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Zhou L, Guess M, Kim KR, Yeo WH. Skin-interfacing wearable biosensors for smart health monitoring of infants and neonates. COMMUNICATIONS MATERIALS 2024; 5:72. [PMID: 38737724 PMCID: PMC11081930 DOI: 10.1038/s43246-024-00511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/23/2024] [Indexed: 05/14/2024]
Abstract
Health monitoring of infant patients in intensive care can be especially strenuous for both the patient and their caregiver, as testing setups involve a tangle of electrodes, probes, and catheters that keep the patient bedridden. This has typically involved expensive and imposing machines, to track physiological metrics such as heart rate, respiration rate, temperature, blood oxygen saturation, blood pressure, and ion concentrations. However, in the past couple of decades, research advancements have propelled a world of soft, wearable, and non-invasive systems to supersede current practices. This paper summarizes the latest advancements in neonatal wearable systems and the different approaches to each branch of physiological monitoring, with an emphasis on smart skin-interfaced wearables. Weaknesses and shortfalls are also addressed, with some guidelines provided to help drive the further research needed.
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Affiliation(s)
- Lauren Zhou
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
- IEN Center for Wearable Intelligent Systems and Healthcare, Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - Matthew Guess
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
- IEN Center for Wearable Intelligent Systems and Healthcare, Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - Ka Ram Kim
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
- IEN Center for Wearable Intelligent Systems and Healthcare, Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - Woon-Hong Yeo
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
- IEN Center for Wearable Intelligent Systems and Healthcare, Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332 USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332 USA
- Parker H. Petit Institute for Bioengineering and Biosciences, Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta, GA 30332 USA
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Mbithi F, Worsley PR. Adhesives for medical application - Peel strength testing and evaluation of biophysical skin response. J Mech Behav Biomed Mater 2023; 148:106168. [PMID: 37847959 DOI: 10.1016/j.jmbbm.2023.106168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Medical adhesives are commonly used for securing wound dressings and medical devices used for diagnostic or therapeutic purposes. Mechanical irritation of skin due to adhesive stripping and repeated application can lead to discomfort and device removal. This study aims to examine the peel strength and skin response to different medical adhesives in a cohort of healthy volunteers. METHOD Twelve healthy participants were recruited for peel strength testing of three candidate adhesive tapes, and evaluation of the skin response after adhesive removal. A modified ASTM D903 peel strength testing was performed at 180° peeling angle and a rate of 300 mm/min on the forehead, upper back and forearm skin. A longitudinal study was conducted on the forearm and back, with the adhesive samples left in-situ for up to 60 h for analysis of repeat application. The effects of two skin preparation approaches (water and alcohol cleaning) prior to adhesive application were also assessed. Skin biophysical properties were assessed at baseline and at various timepoints following adhesive removal using transepidermal water loss (TEWL), erythema and hydration. RESULTS Peel strength reduced uniformly with repeat application over prolonged periods for all the adhesive samples tested. Skin preparation with water and alcohol cleansing prior to adhesive application increased peel strength at both the back (1.1% and 2.9%), and forearm (21.3% and 20%) sites. There was statistically significant increase from baseline to post-tape application for TEWL, skin redness and hydration (p < 0.001). However, there were no statistically significant differences between adhesive types (TEWL: p = 0.38, SR: p = 0.53, HY: p = 0.46). TEWL increased the most post-adhesion across all test sites and adhesive samples with repeat application (p < 0.05). Two-way ANOVA tests revealed no statistically significant interactions between the effects of application duration and adhesive on skin redness or TEWL for both the back and forearm sites (p > 0.05), though a significant interaction was indicted for hydration at the back site (p = 0.01). CONCLUSION This study revealed that site and duration of adhesive application effected peel strength. The corresponding changes in skin properties identified that skin barrier function was disrupted with long-term application of adhesives. The back site was identified to be most reliable for adhesion testing and skin response assessment for future work.
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Affiliation(s)
- Florence Mbithi
- Skin Sensing Research Group, School of Health Sciences, University of Southampton, Southampton, UK.
| | - Peter R Worsley
- Skin Sensing Research Group, School of Health Sciences, University of Southampton, Southampton, UK.
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Allen A, Zana-Taïeb E. Recommendations for use of adhesives on hospitalized newborns: A systematic review of the literature. Arch Pediatr 2023; 30:486-492. [PMID: 37604760 DOI: 10.1016/j.arcped.2023.06.001] [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: 01/04/2023] [Accepted: 06/04/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The skin is the largest organ in the human body. It provides multiple barrier functions, tactile or defensive, and acts as a mediator allowing for the attachment of vital monitoring devices with medical adhesives. Adhesives consist of several layers with varying compositions and properties. We aimed to provide recommendations for their use in the care of hospitalized neonates on the basis of a systematic literature review. METHODS We searched PubMed for English or French articles published before May 29, 2020, using the keywords "adhesive," "tape,", "skin," and "neonat*." Recommendations were developed after review by a multidisciplinary group including 15 professionals and parent representatives. RESULTS We identified 295 studies, and from 30 eligible studies we developed six recommendations according to four perspectives: assessment of the skin condition to improve the methods of application of the different adhesives and their removal; use of adhesives as a platform; and discouraging the regular use of semi-permeable dressings to compensate for the immaturity of the skin barrier. CONCLUSION Skin lesions are common for hospitalized neonates. Use of adhesives may increase the occurrence of such lesions. Adhesives should be subject to good clinical practice guidelines. Health professionals caring for newborns should know the tools for screening and preventing skin lesions.
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Affiliation(s)
- Aurore Allen
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP, Paris, 75014, France; Group of Reflection and Evaluation of the Environment of Newborns (GREEN) study group from the French Neonatal Society
| | - Elodie Zana-Taïeb
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP, Paris, 75014, France; Group of Reflection and Evaluation of the Environment of Newborns (GREEN) study group from the French Neonatal Society
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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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Thernström Blomqvist Y, Ågren J, Karlsson V. The Swedish approach to nurturing extremely preterm infants and their families: A nursing perspective. Semin Perinatol 2022; 46:151542. [PMID: 34911652 DOI: 10.1016/j.semperi.2021.151542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Nurturing extremely premature infants is a complicated task that not only necessitates a systematic approach to the immature physiology and its medical management, but also to the needs of the family. Infants born at 22-24 weeks require many weeks of intensive care including a long duration of mechanical ventilation, numerous stressful medical interventions, and for the parents to spend a lot of time in the Neonatal Intensive Care unit (NICU). This paper aims to outline the Swedish nursing approach to nurturing these infants and their families. The nursing care is structured so the parents are the primary caregivers supported by the staff and is based on: timely expression and provision of mother's own breast milk, early and prolonged skin-to-skin contact and close collaboration with the family. While this presentation is based on a single-center's experience, it well represents the general features of nursing provided to extremely preterm infants in Swedish NICUs.
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Affiliation(s)
- Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit, University Children's Hospital, Uppsala, Sweden; Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Johan Ågren
- Neonatal Intensive Care Unit, University Children's Hospital, Uppsala, Sweden; Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Victoria Karlsson
- Neonatal Intensive Care Unit, University Children's Hospital, Uppsala, Sweden; Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
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6
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Asano H, Hirakawa E, Hayashi H, Hamada K, Asayama Y, Oohashi M, Uchiyama A, Higashino T. A method for improving semantic segmentation using thermographic images in infants. BMC Med Imaging 2022; 22:1. [PMID: 34979965 PMCID: PMC8721998 DOI: 10.1186/s12880-021-00730-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/23/2021] [Indexed: 12/20/2022] Open
Abstract
Background Regulation of temperature is clinically important in the care of neonates because it has a significant impact on prognosis. Although probes that make contact with the skin are widely used to monitor temperature and provide spot central and peripheral temperature information, they do not provide details of the temperature distribution around the body. Although it is possible to obtain detailed temperature distributions using multiple probes, this is not clinically practical. Thermographic techniques have been reported for measurement of temperature distribution in infants. However, as these methods require manual selection of the regions of interest (ROIs), they are not suitable for introduction into clinical settings in hospitals. Here, we describe a method for segmentation of thermal images that enables continuous quantitative contactless monitoring of the temperature distribution over the whole body of neonates. Methods The semantic segmentation method, U-Net, was applied to thermal images of infants. The optimal combination of Weight Normalization, Group Normalization, and Flexible Rectified Linear Unit (FReLU) was evaluated. U-Net Generative Adversarial Network (U-Net GAN) was applied to thermal images, and a Self-Attention (SA) module was finally applied to U-Net GAN (U-Net GAN + SA) to improve precision. The semantic segmentation performance of these methods was evaluated. Results The optimal semantic segmentation performance was obtained with application of FReLU and Group Normalization to U-Net, showing accuracy of 92.9% and Mean Intersection over Union (mIoU) of 64.5%. U-Net GAN improved the performance, yielding accuracy of 93.3% and mIoU of 66.9%, and U-Net GAN + SA showed further improvement with accuracy of 93.5% and mIoU of 70.4%. Conclusions FReLU and Group Normalization are appropriate semantic segmentation methods for application to neonatal thermal images. U-Net GAN and U-Net GAN + SA significantly improved the mIoU of segmentation.
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Affiliation(s)
- Hidetsugu Asano
- Technical Department, Atom Medical Corporation, 2-2-1, Dojo, Sakura-ku, Saitama city, Saitama, 338-0835, Japan.
| | - Eiji Hirakawa
- Department of Neonatology, Nagasaki Harbor Medical Center, 6-39, Shinchi-machi, Nagasaki City, Nagasaki, 850-8555, Japan.,Department of Neonatology, Kagoshima City Hospital, 37-1 Uearata-cho, Kagoshima City, Kagoshima, 890-8760, Japan
| | - Hayato Hayashi
- Technical Department, Atom Medical Corporation, 2-2-1, Dojo, Sakura-ku, Saitama city, Saitama, 338-0835, Japan
| | - Keisuke Hamada
- Department of Clinical Engineering, Nagasaki Harbor Medical Center, 6-39, Shinchi-machi, Nagasaki City, Nagasaki, 850-8555, Japan.,Department of Comprehensive Community Care Education, Nagasaki University Graduate School of Biomedical Sciences, 1-14, Bunkyo-machi, Nagasaki City, Nagasaki, 852-8521, Japan
| | - Yuto Asayama
- Technical Department, Atom Medical Corporation, 2-2-1, Dojo, Sakura-ku, Saitama city, Saitama, 338-0835, Japan
| | - Masaaki Oohashi
- Technical Department, Atom Medical Corporation, 2-2-1, Dojo, Sakura-ku, Saitama city, Saitama, 338-0835, Japan
| | - Akira Uchiyama
- Mobile Computing Laboratory, Graduate School of Information Science and Technology, Osaka University, 1-5, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Teruo Higashino
- Mobile Computing Laboratory, Graduate School of Information Science and Technology, Osaka University, 1-5, Yamadaoka, Suita, Osaka, 565-0871, Japan
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Park JY, Lee Y, Heo R, Park HK, Cho SH, Cho SH, Lim YH. Preclinical evaluation of noncontact vital signs monitoring using real-time IR-UWB radar and factors affecting its accuracy. Sci Rep 2021; 11:23602. [PMID: 34880335 PMCID: PMC8655004 DOI: 10.1038/s41598-021-03069-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/24/2021] [Indexed: 12/03/2022] Open
Abstract
Recently, noncontact vital sign monitors have attracted attention because of issues related to the transmission of contagious diseases. We developed a real-time vital sign monitor using impulse-radio ultrawideband (IR-UWB) radar with embedded processors and software; we then evaluated its accuracy in measuring heart rate (HR) and respiratory rate (RR) and investigated the factors affecting the accuracy of the radar-based measurements. In 50 patients visiting a cardiology clinic, HR and RR were measured using IR-UWB radar simultaneously with electrocardiography and capnometry. All patients underwent HR and RR measurements in 2 postures—supine and sitting—for 2 min each. There was a high agreement between the RR measured using radar and capnometry (concordance correlation coefficient [CCC] 0.925 [0.919–0.926]; upper and lower limits of agreement [LOA], − 2.21 and 3.90 breaths/min). The HR measured using radar was also in close agreement with the value measured using electrocardiography (CCC 0.749 [0.738–0.760]; upper and lower LOA, − 12.78 and 15.04 beats/min). Linear mixed effect models showed that the sitting position and an HR < 70 bpm were associated with an increase in the absolute biases of the HR, whereas the sitting position and an RR < 18 breaths/min were associated with an increase in the absolute biases of the RR. The IR-UWB radar sensor with embedded processors and software can measure the RR and HR in real time with high precision. The sitting position and a low RR or HR were associated with the accuracy of RR and HR measurement, respectively, using IR-UWB radar.
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Affiliation(s)
- Jun-Young Park
- Department of Electronics and Computer Engineering, College of Engineering, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea
| | - Yonggu Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea
| | - Seok-Hyun Cho
- Department of Otorhinolaryngology, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea
| | - Sung Ho Cho
- Department of Electronics and Computer Engineering, College of Engineering, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea.
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea.
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Jung H, Kimball JP, Receveur T, Agdeppa ED, Inan OT. Accurate Ballistocardiogram Based Heart Rate Estimation Using an Array of Load Cells in a Hospital Bed. IEEE J Biomed Health Inform 2021; 25:3373-3383. [PMID: 33729962 DOI: 10.1109/jbhi.2021.3066885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The ballistocardiogram (BCG), a cardiac vibration signal, has been widely investigated for continuous monitoring of heart rate (HR). Among BCG sensing modalities, a hospital bed with multi-channel load-cells could provide robust HR estimation in hospital setups. In this work, we present a novel array processing technique to improve the existing HR estimation algorithm by optimizing the fusion of information from multiple channels. The array processing includes a Gaussian curve to weight the joint probability according to the reference value obtained from the previous inter-beat-interval (IBI) estimations. Additionally, the probability density functions were selected and combined according to their reliability measured by q-values. We demonstrate that this array processing significantly reduces the HR estimation error compared to state-of-the-art multi-channel heartbeat detection algorithms in the existing literature. In the best case, the average mean absolute error (MAE) of 1.76 bpm in the supine position was achieved compared to 2.68 bpm and 1.91 bpm for two state-of-the-art methods from the existing literature. Moreover, the lowest error was found in the supine posture (1.76 bpm) and the highest in the lateral posture (3.03 bpm), thus elucidating the postural effects on HR estimation. The IBI estimation capability was also evaluated, with a MAE of 16.66 ms and confidence interval (95%) of 38.98 ms. The results demonstrate that improved HR estimation can be obtained for a bed-based BCG system with the multi-channel data acquisition and processing approach described in this work.
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9
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Ioannou S, Morris P, Hassanain H, Baker M, Alkattan F, Almakadma AH, Raddaoui L. Under the skin: Exploring 2-month-olds' thermal reactions in different social interactions with mother and stranger. INFANCY 2021; 26:352-368. [PMID: 33645890 DOI: 10.1111/infa.12390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 12/17/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Abstract
Physiological adaptations to external stressors can reveal socio-cognitive health in infancy. With the use of thermal imaging and behavioural analyses, the current study examined the arousal markers accompanying infants' interactions with a familiar and an unfamiliar person. To address the current research question, the mother and a complete stranger interacted with 2 to 3 month-old infants (N= 10, 2 boys)in three different conditions: Neutral, Play, and Compliment. Behavioral analyses showed that overall gaze was longer to the Stranger compared to the Mother independent of condition. Physiological findings showed that skin temperature was significantly higher with the stranger independent of condition. The regions of the face that passed the significance threshold included the maxillary area, the nose, and the forehead. Both behavioral and physiological findings emphasize the ability of the infant to distinguish between a familiar and an unfamiliar person. Most importantly, however thermal imaging has proven to be a promising tool in physiologically differentiating between variable social conditions in very young infants opening up a new experimental portal for identifying healthy physiological development.
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Affiliation(s)
- Stephanos Ioannou
- Department of Physiological Sciences, College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Paul Morris
- Department of Psychology, University of Portsmouth, Portsmouth, UK
| | - Hala Hassanain
- Department of Physiological Sciences, College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Marc Baker
- Department of Psychology, University of Portsmouth, Portsmouth, UK
| | - Faisal Alkattan
- Department of Physiological Sciences, College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Abdul Hakim Almakadma
- Department of Physiological Sciences, College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Lama Raddaoui
- Department of Physiological Sciences, College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
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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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Abstract
In this paper, we investigate an automated pipeline to estimate respiration signals from videos for premature infants in neonatal intensive care units (NICUs). Two flow estimation methods, namely the conventional optical flow- and deep learning-based flow estimation methods, were employed and compared to estimate pixel motion vectors between adjacent video frames. The respiratory signal is further extracted via motion factorization. The proposed methods were evaluated by comparing our automated extracted respiration signals to that extracted from chest impedance on videos of five premature infants. The overall average cross-correlation coefficients are 0.70 for the optical flow-based method and 0.74 for the deep flow-based method. The average root mean-squared errors are 6.10 and 4.55 for the optical flow- and the deep flow-based methods, respectively. The experimental results are promising for further investigation and clinical application of the video-based respiration monitoring method for infants in NICUs.
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Pressure Injuries in the Pediatric Population: A National Pressure Ulcer Advisory Panel White Paper. Adv Skin Wound Care 2019; 32:394-408. [DOI: 10.1097/01.asw.0000577124.58253.66] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Successful Reduction in Electrode-Related Pressure Ulcers During EEG Monitoring in Critically Ill Neonates. Adv Neonatal Care 2019; 19:262-274. [PMID: 31335377 DOI: 10.1097/anc.0000000000000641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Neonates are at a high risk for pressure ulcers (PU) due to skin immaturity and exposure to various medical devices. The prevalence of PU in the neonatal intensive care unit is estimated to be 23%, with 80% of those being related to medical devices, including electroencephalographic (EEG) electrodes. Proposed mechanisms involve prolonged pressure to the electrodes and chemical reactions to conductive agents. PURPOSE The object of this quality improvement project was to reduce PU in neonates during continuous EEG (cEEG) monitoring by 50% within 12 months and 75% within 18 months. A secondary objective was to eliminate electrode-related infections by 12 months. Balancing measures included gestational age at the time of monitoring, integrity of the EEG setup, and cost effectiveness. The process measure was adherence to the skin-monitoring tool kit. METHODS A multiple Plan-Do-Study-Act cycle method was used. All neonates monitored with cEEG were included. The monitoring tool kit was used to document the condition of scalp and EEG electrodes before, during, and after cEEG. RESULTS In the preproject period, 8.5% (9/106) of monitored patients developed PU, and 22.2% (2/9) of those developed infections. During the project period, 3.5% (7/198) of monitored patients developed PU and no infections were observed. During monitoring, 21 patients showed skin irritation, and timely intervention resulted in resolution in more than 90% of the cases and prevented progression into PU. Silver/silver chloride-plated electrodes, when exposed to external heat sources, can cause burns, resembling PU. IMPLICATIONS FOR PRACTICE Intervention at the electrode level together with skin inspection successfully reduces PU in neonates. Silver/silver chloride-plated electrodes should be avoided in neonates. IMPLICATIONS FOR RESEARCH Further research is needed to identify the optimal electrode for neonatal EEG.
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Kim JD, Lee WH, Lee Y, Lee HJ, Cha T, Kim SH, Song KM, Lim YH, Cho SH, Cho SH, Park HK. Non-contact respiration monitoring using impulse radio ultrawideband radar in neonates. ROYAL SOCIETY OPEN SCIENCE 2019; 6:190149. [PMID: 31312485 PMCID: PMC6599793 DOI: 10.1098/rsos.190149] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/10/2019] [Indexed: 05/04/2023]
Abstract
Vital sign monitoring in neonates requires adhesive electrodes, which often damage fragile newborn skin. Because impulse radio ultrawideband (IR-UWB) radar has been reported to recognize chest movement without contact in adult humans, IR-UWB may be used to measure respiratory rates (RRs) in a non-contact fashion. We investigated the feasibility of radar sensors for respiration monitoring in neonates without any respiratory support to compare the accuracy and reliability of radar measurements with those of conventional impedance pneumography measurements. In the neonatal intensive care unit, RRs were measured using radar (RRRd) and impedance pneumography (RRIP) simultaneously. The neonatal voluntary movements were measured using the radar sensor and categorized into three levels (low [M0], intermediate [M1] and high [M2]). RRRd highly agreed with RRIP (r = 0.90; intraclass correlation coefficient [ICC] = 0.846 [0.835-0.856]). For the M0 movement, there was good agreement between RRRd and RRIP (ICC = 0.893; mean bias -0.15 [limits of agreement (LOA) -9.6 to 10.0]). However, the agreement was slightly lower for the M1 (ICC = 0.833; mean bias = 0.95 [LOA -11.4 to 13.3]) and M2 (ICC = 0.749; mean bias = 3.04 [LOA -9.30 to 15.4]) movements than for the M0 movement. In conclusion, IR-UWB radar can provide accurate and reliable estimates of RR in neonates in a non-contact fashion. The performance of radar measurements could be affected by neonate movement.
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Affiliation(s)
- Jong Deok Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Won Hyuk Lee
- Department of Electronics and Computer Engineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Yonggu Lee
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ju Lee
- Division of Neonatology, Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Teahyen Cha
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Ki-Min Song
- Department of Health Sciences, Graduate School, Hanyang University, Seoul, Republic of Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seok Hyun Cho
- Department of Otorhinolaryngology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sung Ho Cho
- Department of Electronics and Computer Engineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Hyun-Kyung Park
- Division of Neonatology, Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
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Kusari A, Han AM, Virgen CA, Matiz C, Rasmussen M, Friedlander SF, Eichenfield DZ. Evidence-based skin care in preterm infants. Pediatr Dermatol 2019; 36:16-23. [PMID: 30548578 DOI: 10.1111/pde.13725] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/07/2018] [Accepted: 10/02/2018] [Indexed: 12/11/2022]
Abstract
Most guidelines on neonatal skin care emphasize issues pertaining to healthy, term infants. Few address the complex task of skin barrier maintenance in preterm, very preterm, and extremely preterm infants. Here, we provide an evidence-based review of the literature on skin care of preterm neonates. Interestingly, the stratum corneum does not fully develop until late in the third trimester, and as such, the barrier function of preterm skin is significantly compromised. Numerous interventions are available to augment the weak skin barrier of neonates. Plastic wraps reduce the incidence of hypothermia while semipermeable and transparent adhesive dressings improve skin quality and decrease the incidence of electrolyte abnormalities. Tub bathing causes less body temperature variability than sponge bathing and can be performed as infrequently as once every four days without increasing bacterial colonization of the skin. Topical emollients, particularly sunflower seed oil, appear to reduce the incidence of skin infections in premature neonates-but only in developing countries. In developed countries, studies indicate that topical petrolatum ointment increases the risk of candidemia and coagulase-negative Staphylococcus infection in the preterm population, perhaps by creating a milieu similar to occlusive dressings. For preterm infants with catheters, povidone-iodine and chlorhexidine are comparably effective at preventing catheter colonization. Further studies are necessary to examine the safety and efficacy of various skin care interventions in premature infants with an emphasis placed on subclassifying the patient population. In the interim, it may be beneficial to develop guidelines based on the current body of evidence.
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Affiliation(s)
- Ayan Kusari
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
- Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, San Diego, California
| | - Allison M Han
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
- Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, San Diego, California
| | - Cesar A Virgen
- Department of Dermatology, University of California, Irvine School of Medicine, San Diego, California
| | - Catalina Matiz
- Department of Dermatology, Southern California Permanente Medical Group, San Diego, California
| | | | - Sheila F Friedlander
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
- Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, San Diego, California
| | - Dawn Z Eichenfield
- Department of Dermatology, University of California, San Diego School of Medicine, San Diego, California
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Kelchen MN, Brogden NK. Effect of dosing regimen and microneedle pretreatment on in vitro skin retention of topically applied beta-blockers. Biomed Microdevices 2018; 20:100. [PMID: 30523423 PMCID: PMC6688608 DOI: 10.1007/s10544-018-0348-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Topical beta-blocker formulations are commonly used to treat infantile hemangiomas (IHs); however, the skin concentrations and drug permeation through the skin have not been quantified. Microneedles (MNs) may increase local skin concentrations, which could further enhance lesion clearance and improve dosing regimens. The objective of this study was to quantify skin concentrations and drug permeation of two beta-blockers, propranolol and timolol, in vitro after application to intact skin and skin pretreated with solid MNs of two lengths. Propranolol skin concentrations and drug permeation were significantly higher than timolol skin concentrations for all study conditions, which is likely due to the lipophilic nature of propranolol compared to the hydrophilicity of timolol. Propranolol skin concentrations were significantly influenced by dosing regimen, as skin concentrations increased with increasing drug application. Pretreatment of the skin with solid 250 μm and 500 μm length MNs increased local skin concentrations of timolol; propranolol skin concentrations did not significantly increase after MN pretreatment. Propranolol and timolol permeation through the skin increased after MN pretreatment with both MN lengths for both compounds. Taken together, solid MN pretreatment prior to application of topical timolol may be beneficial for deep or mixed IHs upon further optimization of the MN treatment paradigm.
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Affiliation(s)
- Megan N Kelchen
- Department of Pharmaceutical Science and Experimental Therapeutics, University of Iowa College of Pharmacy, 115 South Grand Avenue, Iowa City, IA, 52242, USA
| | - Nicole K Brogden
- Department of Pharmaceutical Science and Experimental Therapeutics, University of Iowa College of Pharmacy, 115 South Grand Avenue, Iowa City, IA, 52242, USA.
- Department of Dermatology, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
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Habiballah L. Prevalence of neonate adhesive skin injuries in a Jordanian intensive care unit. Nurs Child Young People 2017; 29:42-46. [PMID: 29206362 DOI: 10.7748/ncyp.2017.e966] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2017] [Indexed: 06/07/2023]
Abstract
AIM To determine the prevalence of adhesive skin injuries in neonates in a Jordanian neonatal intensive care unit (NICU) and to examine the characteristics of neonates with these injuries. METHOD A cross-sectional period-prevalence study was conducted in a NICU in Irbid National University Hospital in Jordan. A total of 169 neonates were examined for skin injuries caused by adhesive equipment. RESULTS The prevalence of skin injuries in this population was 26.6%. The injuries were located mostly on the face, arms, hands and chest, and were caused by endotracheal tubes, intravenous cannulae, fixation of nasogastric tubes and electrodes. Neonates with skin injuries were more likely to be preterm and underweight, to have respiratory problems and to have been connected to a mechanical ventilator. CONCLUSION Adhesive skin injuries were found in more than one quarter of the neonates in this NICU and healthcare service providers should endeavour to minimise the occurrence of these injuries.
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Abstract
BACKGROUND Nurses have a primary role in promoting neonatal skin integrity and skin care management of the critically ill neonate. Adhesive products are essential to secure needed medical devices but can be a significant factor contributing to skin breakdown. Current literature does not offer a definitive answer regarding which products most safely and effectively work to secure needed devices in the high-risk neonatal population. PURPOSE To determine which adhesive method is best practice to safely and effectively secure lines/tubes in the high-risk neonate population. FINDINGS/RESULTS The only main effect that was significant was age group with mean skin scores. Subjects in the younger group (24-28 weeks) had higher skin scores than in the older group (28-34 weeks), validating that younger gestations are at higher risk of breakdown with the use of adhesives. IMPLICATIONS FOR PRACTICE The findings did not clearly identify which product was superior to secure tubes and lines, or was the least injurious to skin of the high-risk neonate. Neither a transparent dressing only or transparent dressing over hydrocolloid method clearly demonstrated an advantage in the high-risk, preterm neonate. Anecdotal comments suggested staff preferred the transparent dressing over hydrocolloid method as providing better adhesive while protecting skin integrity. The findings validated that younger gestations are at higher risk of breakdown with the use of adhesives and therefore require close vigilance to maintain skin integrity.
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August D, Kandasamy Y. Significance of antenatal glucocorticoid exposure for pressure injury prevalence in neonates. J Neonatal Perinatal Med 2016; 9:23-9. [PMID: 27002268 DOI: 10.3233/npm-16915063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS Studies have highlighted that antenatal steroids could have an effect on neonatal skin maturation. This study examined if there was a relationship between the administration of antenatal glucocorticoids for mothers and the skin injuries in their neonates. Data from skin injury audit were extracted from the neonatal database and analyzed to determine differences in the prevalence of neonates with pressure injuries [cases] whose mothers had received antenatal steroids, compared to those without pressure injuries [control]. RESULTS Of 247 neonates audited, 77 [31%], had documented pressure injuries, 170 [69%] had no documented injury. The median birth weight and gestation were 1400 g [IQR 893-2268 g] and 30.3 weeks [IQR 26.3-40.0 weeks] respectively. Of the neonates born less than 34 weeks, 80% were exposed to antenatal steroids and were equally distributed across patient genders. Within the 77 cases, 53 [66%] were exposed to antenatal steroids compared to controls in which 88 [53%] had not. The effect between cases and controls was not statistically significant [χ2 = 2.81, P = 0.09]. However a difference was noted between genders, as female neonates benefited from the exposure to steroids [OR = 0.317, 95% [CI 0.105-0.956], p value -0.041]. CONCLUSION Antenatal glucocorticoids appear to be beneficial in reducing pressure injury prevalence in female neonates.
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Affiliation(s)
- D August
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Department of Neonatology, Townsville Hospital and Health Service, Angus Smith Dr. Douglas, QLD, Australia
| | - Y Kandasamy
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Department of Neonatology, Townsville Hospital and Health Service, Angus Smith Dr. Douglas, QLD, Australia
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Haldar R, Kaushal A, Srivastava S, Singh PK. Paediatric Intravenous Splint: A Cause of Pressure Injury during Neurosurgery in Prone Position. Pediatr Neurosurg 2015; 51:55-6. [PMID: 26575479 DOI: 10.1159/000441062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/10/2015] [Indexed: 02/04/2023]
Abstract
Splint application avoids unwanted movement of limbs and kinking of intravenous catheters in infants, allowing free flow of intravenous fluids. However, if placed in contact with dependent surfaces during prone surgeries, they have the propensity to cause inadvertent pressure injuries. This occurs due to the weight of the limb and continuous friction and is augmented by a rise in the local temperature and perspiration. We wish to share our experience of such an unintentional injury caused by a paediatric intravenous splint.
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Affiliation(s)
- Rudrashish Haldar
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Oranges T, Dini V, Romanelli M. Skin Physiology of the Neonate and Infant: Clinical Implications. Adv Wound Care (New Rochelle) 2015; 4:587-595. [PMID: 26487977 DOI: 10.1089/wound.2015.0642] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Significance: The skin is a complex and dynamic organ that performs several vital functions. The maturation process of the skin starts at birth with the adaption of the skin to the comparatively dry environment compared to the in utero milieu. This adaptive flexibility results in the unique properties of infant skin. To deliver appropriate care to infant skin, it is necessary to understand that it is evolving with unique characteristics. Recent Advances: The role of biophysical noninvasive techniques in the assessment of skin development underlines the importance of an objective evaluation of skin physiology parameters. Skin hydration, transepidermal water loss, and pH values are measurable with specific instruments that give us an accurate and reproducible assessment during infant skin maturation. The recording of these values, following standard measurement procedures, allows us to evaluate the integrity of the skin barrier and to monitor the functionality of the maturing skin over time. Critical Issues: During the barrier development, impaired skin function makes the skin vulnerable to chemical damage, microbial infections, and skin diseases, possibly compromising the general health of the infant. Preterm newborns, during the first weeks of life, have an even less developed skin barrier and, therefore, are even more at risk. Thus, it is extremely important to evaluate the risk of infection, skin breakdown, topical agent absorption, and the risk of thermoregulation failure. Future Directions: Detailed and objective evaluations of infant skin maturation are necessary to improve infant skin care. The results of these evaluations should be formed into general protocols that will allow doctors and caregivers to give more personalized care to full-term newborns, preterm newborns, and infants.
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Affiliation(s)
- Teresa Oranges
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Pisa, Italy
| | - Valentina Dini
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Pisa, Italy
| | - Marco Romanelli
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Pisa, Italy
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Man G, Cheung C, Crumrine D, Hupe M, Hill Z, Man MQ, Elias PM. An optimized inexpensive emollient mixture improves barrier repair in murine skin. DERMATOL SIN 2015. [DOI: 10.1016/j.dsi.2015.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Randomized comparison of a silicone tape and a paper tape for gentleness in healthy children. J Wound Ostomy Continence Nurs 2015; 41:40-8. [PMID: 24240641 DOI: 10.1097/01.won.0000436669.79024.b0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the relative gentleness of a silicone tape to a paper tape in healthy infants and children. DESIGN A randomized, grader-blinded, comparative study. SUBJECTS AND SETTING The sample group comprised 24 healthy infants and children 9.1 to 46.7 months of age (mean ± SEM, 34.0 ± 2.21). The study was conducted at a dermatological research facility (cyberDERM, Inc) located in Broomall, Pennsylvania. All volunteers were recruited from the surrounding community. METHODS Tapes measuring 1 × 1.5 inches were randomly applied to the left and right intrascapular regions of the upper back. Tapes were removed in a standardized fashion after 24 hours. The primary study outcome, gentleness, was based on visual assessments of skin damage, discomfort, and quantification of keratin removal. Four-point scales were used to assess skin damage, and a 10-point Faces, Legs, Activity, Cry, and Consolability instrument was used to assess discomfort. Secondary assessments included hair removal, tape edge-lift assessments, and parent preference for either tape. RESULTS There was a significantly lower mean ± SEM erythema response for the silicone tape (0.93 ± 0.14 vs 1.35 ± 0.11, P = .0129) than for the paper tape. No measurable epidermal stripping occurred with the silicone tape compared to a mean ± SEM response of 0.29 ± 0.11 for the paper tape (P = .0039). Discomfort was significantly lower (P = .0002) for the silicone tape as compared to the paper tape (Faces, Legs, Activity, Cry, and Consolability score mean difference from baseline 0.5 vs 3.3, P = .0002). Keratin removal was significantly less with the silicone as compared to paper tape (8.7 ± 0.5 μg/mL vs 15.2 ± 1.3 μg/mL, P < .0001). Few hairs were removed with either tape. There was significantly less (P < .0001) edge-lift with the paper tape than the silicone tape; no statistically significant differences in parent preferences for silicone versus paper tapes were measured (P = .3359). CONCLUSIONS Gentleness assessments favored the silicone tape compared to a paper tape and warrant further clinical investigation in the neonatal intensive care unit.
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Erdemir A, Kahramaner Z, Yuksel Y, Cosar H, Turkoglu E, Sutcuoglu S, Ozer EA, Kose S. The effect of topical ointment on neonatal sepsis in preterm infants. J Matern Fetal Neonatal Med 2014; 28:33-6. [DOI: 10.3109/14767058.2014.900037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Scientific and Clinical Abstracts From the WOCN® Society's 44th Annual Conference. J Wound Ostomy Continence Nurs 2012. [DOI: 10.1097/won.0b013e3182546a04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The skin is a vital organ with key protective functions. Infants in the NICU are at risk for skin injury because of developmental immaturity and intensive care treatments. When skin injury occurs, the neonatal nurse is challenged to provide wound care to optimize functional and cosmetic healing. Optimal wound care requires basic knowledge of the mechanisms of injury, physiology of wound healing, host factors affecting wound healing, and wound assessment. This knowledge provides the basis for determining appropriate wound treatment, including dressing selection. Attention to pain issues associated with wound care is difficult because of the infant's developmental stage, but is essential because of the potentially negative life-long impact of pain. The premature infant's propensity for skin stripping limits the selection of appropriate dressing, as does the paucity of research examining wound care products in this population.
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Effectiveness of No-Sting skin protectant and Aquaphor on water loss and skin integrity in premature infants. J Perinatol 2010; 30:414-9. [PMID: 19890343 DOI: 10.1038/jp.2009.174] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effects of No-Sting skin protectant and Aquaphor, a water-based emollient, on skin integrity measured by Neonatal Skin Condition Score (NSCS) and transepidermal water loss (TEWL) in premature infants. In addition, with no data regarding the use of No-Sting in the neonatal population and its desirability because it requires less infant manipulation and less nursing time, it was important to evaluate the use of this product. STUDY DESIGN In all, 69 premature infants born at <33 weeks gestation were randomly assigned to one of the two treatment groups: (1) No-Sting or (2) Aquaphor for a total of 14 days. RESULT Gestational age and total fluid intake were related to NSCS whereas gestational age, incubator humidity levels and total daily fluid intake were significantly related to TEWL. Infants receiving Aquaphor had significantly higher NSCS, but the mean scores in both groups over the 14-day period were in the normal range (<4). There were no differences between Aquaphor and No-Sting in the rate of TEWL over the 14-day period. CONCLUSION This study provides the first information regarding the use of No-Sting in the neonatal population. This skin protectant seems as effective as Aquaphor in decreasing TEWL and maintaining skin integrity, and is less resource intensive.
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Abstract
OBJECTIVE To determine the effects of chlorhexidine gluconate (CHG) on skin inflammation and stratum corneum barrier integrity at peripherally inserted central catheter (PICC) sites among patients in the neonatal intensive care setting. STUDY DESIGN In a within-subject design, PICC sites with CHG plus semipermeable dressing (PICC) were compared with contralateral dressing sites and untreated controls among 40 neonates (gestational age 32.1+/-4.7) at weekly dressing changes, using quantitative measures of skin erythema, dryness and barrier integrity (transepidermal water loss, TEWL). Data were analyzed using analysis of variance and linear mixed methods. RESULTS At week 1, all three sites differed for erythema with the highest value indicating poorer skin condition at the PICC site. Dressing-site erythema was higher than the untreated control. Dryness and TEWL were higher, indicating poorer skin integrity, for the PICC site than either the dressing or the control. After 2 weeks, erythema and dryness scores were higher for the PICC site than the dressing and control skin. By week 3, scores were comparable for PICC and dressing sites and both were higher than the control for erythema and dryness. After 3 weeks, PICC skin TEWL was higher than both dressing and control and they did not differ from each other. CONCLUSION The dressings used to secure PICC lines contribute to the observed skin compromise at CHG-treated skin sites and may affect skin barrier development in similar populations of neonates.
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Shannon RJ, Chakravarthy D. Effect of a water-based no-sting, protective barrier formulation and a solvent-containing similar formulation on skin protection from medical adhesive trauma. Int Wound J 2009; 6:82-8. [PMID: 19291121 DOI: 10.1111/j.1742-481x.2008.00559.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Trauma to the skin from repeated removal of adhesive-based medical products can cause pain, anxiety, risk of secondary infections and additional health care costs. Skin barrier formulations are used to protect the integrity from such trauma. However, not all formulations are equally protective. We report the results of a randomised controlled study comparing a solvent-free (SF) formulation and a solvent-containing (SC) formulation to the skin of 12 healthy volunteers aged 18-55 years. Treatments were applied at baseline to two of the four test sites on the back of each subject and repeated for 5 days. Measurements of pain, discomfort, erythema and skin water loss were taken 24 hours after each application. The SF formulation is associated with lower mean scores for erythema (day 5, P < 0.05) and lower values for transepidermal water loss (day 5, P < 0.05) and redness (days 4 and 5, P < 0.05) when compared with either no treatment or daily treatment with a SC formulation. There were no significant differences between subject responses when pain on application of the test formulation or discomfort associated with removal of the medical adhesive tapes were rated. We conclude that a SF formulation provides better security against adhesive-derived skin trauma than a SC formulation.
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Affiliation(s)
- Ronald J Shannon
- Global Health Economic Projects, LLC, Clifton Park, NY 12065, USA.
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Topical peroxisome proliferator activated receptor activators accelerate postnatal stratum corneum acidification. J Invest Dermatol 2008; 129:365-74. [PMID: 18704104 DOI: 10.1038/jid.2008.218] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Previous studies have shown that pH declines from between 6 and 7 at birth to adult levels (pH 5.0-5.5) over 5-6 days in neonatal rat stratum corneum (SC). As a result, at birth, neonatal epidermis displays decreased permeability barrier homeostasis and SC integrity, improving days 5-6. We determined here whether peroxisome proliferator-activated receptor (PPAR) activators accelerate postnatal SC acidification. Topical treatment with two different PPARalpha activators, clofibrate and WY14643, accelerated the postnatal decline in SC surface pH, whereas treatment with PPARgamma activators did not and a PPARbeta/delta activator had only a modest effect. Treatment with clofibrate significantly accelerated normalization of barrier function. The morphological basis for the improvement in barrier function in PPARalpha-treated animals includes accelerated secretion of lamellar bodies and enhanced, postsecretory processing of secreted lamellar body contents into mature lamellar membranes. Activity of beta-glucocerebrosidase increased after PPARalpha-activator treatment. PPARalpha activator also improved SC integrity, which correlated with an increase in corneodesmosome density and increased desmoglein-1 content, with a decline in serine protease activity. Topical treatment of newborn animals with a PPARalpha activator increased secretory phospholipase A2 activity, which likely accounts for accelerated SC acidification. Thus, PPARalpha activators accelerate neonatal SC acidification, in parallel with improved permeability homeostasis and SC integrity/cohesion. Hence, PPARalpha activators might be useful to prevent or treat certain common neonatal dermatoses.
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Nikolovski J, Stamatas GN, Kollias N, Wiegand BC. Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life. J Invest Dermatol 2008; 128:1728-36. [PMID: 18200056 DOI: 10.1038/sj.jid.5701239] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Skin water barrier development begins in utero and is believed to be complete by week 34 of gestational age. The goal of this investigation was to assess the dynamic transport and distribution of water of the stratum corneum of infants and compare it to those of adults. The interaction of water with the stratum corneum was assessed by measuring capacitance, transepidermal water loss (TEWL), rates of absorption-desorption as well as Raman spectra as a function of depth (a total of 124 infants (3-12 months) and 104 adults (14-73 years)). The results show that capacitance, TEWL, and absorption-desorption rates had larger values consistently for infant stratum corneum throughout the first year of life and showed greater variation than those of adults. The Raman spectra analyzed for water and for the components of natural moisturizing factor (NMF) showed the distribution of water to be higher and have a steeper gradient in infants than in adults; the concentration of NMF was significantly lower in infants. The results suggest that although the stratum corneum of infants may appear intact shortly after birth (<1 month), the way it stores and transports water becomes adult-like only after the first year of life.
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Affiliation(s)
- Janeta Nikolovski
- Advanced Technologies, Johnson & Johnson Consumer and Personal Products Worldwide, Skillman, New Jersey 08558, USA
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Cisler-Cahill L. A protocol for the use of amorphous hydrogel to support wound healing in neonatal patients: an adjunct to nursing skin care. Neonatal Netw 2006; 25:267-73. [PMID: 16913237 DOI: 10.1891/0730-0832.25.4.267] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The care registered nurses offer makes a critical difference in the quality and cost-effectiveness of patient outcomes. The prevention and treatment of alterations in skin integrity remain primary nurse-sensitive quality indicators. Although wound prevention is a primary goal for nurses, iatrogenic wounds do occur. Neonatal patients are at greater risk for alterations in skin integrity because of the fragile nature of their skin. When skin breakdown occurs, nurses must have knowledge of effective treatment alternatives. The purpose of this article is to describe the use of a collaborative practice protocol to introduce and document patient outcomes with the use of amorphous hydrogel as a treatment modality for iatrogenic neonatal wounds. All hospitals collect data on the quality of patient care, and it has been known for some time that registered nurses can make a critical difference in the quality of patient care and the effectiveness of patient outcomes. The American Nurses Association has identified ten specific quality measures that are impacted by nursing care. Referred to as nurse-sensitive quality indicators, these measures include the maintenance of skin integrity.
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Fischer M, Donath C, Radke J, Marsch WC, Soukup J. Skin function parameters in intensive-care patients. Skin Res Technol 2005; 11:268-71. [PMID: 16221143 DOI: 10.1111/j.0909-725x.2005.00122.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE The study was performed to investigate the transepidermal water loss (TEWL) and pH-value in patients in intensive care. METHODS Forty intensive-care patients (22 men, 18 women) were included in the study. TEWL and pH-values were measured at admission, and after 24, 96 and 168 h. The areas of measurement were the forehead, the volar forearm, paraumbilical and the ventral thigh. The measurements were made under standardized environmental conditions according to the recommendations of the EMCO Group. RESULTS Elevated values were found on the forehead compared with the other skin areas examined. There was no significant change in mean TEWL-values in any patient in the course of the study. There was also no significant influence of TEWL at the time of admission on the prognosis. The course analysis of the mean pH-values, however, showed that patients who developed a systemic inflammatory response syndrome (SIRS) or sepsis during the further course had a higher pH-value over the entire study period. CONCLUSION TEWL and the pH of the skin surface could be measured at bedside in the intensive-care unit and delivered reproducible results. These parameters appear, however, to be relevant only for subgroups of patients under intensive care.
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Affiliation(s)
- Matthias Fischer
- Department of Dermatology and Venereology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
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Lund CH, Osborne JW. Validity and reliability of the neonatal skin condition score. J Obstet Gynecol Neonatal Nurs 2004; 33:320-7. [PMID: 15180195 DOI: 10.1177/0884217504265174] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To demonstrate the validity and reliability of the Neonatal Skin Condition Scale (NSCS) used in the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the National Association of Neonatal Nurses (NANN) neonatal skin care evidence-based practice project. SETTING NICU and well-baby units in 27 hospitals located throughout the United States. PARTICIPANTS Site coordinators (N = 27) and neonates (N = 1,006) observed during both the pre and postimplementation phases of the original neonatal skin care project. METHOD To assess reliability, two consecutive NSCS assessments on a single infant were analyzed. Site coordinators were contacted after the original project was concluded. Sites indicating that a single nurse scored all infant skin observations provided data that were used to evaluate intrarater reliability. Sites using more than one nurse to score skin observations provided data that were used to assess interrater reliability. To assess validity, the following variables were used from the original data set: the Neonatal Skin Condition Scale (NSCS), with three subscales for dryness, erythema, and breakdown; birth weight in grams; number of skin score observations for each infant; and the prevalence of infection, defined as a positive blood culture. RESULTS For intrarater reliability, 16 sites used a single nurse for all NSCS assessments; total NSCS assessments 475. For interrater reliability, 11 sites used multiple raters; total assessments 531. The NSCS demonstrated adequate reliability for each of the three subscales and for the total score, with the percent agreement between scores ranging from 68.7% to 85.4% (intrarater) and 65.9% to 89% (interrater); all Kappas were significant at p < .001 and were in the moderate range for reliability. The validity of the NSCS was demonstrated by the findings that smaller infants were 6 times more likely to have erythema (chi2(6) = 109.55, p < .0001), and approximately twice as likely to have the most severe breakdown (chi2(6) = 108.01, p < .0001). Infants with more observations (longer length of stay) had higher skin scores (odds ratio = 1.21, p < .0001), and an increased probability of infection was noted for infants with higher skin scores (odds ratio = 2.25, p < .0001). CONCLUSIONS The Neonatal Skin Condition Score (NSCS) is reliable when used by single and multiple raters to assess neonatal skin condition, even across weight groups and racial groups. Validity of the NSCS was demonstrated by confirmation of the relationship of the skin condition scores with birth weight, number of observations, and prevalence of infection.
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Edwards WH, Conner JM, Soll RF. The effect of prophylactic ointment therapy on nosocomial sepsis rates and skin integrity in infants with birth weights of 501 to 1000 g. Pediatrics 2004; 113:1195-203. [PMID: 15121929 DOI: 10.1542/peds.113.5.1195] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Extremely low birth weight infants have a high risk of developing nosocomial bacterial sepsis (NBS). Immature fragile skin may represent an inadequate protective barrier to bacteria colonizing the skin. We conducted a randomized, multicenter trial to determine whether prophylactic application of an emollient ointment would result in a lower incidence of death and/or NBS in the first 28 days of life, compared with routine skin care. METHODS Infants of birth weight 501 to 1000 g and gestational age < or =30 weeks were assigned randomly to receive generalized application of ointment twice a day through day 14 (prophylactic group [P]) or local application of ointment to the site of injury (routine skin care [R]). The study was conducted at 53 neonatal intensive care units that were members of the Vermont Oxford Network. RESULTS Included in the analysis were 1191 infants (P: 602; R: 589). No difference was found in the combined primary outcome of NBS or death (33.6% P vs 30.3% R; relative risk [RR]: 1.10; 95% confidence interval [CI]: 0.89, 1.27). The incidence of death was no different between the groups (10.8% P vs 12.1% R; RR: 0.87; 95% CI: 0.59, 1.25). More infants in the prophylactic group had NBS (25.8% P vs 20.4% R; RR: 1.26; 95% CI: 1.02, 1.54), predominantly in the lower birth weight infants (501-750 g) and for infections caused by coagulase-negative staphylococci. Infants in the prophylactic group had better skin condition on days 1 to 14 of life and less skin injury on days 15 to 28 of life. There was no difference between groups in other complications of prematurity. CONCLUSIONS Prophylactic application of ointment did not lead to a difference in death and/or NBS in the first 28 days of life. There may be an increase in the risk of NBS associated with this practice.
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Affiliation(s)
- William H Edwards
- Department of Pediatrics, Children's Hospital at Dartmouth, Lebanon, New Hampshire 03756, USA.
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Weinberger B, Hanna N, Gropper CA, Heck DE, Laskin DL, Laskin JD. Transdermal Xenobiotics in Newborn Skin. ACTA ACUST UNITED AC 2003; 22:51-67. [PMID: 37007905 PMCID: PMC10061589 DOI: 10.1081/cus-120019330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Newborn infants are regularly exposed to a wide variety of topical agents, including treatments for rashes, antimicrobial agents, solvents, and skin barriers or moisturizers. Premature and hospitalized infants are also exposed to topical iodine for antisepsis and to topical analgesic agents. The fact that most of these agents have not been specifically evaluated for use in infants has recently been recognized as a major public health concern. The epidermis of preterm infants is not fully developed, constituting an incomplete barrier to systemic absorption of topical agents. Thus, substances applied to the skin can have adverse systemic effects. Povidone-iodine and steroid creams have been associated with thyroid and hypothalamic-pituitary axis suppression, respectively, in premature infants. Application of topical EMLA (Eutectic Mixture of Local Anesthetics) for analgesia has been implicated in methemoglobinemia in premature infants. Exposure to natural latex in gloves and medical equipment may sensitize infants, leading to the development of airway hyperreactivity and other allergic manifestations. Therefore, it is advisable to limit skin exposure of premature infants to xenobiotics. Further work is required to define safe doses of common agents. In addition, transdermal administration of systemic medications, including methylxanthines, may be practical in premature infants.
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Affiliation(s)
- Barry Weinberger
- Division of Neonatology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Correspondence: Barry Weinberger, M.D., Associate Professor of Pediatrics, Division of Neonatology, St. Peter’s University Hospital, 254 Easton Avenue, New Brunswick, NJ 08903, USA; Fax: 732-249-6306;
| | - Nazeeh Hanna
- Division of Neonatology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Charles A. Gropper
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York, USA
| | - Diane E. Heck
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, New Jersey, USA
| | - Debra L. Laskin
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, New Jersey, USA
| | - Jeffrey D. Laskin
- Department of Environmental and Community Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Blackburn S, DePaul D, Loan LA, Marbut K, Taquino LT, Thomas KA, Wilson SK. Neonatal thermal care, part II: Microbial growth under temperature probe covers. Neonatal Netw 2001; 20:19-23. [PMID: 12144211 DOI: 10.1891/0730-0832.20.3.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine if temperature probe covers contribute to nosocomial infections by providing an environment for skin microbe colonization. DESIGN Descriptive, comparative design with infants randomized into two groups: foam probe cover and hydrogel probe cover. Skin cultures were obtained 72 hours after cover placement. Bacterial growth was quantified after 24 and 48 hours. Skin integrity was assessed using visual irritations scores (VIS) every 5 minutes for 30 minutes following cover removal. ANOVA and ANOVA-RM were used to compare amounts of microbes and VIS scores between groups. SAMPLE Twenty-six medically stable infants, 29 to 34 weeks gestational age, less than 10 days postbirth, and in an incubator. MAIN OUTCOME VARIABLE Microbial growth and VIS. RESULTS There were no statistically significant differences in microbial growth and VIS scores between groups (p > .05). Clinical significance was noted in VIS scores. Infants who had foam covers had more sustained irritation scores.
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Affiliation(s)
- S Blackburn
- Department of Family and Child Nursing, University of Washington, Seattle 98198-7262, USA
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Blackburn S, DePaul D, Loan LA, Marbut K, Taquino LT, Thomas KA, Wilson SK. Neonatal thermal care, part I: Survey of temperature probe practices. Neonatal Netw 2001; 20:15-8. [PMID: 12144210 DOI: 10.1891/0730-0832.20.3.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine nurses' practices regarding skin temperature probes. DESIGN Data were collected using an anonymous questionnaire, which was returned by mail. Questionnaires were distributed by volunteer neonatal nurses. Items included frequency of probe change, position of probe, use of probes in skin and air servocontrolled incubators and radiant warmers, as well as demographic data. SAMPLE Eighty-three neonatal nurses. RESULTS Nurses reported that skin servocontrolled incubators are used widely, but generally only for infants less than 28 weeks gestational age; a high proportion of respondents reported using continuous monitoring of skin temperature in air servocontrol incubators. Although most nurses reported positioning infants to prevent their lying on the probe, 21 percent reported using the same probe site regardless of infant position. Routine changing of the probe cover was reported by a number of nurses. Practices were influenced by individual knowledge, beliefs, and experience as well as by unit protocols, which varied widely.
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Affiliation(s)
- S Blackburn
- Department of Family and Child Nursing, University of Washington, Seattle 98198-7262, USA
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Nonato LB, Lund CH. Transepidermal water loss in the intensive care nursery: Measuring techniques and research recommendations. ACTA ACUST UNITED AC 2001. [DOI: 10.1053/nbin.2001.22121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
The goal of this study was to instrumentally evaluate the skin of healthy infants and to compare it to adult skin. A total of 70 infants, 45 girls and 25 boys, ages 8-24 months, and 30 healthy women were studied by means of transepidermal water loss (TEWL), capacitance, and pH measurements at two different skin sites, the volar forearm and the buttocks. No significant differences in TEWL were found between infants and adults, either on the buttocks or on the volar forearm. On the contrary, capacitance values were higher in infants. Their skin also appeared less acid than that of adults, with high statistical significance. No TEWL, capacitance, or pH variations were observed in infants according to sex and age. On the basis of the above data, the skin of infants 8-24 months of age shows functional signs of immaturity. This may lead to an increased permeability and a reduced capacity for defense against chemical and microbial aggression.
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Affiliation(s)
- F Giusti
- Department of Dermatology, University of Modena, Modena, Italy
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Lund CH, Kuller J, Lane AT, Lott JW, Raines DA, Thomas KK. Neonatal Skin Care: Evaluation of the AWHONN/NANN Research-Based Practice Project on Knowledge and Skin Care Practices. J Obstet Gynecol Neonatal Nurs 2001. [DOI: 10.1111/j.1552-6909.2001.tb01519.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lund CH, Osborne JW, Kuller J, Lane AT, Lott JW, Raines DA. Neonatal Skin Care: Clinical Outcomes of the AWHONN/NANN Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2001. [DOI: 10.1111/j.1552-6909.2001.tb01520.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Hoath SB, Narendran V. Adhesives and emollients in the preterm infant. SEMINARS IN NEONATOLOGY : SN 2000; 5:289-96. [PMID: 11032712 DOI: 10.1053/siny.2000.0015] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This chapter focuses on recent advances in preterm infant skin care related to skin adhesion and skin emolliency. Different types of adhesives and hydrating agents are reviewed. Clinical applications are best guided by understanding the biology of epidermal barrier development. The role of xeric stress in accelerating formation of the stratum corneum is discussed along with the effects of occlusive agents and emollients on wound healing and epidermal barrier repair. The principles of skin moisturization are introduced. The concept is advanced that programmatic changes in skin adhesion and water handling occur during the normal ontogeny of superficial biofilms (sebum, sweat, acid mantle).
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Affiliation(s)
- S B Hoath
- Skin Sciences Institute, Division of Neonatology, Children's Hospital Research Foundation, Cincinnati, Ohio 45267-0541, USA
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