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Ji F, Li D, Lyu T, Yang T, Yuan H, Huang X, Hu X. Iatrogenic skin injuries in infants admitted to neonatal intensive care units: An investigation in 22 Chinese units. J Tissue Viability 2024:S0965-206X(24)00033-0. [PMID: 38561302 DOI: 10.1016/j.jtv.2024.03.007] [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: 01/22/2024] [Revised: 02/28/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To investigate the incidence of iatrogenic skin injuries in neonates across 22 neonatal intensive care units (NICUs) in China. DESIGN Prospective study. SETTING 22 NICUs in China. PATIENTS Infants admitted to NICU. INTERVENTIONS None. MEASUREMENTS The "Iatrogenic Skin Injuries Data Collection Form of infants" were used to collect the data during hospitalization. MAIN RESULTS A total of 8126 neonates who were hospitalized in 22 tertiary hospitals across 15 provinces, cities, and autonomous regions of China between December 1, 2019 and January 31, 2020 were analyzed. Five hundred and twenty-one infants had iatrogenic skin injuries, including 250 with diaper dermatitis (47.98%), 70 with physicochemical factor-related skin lesions (PCFRSIs) (13.44%), 81 with medical device-related pressure injuries (MDRPIs) (15.55%), and 69 with medical adhesive-related skin injuries (MARSIs) (13.24%), accounting for 91% of the total number of iatrogenic injuries. Among these, diaper dermatitis was closely related to the skin and feeding status. Furthermore, the risk was higher among neonates who had skin damage upon admission or were already fully fed orally. The influencing factors of MDRPIs and MARSIs were similar. They were negatively associated with gestational age and birth weight, and were closely related to the presence of various tubes. CONCLUSIONS Diaper dermatitis, PCFRSIs, MDRPIs, and MARSIs were the four common types of iatrogenic skin injuries in newborns. The various types of iatrogenic skin injuries were influenced by varying factors. Specialized nursing measurements can reduce the likelihood of these injuries.
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Affiliation(s)
- Futing Ji
- Fujian Key Laboratory of Neonatal Diseases, Xiamen, 361006, China; Children's Hospital of Fudan University, Shanghai, 201102, China; Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, 361006, China; Key Laboratory of Neonatal Diseases, Xiamen, 361006, China
| | - Dan Li
- Fujian Key Laboratory of Neonatal Diseases, Xiamen, 361006, China; Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, 361006, China; Key Laboratory of Neonatal Diseases, Xiamen, 361006, China
| | - Tianchan Lyu
- Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Tongling Yang
- Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Hao Yuan
- Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Xianghui Huang
- Fujian Key Laboratory of Neonatal Diseases, Xiamen, 361006, China; Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, 361006, China; Key Laboratory of Neonatal Diseases, Xiamen, 361006, China.
| | - Xiaojing Hu
- Fujian Key Laboratory of Neonatal Diseases, Xiamen, 361006, China; Children's Hospital of Fudan University, Shanghai, 201102, China; Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, 361006, China; Key Laboratory of Neonatal Diseases, Xiamen, 361006, China.
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Ferreira EMC, Pereira ARDC, Montoito AIM, Curado MADS. Clinical validation of the Neonatal Skin Condition Score with Portuguese newborns. Rev Gaucha Enferm 2023; 44:e20220059. [PMID: 37377269 DOI: 10.1590/1983-1447.2023.20220059.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/29/2022] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE Clinically validate the Neonatal Skin Condition Score - Portuguese version with Portuguese newborns, verifying if the risk of skin injury in this population is influenced by their condition. METHOD Observational, cross-sectional and methodological study, conducted from 2018 to 2021. The Neonatal Skin Risk Assessment Scale - Portuguese version and Neonatal Skin Condition Score were used in data collection. Of the latter, content validation and sensitivity of the items were improved. MANOVA was used to evaluate whether the effect of independent variables (intrinsic and extrinsic factors) on dependent variables (score of both scales) was statistically significant. Non-random sampling (n=167). RESULTS The items showed good sensitivity. MANOVA revealed that the factors had a significant effect on the scores of the two scales. CONCLUSION The comparison of the scales shows clinical validity, revealing that better skin condition corresponds to a lower risk of injury, and the two scales can be applied concomitantly.
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Affiliation(s)
- Eva Madalena Canha Ferreira
- Centro Hospitalar de Lisboa Ocidental (CHLO), Hospital de São Francisco Xavier, Unidade de Neonatologia. Lisboa, Portugal
- Escola Superior de Enfermagem de Lisboa (ESEL), Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa. Lisboa, Portugal
| | - Ana Rita da Conceição Pereira
- Centro Hospitalar de Lisboa Ocidental (CHLO), Hospital de São Francisco Xavier, Unidade de Neonatologia. Lisboa, Portugal
- Escola Superior de Enfermagem de Lisboa (ESEL), Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa. Lisboa, Portugal
| | - Ana Isabel Morais Montoito
- Centro Hospitalar de Lisboa Ocidental (CHLO), Hospital de São Francisco Xavier, Unidade de Neonatologia. Lisboa, Portugal
- Escola Superior de Enfermagem de Lisboa (ESEL), Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa. Lisboa, Portugal
| | - Maria Alice Dos Santos Curado
- Escola Superior de Enfermagem de Lisboa (ESEL), Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa. Lisboa, Portugal
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Management of Pediatric Facial Burns with Zinc-Hyaluronan Gel. CHILDREN 2022; 9:children9070976. [PMID: 35883959 PMCID: PMC9323794 DOI: 10.3390/children9070976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
Zinc-hyaluronan-containing burn dressings have been associated with enhanced reepithelialization and low infection rates, although their effectiveness has not yet been investigated in pediatric facial thermal injuries. This single-arm, retrospective cohort study assessed the characteristics of 23 children (≤17-year-old) with facial superficial partial-thickness burns and the wound closure capabilities of the applied zinc-hyaluronan gel. Patients were admitted consecutively to the Pediatric Surgery Division in Pécs, Hungary, between 1 January 2016 and 15 October 2021. The mean age of the children was 6.2 years; 30.4% of them were younger than 1 year. An average of 3% total body surface was injured in the facial region and 47.8% of the patients had other areas damaged as well, most frequently the left upper limb (30.4%). The mean time until complete reepithelialization was 7.9 days and the children spent 2 days in the hospital. Wound cultures revealed normal bacterial growth in all cases and follow-up examinations found no hypertrophic scarring. In conclusion, pediatric facial superficial partial-thickness burns are prevalent during infancy and coincide with left upper limb injuries. Rapid wound closure and low complication rates are accountable for the moderate amount of hospitalization. These benefits, along with the gel’s ease of applicability and spontaneous separation, are linked to child-friendly burn care.
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Paediatric Partial-Thickness Burn Therapy: A Meta-Analysis and Systematic Review of Randomised Controlled Trials. Life (Basel) 2022; 12:life12050619. [PMID: 35629287 PMCID: PMC9144506 DOI: 10.3390/life12050619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 12/28/2022] Open
Abstract
Background: Paediatric second-degree burn injuries are a significant source of medical challenges to the population that may cause severe, lifelong complications. Currently, there are dozens of therapeutic modalities and we aimed to summarise their reported outcomes and determine their effectiveness, compared to the widely used silver sulphadiazine (SSD). Methods: We conducted the meta-analysis and systematic review of randomised controlled trials (RCTs), which investigated the performance of dressings in acute paediatric partial-thickness burns. The evaluated endpoints were time until wound closure, grafting and infection rate, number of dressing changes and length of hospitalisation. Results: Twenty-nine RCTs were included in the qualitative and 25 in the quantitative synthesis, but only three trials compared SSD directly to the same intervention (Biobrane). Data analysis showed a tendency for faster healing times and a reduced complication rate linked to biosynthetic, silver foam and amnion membrane dressings. A substantial difference was found between the number of dressing changes associated with less pain, narcosis and treatment duration. Conclusions: Considerable between-study heterogeneity was caused by the unequal depth subcategory ratio and surface area of the injuries; therefore, no significant difference was found in the main outcomes. Further research is necessary to establish the most effective treatment for these burns.
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Slagle C, Gist KM, Starr MC, Hemmelgarn TS, Goldstein SL, Kent AL. Fluid Homeostasis and Diuretic Therapy in the Neonate. Neoreviews 2022; 23:e189-e204. [PMID: 35229135 DOI: 10.1542/neo.23-3-e189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Understanding physiologic water balance and homeostasis mechanisms in the neonate is critical for clinicians in the NICU as pathologic fluid accumulation increases the risk for morbidity and mortality. In addition, once this process occurs, treatment is limited. In this review, we will cover fluid homeostasis in the neonate, explain the implications of prematurity on this process, discuss the complexity of fluid accumulation and the development of fluid overload, identify mitigation strategies, and review treatment options.
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Affiliation(s)
- Cara Slagle
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Katja M Gist
- Division of Cardiology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Michelle C Starr
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, IN
| | - Trina S Hemmelgarn
- Division of Pharmacology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Pharmacy, Cincinnati, OH
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Alison L Kent
- Department of Pediatrics, University of Rochester, NY, and Australian National University Medical School, Canberra, ACT, Australia
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