study describes skin injuries, variation in skincare practices and investigates any association between them. METHODS A web-based survey was conducted between February 2019 and August 2021. Quantifying skin injuries and describing skincare practices in extremely preterm infants were the main outcomes. The association between skin injuries and skincare practices was established using binary multivariable logistic regression adjusted for regions. RESULTS Responses from 848 neonatal intensive care units, representing all geographic regions and income status groups were received. Diaper dermatitis (331/840, 39%) and medical adhesive-related skin injuries (319/838, 38%) were the most common injuries. Following a local skincare guideline reduced skin injuries [medical adhesive-related injuries: adjusted odds ratios (aOR) = 0.63, 95% confidence interval (CI) = 0.45-0.88; perineal injuries: aOR = 0.66, 95% CI = 0.45-0.96; local skin infections: OR = 0.41, 95% CI = 0.26-0.65; chemical burns: OR = 0.46, 95% CI = 0.26-0.83; thermal burns: OR = 0.51, 95% CI = 0.27-0.96]. Performing skin assessments at least every four hours reduced skin injuries (abrasion: aOR = 0.48, 95% CI = 0.33-0.67; pressure: aOR = 0.51, 95% CI = 0.34-0.78; diaper dermatitis: aOR = 0.71, 95% CI = 0.51-0.99; perineal: aOR = 0.52, 95% CI = 0.36-0.75). Regional and resource settings-based variations in skin injuries and skincare practices were observed. CONCLUSIONS Skin injuries were common in extremely preterm infants. Consistency in practice and improved surveillance appears to reduce the occurrence of these injuries. Better evidence regarding optimal practices is needed to reduce skin injuries and minimize practice variations.
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Affiliation(s)
- Pranav Jani
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia.
| | - Umesh Mishra
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Julia Buchmayer
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Rajesh Maheshwari
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Daphne D'Çruz
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Karen Walker
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Newborn Care, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Council of International Neonatal Nurses, Boston, MA, USA
- The George Institute for Global Health, Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, Sydney, NSW, Australia
| | - Duygu Gözen
- Pediatric Nursing Department, Florence Nightingale Faculty of Nursing, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Krista Lowe
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Audrey Wright
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - James Marceau
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Mihaela Culcer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Archana Priyadarshi
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Adrienne Kirby
- The National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - James E Moore
- Connecticut Children's Division of Neonatal-Perinatal Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
- UCONN School of Medicine, Farmington, CT, USA
| | - Ju Lee Oei
- The Royal Hospital for Women, Randwick, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Vibhuti Shah
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, Mount Sinai Hospital, Toronto, Canada
| | - Umesh Vaidya
- Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | | | - Sunit Godambe
- Divisional Director for Clinical Governance, Women's, Children's and Clinical Support, Imperial College Healthcare NHS Trust, London, UK
| | - Fook Choe Cheah
- Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan, Bangi, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Wen-Hao Zhou
- Department of Neonatology and Vice President, Children's Hospital of Fudan University, Shanghai, China
| | - Xiao-Jing Hu
- Vice Director of Nursing Department, Children's Hospital of Fudan University, Shanghai, China
| | - Muneerah Satardien
- Department of Paediatrics and Child Health, Tygerberg Hospital, Cape Town, South Africa
- University of Stellenbosch, Cape Town, South Africa
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8
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August D, Ullman A, Coyer F. Device related pressure injuries across the critical care lifespan. Nurs Crit Care 2023; 28:6-8. [PMID: 36715234 DOI: 10.1111/nicc.12874] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Deanne August
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Queensland, Australia.,Hospital and Health Service, Children's Heath Queensland, South Brisbane, Queensland, Australia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Queensland, Australia.,Hospital and Health Service, Children's Heath Queensland, South Brisbane, Queensland, Australia
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Queensland, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Araújo DADS, Araújo JNDM, Silva ABD, Lopes JV, Dantas AC, Martins QCS. Alteration of skin condition in newborns admitted to neonatal intensive care: a concept analysis. Rev Bras Enferm 2022; 75:e20210473. [PMID: 35352784 DOI: 10.1590/0034-7167-2021-0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/04/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the concept of alteration of skin condition in newborns admitted to the Neonatal Intensive Care Unit. METHODS this is a concept analysis operationalized by scoping review. The search was conducted in three parts: the first, in sources like Scopus and Web of Science; the second, in Google Scholar®; and the third, through a parallel list of references. RESULTS according to the types of skin, the most frequent alterations were erythema/redness and pressure injuries. The concept analysis was more evident in the attribute "skin lesions or alterations" than the others. The most frequent antecedents were gestational age, birth weight, and factors related to hospitalization. Among the consequences stood out infection/sepsis. CONCLUSIONS this study allows improving the vision of health professionals regarding alterations in skin condition of neonates and, therefore, may contribute to a safe and systematized nursing practice.
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Affiliation(s)
| | | | | | | | - Ana Clara Dantas
- Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil
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10
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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: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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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11
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Cay G, Ravichandran V, Saikia MJ, Hoffman L, Laptook A, Padbury J, Salisbury AL, Gitelson-Kahn A, Venkatasubramanian K, Shahriari Y, Mankodiya K. An E-Textile Respiration Sensing System for NICU Monitoring: Design and Validation. JOURNAL OF SIGNAL PROCESSING SYSTEMS 2021; 94:543-557. [PMID: 34306304 PMCID: PMC8286045 DOI: 10.1007/s11265-021-01669-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/16/2021] [Accepted: 05/02/2021] [Indexed: 06/13/2023]
Abstract
The world is witnessing a rising number of preterm infants who are at significant risk of medical conditions. These infants require continuous care in Neonatal Intensive Care Units (NICU). Medical parameters are continuously monitored in premature infants in the NICU using a set of wired, sticky electrodes attached to the body. Medical adhesives used on the electrodes can be harmful to the baby, causing skin injuries, discomfort, and irritation. In addition, respiration rate (RR) monitoring in the NICU faces challenges of accuracy and clinical quality because RR is extracted from electrocardiogram (ECG). This research paper presents a design and validation of a smart textile pressure sensor system that addresses the existing challenges of medical monitoring in NICU. We designed two e-textile, piezoresistive pressure sensors made of Velostat for noninvasive RR monitoring; one was hand-stitched on a mattress topper material, and the other was embroidered on a denim fabric using an industrial embroidery machine. We developed a data acquisition system for validation experiments conducted on a high-fidelity, programmable NICU baby mannequin. We designed a signal processing pipeline to convert raw time-series signals into parameters including RR, rise and fall time, and comparison metrics. The results of the experiments showed that the relative accuracies of hand-stitched sensors were 98.68 (top sensor) and 98.07 (bottom sensor), while the accuracies of embroidered sensors were 99.37 (left sensor) and 99.39 (right sensor) for the 60 BrPM test case. The presented prototype system shows promising results and demands more research on textile design, human factors, and human experimentation.
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Affiliation(s)
- Gozde Cay
- Department of Electrical, Computer, and Biomedical Engineering, University of Rhode Island, Kingston, RI USA
| | - Vignesh Ravichandran
- Department of Electrical, Computer, and Biomedical Engineering, University of Rhode Island, Kingston, RI USA
| | - Manob Jyoti Saikia
- Department of Electrical, Computer, and Biomedical Engineering, University of Rhode Island, Kingston, RI USA
- Center for Applied Brain and Cognitive Sciences, Tufts University, Medford, MA USA
| | - Laurie Hoffman
- Pediatrics, Women and Infants Hospital, Providence, RI USA
| | - Abbot Laptook
- Pediatrics, Women and Infants Hospital, Providence, RI USA
| | - James Padbury
- Pediatrics, Women and Infants Hospital, Providence, RI USA
| | - Amy L. Salisbury
- Pediatrics, Women and Infants Hospital, Providence, RI USA
- School of Nursing, Virginia Commonwealth University, Richmond, VA USA
| | - Anna Gitelson-Kahn
- Department of Textiles, Rhode Island School of Design, Providence, RI USA
| | | | - Yalda Shahriari
- Department of Electrical, Computer, and Biomedical Engineering, University of Rhode Island, Kingston, RI USA
| | - Kunal Mankodiya
- Department of Electrical, Computer, and Biomedical Engineering, University of Rhode Island, Kingston, RI USA
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12
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August DL, Kandasamy Y, Ray R, Lindsay D, New K. Fresh Perspectives on Hospital-Acquired Neonatal Skin Injury Period Prevalence From a Multicenter Study: Length of Stay, Acuity, and Incomplete Course of Antenatal Steroids. J Perinat Neonatal Nurs 2021; 35:275-283. [PMID: 32826705 DOI: 10.1097/jpn.0000000000000513] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to explore neonatal skin injury period prevalence, classification, and risk factors. Skin injury period prevalence over 9 months and χ2, Mann-Whitney U, and independent-samples t tests compared injured and noninjured neonates, with P values less than .05 considered statistically significant. Injury prediction models were developed using Classification and Regression Tree (CART) analysis for the entire cohort and separately for those classified as high or low acuity. The study took place in 3 Australian and New Zealand units. Neonates enrolled (N = 501) had a mean birth gestational age of 33.48 ± 4.61 weeks and weight of 2138.81 ± 998.92 g. Of the 501 enrolled neonates, 206 sustained skin injuries (41.1%), resulting in 391 injuries to the feet (16.4%; n = 64), cheek (12.5%; n = 49), and nose (11.3%; n = 44). Medical devices were directly associated with 61.4% (n = 240) of injuries; of these medical devices, 50.0% (n = 120) were unable to be repositioned and remained in a fixed position for treatment duration. The strongest predictor of skin injury was birth gestation of 30 weeks or less, followed by length of stay of more than 12 days, and birth weight of less than 1255 g. Prediction for injury based on illness acuity identified neonates less than 30 weeks' gestation and length of stay more than 39 days were at a greater risk (high acuity), as well as neonates less than 33 weeks' gestation and length of stay of more than 9 days (low acuity). More than 40% of hospitalized neonates acquired skin injury, of which the majority skin injuries were associated with medical devices required to sustain life. Increased neonatal clinician education and improved skin injury frameworks, informed by neonatal epidemiological data, are vital for the development of effective prevention strategies.
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Affiliation(s)
- Deanne L August
- College of Medicine and Dentistry (Ms August and Drs Kandasamy and Ray) and College of Public Health, Medical and Vet Sciences (Dr Lindsay), James Cook University, Townsville, Queensland, Australia; The Townsville Hospital and Health Service, Neonatology, Townsville, Queensland, Australia (Dr Kandasamy); and School of Nursing, Midwifery; and Social Work, University of Queensland, Brisbane, Queensland, Australia (Dr New)
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13
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de Oliveira Marcatto J, Santos AS, Oliveira AJF, Costa ACL, Regne GRS, da Trindade RE, Couto DL, de Souza Noronha KVM, Andrade MV. Medical adhesive-related skin injuries in the neonatology department of a teaching hospital. Nurs Crit Care 2021; 27:583-588. [PMID: 33768691 DOI: 10.1111/nicc.12621] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Medical adhesives are used to affix components to the skin. They are part of procedures performed by medical specialties because of their participation as constituents of different products, such as tapes, dressings, and electrodes. AIM This study aims to assess the prevalence of, and factors associated with, the development of medical adhesive-related skin injuries (MARSIs) in patients treated with medical tapes in the neonatology department of a large teaching hospital in Brazil. STUDY DESIGN Cohort study. METHODS All premature newborns (gestational age from 28 to <37 weeks) admitted in the neonatal intensive care unit of a teaching hospital, from March to August 2019, were followed up. Neonate skin condition was assessed based on the Neonatal Skin Condition Scale (NSCS). Data analyses were conducted in R software. RESULTS In total, 46 premature newborns were included in the study; 552 evaluations were performed-mean of 11.7 per patient. Most neonates (n = 41; 89.1%) used adhesive tapes, either paper tape (n = 37; 80.4%) or transparent film dressing (n = 34; 73.9%). Newborns' face and head were the most affected body regions (n = 125; 50.2%). Eight patients had MARSIs (19.5% of patients who used tape). NSCS scores (P value <.001) and the adopted warming system (P value = .01302) were associated with the occurrence of MARSIs. Incubators seem to be a protective factor for MARSI (OR = 0.048; IC95% = 0.0008-0.75; P value = .013). CONCLUSION Adhesive tapes in premature newborns should be considered a risk factor for injuries. Although NSCS showed mild-to-moderate impairment and lesion severity was low, this event is relatively frequent in neonatal units. RELEVANCE TO CLINICAL PRACTICE Awareness of the risk associated with adhesive tape application and removal in newborns allow health services to better address the problem by enforcing good practices, elaborating better protocols, qualifying the health care professionals, and potentially selecting softer tapes for neonates.
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Affiliation(s)
- Juliana de Oliveira Marcatto
- Department of Maternal Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - André Soares Santos
- Centre for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Economics, School of Economics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Raquel Elias da Trindade
- Department of Maternal Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Débora Lara Couto
- Neonatal Intensive Care Unit, Hospital of Clinics of UFMG, Belo Horizonte, Brazil
| | | | - Mônica Viegas Andrade
- Department of Economics, School of Economics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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14
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Lawrence C, Mohr LD, Geistkemper A, Murphy S, Fleming K. Sustained Reduction of Nasal Pressure Injuries in the Neonatal Intensive Care Unit With the Use of Bubble Continuous Positive Airway Pressure: A Quality Improvement Project. J Wound Ostomy Continence Nurs 2021; 48:101-107. [PMID: 33690243 DOI: 10.1097/won.0000000000000748] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this interprofessional team-driven quality improvement project was to implement a Bubble continuous positive airway pressure (CPAP) Skincare Protocol proactively to prevent potential device-related pressure injuries. PARTICIPANTS AND SETTING The setting was a level 3, 60-bed single patient room neonatal intensive care unit (NICU) located within a Midwest urban academic medical center with more than 200 healthcare providers. Prior to the beginning of this project, the NICU had been using the CPAP apparatus that had documented 6 nasal pressure injuries over a 6-month period. Because of ease of use, the NICU moved to using Bubble CPAP (BCPAP), which is known to place patients at a higher risk of nasal pressure injuries due to the way the apparatus sits inside the nares. APPROACH An evidence-based practice model provided the guiding framework for the development of our BCPAP Skincare Protocol. Knowing that the unit had already documented nasal pressure injuries, the interprofessional-devised protocol was developed to decrease the risk of nasal injuries with the use of BCPAP in premature infants. The protocol was disseminated via an all-healthcare provider educational program. OUTCOMES During the first 3 months postprotocol implementation period, one stage 2 nasal injury was noted and immediately treated and healed without incident. During the next 24-month, postimplementation period, there were zero nasal pressure injuries reported. IMPLICATIONS FOR PRACTICE The healthcare providers found that using an interprofessional team approach in developing and implementing an evidence-based BCPAP Skincare Protocol reduced the incidence of nasal pressure injuries associated with the use of BCPAP in the NICU.
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Affiliation(s)
- Christie Lawrence
- Christie Lawrence, DNP, APRN, RNC-NIC, CNL, Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
- Lynn D. Mohr, PhD, APRN, PCNS-BC, CPN, FCNS, Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
- Anne Geistkemper, MSc, RRT, RRT-NPS, Neonatal Pediatric Respiratory Care, Rush University Medical Center, Chicago, Illinois
- Sara Murphy, MBA, RRT, RRT-NPS, Neonatal Pediatric Respiratory Care, Rush University Medical Center, Chicago, Illinois
- Kellianne Fleming, MSc, RRT, RRT-NPS, Pulmonary Services, Froedtert Hospital, Milwaukee, Wisconsin
| | - Lynn D Mohr
- Christie Lawrence, DNP, APRN, RNC-NIC, CNL, Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
- Lynn D. Mohr, PhD, APRN, PCNS-BC, CPN, FCNS, Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
- Anne Geistkemper, MSc, RRT, RRT-NPS, Neonatal Pediatric Respiratory Care, Rush University Medical Center, Chicago, Illinois
- Sara Murphy, MBA, RRT, RRT-NPS, Neonatal Pediatric Respiratory Care, Rush University Medical Center, Chicago, Illinois
- Kellianne Fleming, MSc, RRT, RRT-NPS, Pulmonary Services, Froedtert Hospital, Milwaukee, Wisconsin
| | - Anne Geistkemper
- Christie Lawrence, DNP, APRN, RNC-NIC, CNL, Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
- Lynn D. Mohr, PhD, APRN, PCNS-BC, CPN, FCNS, Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
- Anne Geistkemper, MSc, RRT, RRT-NPS, Neonatal Pediatric Respiratory Care, Rush University Medical Center, Chicago, Illinois
- Sara Murphy, MBA, RRT, RRT-NPS, Neonatal Pediatric Respiratory Care, Rush University Medical Center, Chicago, Illinois
- Kellianne Fleming, MSc, RRT, RRT-NPS, Pulmonary Services, Froedtert Hospital, Milwaukee, Wisconsin
| | - Sara Murphy
- Christie Lawrence, DNP, APRN, RNC-NIC, CNL, Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
- Lynn D. Mohr, PhD, APRN, PCNS-BC, CPN, FCNS, Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
- Anne Geistkemper, MSc, RRT, RRT-NPS, Neonatal Pediatric Respiratory Care, Rush University Medical Center, Chicago, Illinois
- Sara Murphy, MBA, RRT, RRT-NPS, Neonatal Pediatric Respiratory Care, Rush University Medical Center, Chicago, Illinois
- Kellianne Fleming, MSc, RRT, RRT-NPS, Pulmonary Services, Froedtert Hospital, Milwaukee, Wisconsin
| | - Kellianne Fleming
- Christie Lawrence, DNP, APRN, RNC-NIC, CNL, Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
- Lynn D. Mohr, PhD, APRN, PCNS-BC, CPN, FCNS, Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
- Anne Geistkemper, MSc, RRT, RRT-NPS, Neonatal Pediatric Respiratory Care, Rush University Medical Center, Chicago, Illinois
- Sara Murphy, MBA, RRT, RRT-NPS, Neonatal Pediatric Respiratory Care, Rush University Medical Center, Chicago, Illinois
- Kellianne Fleming, MSc, RRT, RRT-NPS, Pulmonary Services, Froedtert Hospital, Milwaukee, Wisconsin
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15
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Santos SV, Ramos FRS, Costa R, Batalha LMDC. VALIDATION OF NURSING INTERVENTIONS TO PREVENT SKIN LESIONS IN HOSPITALIZED NEWBORNS. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2019-0136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective to determine the content validity of Nursing interventions to prevent skin lesions in hospitalized newborns, with an experts committee. Method a content validation methodological research study conducted by means of an online form between April and June 2018. The participants were five nurses from different Brazilian regions, with experience in the neonatal area: two professors, two stomatherapists, and one assistance nurse. The interventions evaluated were constructed based on scientific knowledge, resorting to the literature based on the available evidence, technical manuals and books, in addition to the researchers' experience in care for the newborn. The content was validated in two rounds. First, each intervention and its set were evaluated regarding agreement, using a minimum Committee Agreement Index (CAI) of 80%. Subsequently, a minimum Content Validity Index (CVI) of 0.8 was used to validate the clarity and relevance of the interventions. Results a total of 298 interventions were evaluated in the first round, and only eight did not obtain the adequate index. 39 interventions were evaluated in the second round, all reformulated based on the suggestions of the experts committee. Of these, there were eight not validated in the first round, 20 with small changes, and 11 newly elaborated interventions. All the interventions were validated in the second round, totaling 310 validated interventions. Conclusion the Nursing interventions proposed were considered valid regarding content, and can be used in the care provided to hospitalized newborns, in order to prevent skin lesions and to contribute with the quality of the assistance provided and with the safety of the neonatal patient.
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16
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August DL, Ray RA, Kandasamy Y, New K. Neonatal skin assessments and injuries: Nomenclature, workplace culture and clinical opinions-Method triangulation a qualitative study. J Clin Nurs 2020; 29:3986-4006. [PMID: 32702143 DOI: 10.1111/jocn.15422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/19/2020] [Accepted: 07/10/2020] [Indexed: 11/26/2022]
Abstract
AIM AND OBJECTIVE To explore and establish the language, clinical opinions and workplace culture around neonatal skin injury nomenclature. Specifically, what nomenclature is used to describe, define, identity and communicate neonatal skin injuries including (a) terms, (b) locations, (c) associated risks and (d) mechanical forces. BACKGROUND Skin injuries are affirmed or denied based on visual assessment with findings reported by language rather than measurements. However, if language or nomenclature is ambiguous, assessments could be misinterpreted effecting healthcare delivery. DESIGN Qualitative enquiry including applied discourse analysis and between-method triangulation, within a larger exploratory mixed-methods study. METHODS Data were collected over two years from four sources: literature, documents, interviews/focus groups and free text injury assessments. Data analysis included content analysis, selective coding and thematic analysis. The collective data were further explored using discourse analysis and triangulation to achieve collective conclusions about opinions, emotions, feelings, perceptions and workplace cultures. The COREQ checklist provided structure for the reporting of study methods, analysis and findings. RESULTS A total of 427 data points were collected from literature, documentation and two clinical data sources. Data convergence revealed that neonatal skin injuries are described by numerous terms with preferences for "injury," "trauma" or "redness." Injuries occur in over 20 anatomical locations and risks for injuries included hospitalisation, specific treatments and prematurity. Essential medical devices, clinical condition, lack of clinician experience and overactive neonates were uniquely associated risks. There was incongruency between sources. The literature and documents empathise pressure as the primary force related to skin injury, while varied forces were identified within interviews, focus groups and free text injury assessments. CONCLUSIONS The variety of unique terms, locations and risks for injury indicate the need for updated neonatal skin injury frameworks. If frameworks and policies continue to be created without the empirical knowledge of neonatal clinicians, misrepresentation of neonatal skin injury locations and risk will continue to dominate the literature. RELEVANCE TO CLINICAL PRACTICE The recognition and management of neonatal skin injuries are related to language used to describe assessments in the absence of diagnostic confirmation, which has implications for both the neonate and the healthcare team.
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Affiliation(s)
- Deanne L August
- James Cook University, College of Medicine and Dentistry, Townsville, Qld, Australia
| | - Robin A Ray
- James Cook University, College of Medicine and Dentistry, Townsville, Qld, Australia
| | - Yoga Kandasamy
- James Cook University, College of Medicine and Dentistry, Townsville, Qld, Australia.,The Townsville Hospital and Health Service, Neonatology Townsville Hospital Townsville, Townsville, Qld, Australia
| | - Karen New
- School of Nursing, Midwifery and Social Work Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Qld, Australia
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17
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The Phenomenon of Trombley-Brennan Terminal Tissue Injury in a Neonate: A Case Study. Adv Neonatal Care 2020; 20:171-175. [PMID: 31895137 DOI: 10.1097/anc.0000000000000688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trombley-Brennan terminal tissue injury (TB-TTI), also known as skin failure, was first identified in 2009 among critically ill adults receiving palliative care. Identification of this skin injury can be misinterpreted as a pressure ulcer. However, this phenomenon is now accepted as an early sign of impending death among critically ill adults. CLINICAL FINDINGS This case study describes TB-TTI in a terminally ill infant in a neonatal intensive care unit evidenced by intact, 2-cm oval skin discoloration on the lateral side of both knees with rapid progression in size. PRIMARY DIAGNOSIS TB-TTI was identified on the day of death in an infant with a primary diagnosis of hypoxic-ischemic encephalopathy born at 32 weeks' gestation. INTERVENTIONS The neonatal intensive care unit (NICU) team mobilized the NICU advanced care team, institution's ethical council, and "Team Lavender" to provide infant comfort measures and emotional support to the family and care givers. OUTCOMES Infant death occurred 8 hours after TB-TTI was identified. PRACTICE RECOMMENDATIONS To our knowledge, this case study of TB-TTI in a terminally ill neonate in the NICU has not been previously described in the neonatal or pediatric population. Early recognition of the phenomenon can enable the healthcare team to provide timely emotional, spiritual, and psychosocial support to the family and allow time to "be present" with the infant at "end of life." Future work should explore additional signs of TB-TTI and the occurrence rate.
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18
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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: 169] [Impact Index Per Article: 42.3] [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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19
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August D, Hitchcock I, Tangney J, Ray RA, Kandasamy Y, New K. Graduated colour tape measure: Development and demonstration of this tool in a case series of neonatal skin injuries. J Tissue Viability 2019; 28:133-138. [DOI: 10.1016/j.jtv.2019.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 11/24/2022]
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20
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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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