1
|
Visscher MO, Taleghani A, Nurre M, Meganathan K, Strange R, Kinnett M, Narendran V. Assessment of diaper dermatitis using a novel electronic health record-embedded scale. J Perinatol 2024; 44:501-507. [PMID: 37985814 DOI: 10.1038/s41372-023-01824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Quantify the evolution and severity of neonatal skin injury, specifically diaper skin compromise, by embedding a validated skin integrity evaluation into the electronic health record (EHR). METHODS Retrospective longitudinal cohort analysis of 747 patients stratified by gestation: 22-27, 28-31, 32-24, and 35-37 weeks, from birth to discharge. Primary outcomes were time to first perineal erythema, duration as percent days with erythema, and severity as maximum score. Data were analyzed using generalized linear models and multiple linear regression methods. RESULTS Seventy percent had erythema and, of these, 34% had at least one high score with bleeding. Days with erythema ranged from 34-44% (p < 0.05). Days to first erythema were inversely correlated with gestational age. Risks for severe injury included short time to first erythema, 5 or more stools/day, infection, and Caucasian race/ethnicity. CONCLUSIONS The EHR-based scale can be readily implemented to mitigate diaper skin compromise in premature infants.
Collapse
Affiliation(s)
- Marty O Visscher
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA.
| | - Afshin Taleghani
- Neonatal Intensive Care Unit, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Melissa Nurre
- Neonatal Intensive Care Unit, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Karthikeyan Meganathan
- College of Medicine, Department of Environmental and Public Health, University of Cincinnati, Cincinnati, OH, USA
| | - Ruthann Strange
- Neonatal Intensive Care Unit, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Melissa Kinnett
- Neonatal Intensive Care Unit, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Vivek Narendran
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
2
|
Burns HR, Yim NH, Dibbs RP, Ferry AM, Belfort MA, Buchanan EP. A Unique Case of Intrauterine Pressure Injury. Adv Skin Wound Care 2023; 36:667-671. [PMID: 37983580 DOI: 10.1097/asw.0000000000000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
ABSTRACT The authors present a review of the literature regarding pressure injuries (PIs) in neonates and a case of a newborn who developed a PI following a prolonged labor process and fetal malposition. A girl born at 35 weeks' gestation to a 34-year-old gravida 7 para 6 mother with a medical history of untreated gestational diabetes, preeclampsia, and COVID-19 was delivered via cesarean section after failure to progress through labor. The premature infant was found to have a 3.2 × 2.3-cm PI at the nape of the posterior neck. Premature infants have a histologically proven, age-dependent decreased thickness of their stratum corneum, epidermis, and dermis, which places them at increased risk of developing PIs that can be painful and lead to infection. In the present case, the neonate's congenital PI was successfully treated with medical-grade honey for approximately a month.
Collapse
Affiliation(s)
- Heather R Burns
- In the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, Heather R. Burns, BA, is a Research Fellow; Nicolas H. Yim, BA, is Research Fellow; and Rami P. Dibbs, MD, and Andrew M. Ferry, MD, are Plastic Surgery Residents. At Texas Children's Hospital, Houston, Michael A. Belfort, MD, PhD, is Obstetrician/Gynecologist-in-Chief and Chair of Obstetrics and Gynecology and Edward P. Buchanan, MD, is Chief of Plastic Surgery. The authors have disclosed no financial relationships related to this article. Submitted August 29, 2022; accepted in revised form December 22, 2022
| | | | | | | | | | | |
Collapse
|
3
|
Lucaciu SA, Figliuzzi R, Neumann R, Nazarali S, Del Sordo L, Leighton SE, Hauser A, Shao Q, Johnston D, Bai D, Laird DW. GJB4 variants linked to skin disease exhibit a trafficking deficiency en route to gap junction formation that can be restored by co-expression of select connexins. Front Cell Dev Biol 2023; 11:1073805. [PMID: 36861039 PMCID: PMC9968944 DOI: 10.3389/fcell.2023.1073805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/01/2023] [Indexed: 02/15/2023] Open
Abstract
Epidermal keratinocytes are enriched with at least nine connexins that are key regulators of epidermal homeostasis. The role of Cx30.3 in keratinocytes and epidermal health became evident when fourteen autosomal dominant mutations in the Cx30.3-encoding GJB4 gene were linked to a rare and incurable skin disorder called erythrokeratodermia variabilis et progressiva (EKVP). While these variants are linked to EKVP, they remain largely uncharacterized hindering therapeutic options. In this study, we characterize the expression and functional status of three EKVP-linked Cx30.3 mutants (G12D, T85P, and F189Y) in tissue-relevant and differentiation-competent rat epidermal keratinocytes. We found that GFP-tagged Cx30.3 mutants were non-functional likely due to their impaired trafficking and primary entrapment within the endoplasmic reticulum (ER). However, all mutants failed to increase BiP/GRP78 levels suggesting they were not inducing an unfolded protein response. FLAG-tagged Cx30.3 mutants were also trafficking impaired yet occasionally exhibited some capacity to assemble into gap junctions. The pathological impact of these mutants may extend beyond their trafficking deficiencies as keratinocytes expressing FLAG-tagged Cx30.3 mutants exhibited increased propidium iodide uptake in the absence of divalent cations. Attempts to rescue the delivery of trafficking impaired GFP-tagged Cx30.3 mutants into gap junctions by chemical chaperone treatment were ineffective. However, co-expression of wild type Cx30.3 greatly enhanced the assembly of Cx30.3 mutants into gap junctions, although endogenous levels of Cx30.3 do not appear to prevent the skin pathology found in patients harboring these autosomal dominant mutations. In addition, a spectrum of connexin isoforms (Cx26, Cx30, and Cx43) exhibited the differential ability to trans-dominantly rescue the assembly of GFP-tagged Cx30.3 mutants into gap junctions suggesting a broad range of connexins found in keratinocytes may favourably interact with Cx30.3 mutants. We conclude that selective upregulation of compatible wild type connexins in keratinocytes may have potential therapeutic value in rescuing epidermal defects invoked by Cx30.3 EKVP-linked mutants.
Collapse
Affiliation(s)
- Sergiu A. Lucaciu
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada,Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - Rhett Figliuzzi
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Ruth Neumann
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Samina Nazarali
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Luigi Del Sordo
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada,Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - Stephanie E. Leighton
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Alexandra Hauser
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Qing Shao
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Danielle Johnston
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada
| | - Donglin Bai
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - Dale W. Laird
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, Canada,Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada,*Correspondence: Dale W. Laird,
| |
Collapse
|
4
|
Exploring Environmental Factors Contributing to Fluid Loss in Diapers Placed in Neonatal Incubators. Adv Neonatal Care 2022; 23:192-199. [PMID: 36191332 DOI: 10.1097/anc.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Assessing fluid output for infants in the neonatal intensive care unit is essential to understanding fluid and electrolyte balance. Wet diaper weights are used as standard practice to quantify fluid output; yet, diaper changes are intrusive and physiologically distressing. Less frequent diaper changes may have physiologic benefits but could alter diaper weights following extended intervals. METHODS This pilot study examined the impact of initial diaper fluid volume, incubator air temperature and humidity, and diaper brand on wet diaper weight over time. Baseline fluid volume was instilled, and then diapers were placed in a neonatal incubator. Wet diaper weight was assessed longitudinally to determine changes in fluid volume over time. A factorial design with repeated measures (baseline, 3 hours, and 6 hours) was used to explore the effects of diaper brand (brand 1 vs brand 2), baseline fluid volume (3 mL vs 5 mL), and incubator temperature (28°C vs 36°C) and humidity (40% vs 80%) on the trajectory of weight in 80 diapers. RESULTS Wet diaper weight was significantly reduced over 6 hours (P < .005). However, wet diaper weight increased in 80% humidity, but decreased in the 40% humidity over time (P < .0001). Baseline fluid volume, incubator temperature, and diaper brand did not influence wet diaper weight over time (all P > .05). IMPLICATIONS Understanding environmental factors that influence the trajectory of wet diaper weight may support clinicians in optimizing the interval for neonatal diaper changes to balance the impact of intrusive care with need to understand fluid volume loss.
Collapse
|
5
|
Visscher MO, Carr AN, Narendran V. Epidermal Immunity and Function: Origin in Neonatal Skin. Front Mol Biosci 2022; 9:894496. [PMID: 35755808 PMCID: PMC9215705 DOI: 10.3389/fmolb.2022.894496] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022] Open
Abstract
The fascinating story of epidermal immunity begins in utero where the epidermal barrier derives from the ectoderm and evolves through carefully orchestrated biological processes, including periderm formation, keratinocyte differentiation, proliferation, cornification, and maturation, to generate a functional epidermis. Vernix caseosa derives from epidermal cells that mix with sebaceous lipids and coat the fetus during late gestation, likely to provide conditions for cornification. At birth, infants dramatically transition from aqueous conditions to a dry gaseous environment. The epidermal barrier begins to change within hours, exhibiting decreased hydration and low stratum corneum (SC) cohesion. The SC varied by gestational age (GA), transformed over the next 2–3 months, and differed considerably versus stable adult skin, as indicated by analysis of specific protein biomarkers. Regardless of gestational age, the increased infant SC proteins at 2–3 months after birth were involved in late differentiation, cornification, and filaggrin processing compared to adult skin. Additionally, the natural moisturizing factor (NMF), the product of filaggrin processing, was higher for infants than adults. This suggests that neonatal skin provides innate immunity and protection from environmental effects and promotes rapid, continued barrier development after birth. Functional genomic analysis showed abundant differences across biological processes for infant skin compared to adult skin. Gene expression for extracellular matrix, development, and fatty acid metabolism was higher for infant skin, while adult skin had increased expression of genes for the maintenance of epidermal homeostasis, antigen processing/presentation of immune function, and others. These findings provide descriptive information about infant epidermal immunity and its ability to support the newborn’s survival and growth, despite an environment laden with microbes, high oxygen tension, and irritants.
Collapse
Affiliation(s)
- Marty O Visscher
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, United States
| | - Andrew N Carr
- The Procter and Gamble Company, Cincinnati, OH, United States
| | - Vivek Narendran
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| |
Collapse
|
6
|
Kim JG, Kang HY, Kim MJ, Lim S, Lee CJ, Kim KM, Jung SK. 4-phenylpyridine suppresses UVB-induced skin inflammation by targeting c-Src in vitro and in vivo. J Cell Mol Med 2022; 26:3891-3901. [PMID: 35686492 PMCID: PMC9279582 DOI: 10.1111/jcmm.17422] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/11/2022] [Accepted: 05/20/2022] [Indexed: 11/27/2022] Open
Abstract
Acute or repetitive exposure to ultraviolet (UV) cause disruptions to the skin barrier and subsequent inflammatory skin disease. 4‐phenylpyridine (4‐PP) is a constituent of Brassica campestris L. ssp. Pekinensis and its effect on skin inflammation and molecular target remain unclear. The purpose of this study is to confirm the anti‐inflammatory efficacy of 4‐PP on UVB‐induced skin inflammation in human keratinocytes HaCaT and mouse skin and validation of its molecular target. 4‐PP also attenuated UVB‐induced phosphorylation of p38/mitogen‐activated protein kinase kinase (MKK) 3/6, c‐Jun N‐terminal kinase 1/2, MKK 4/7, extracellular‐signal‐regulated kinase 1/2, mitogen‐activated protein kinase 1/2. Additionally, 4‐PP inhibited UVB‐induced phosphorylation of epidermal growth factor receptor (EGFR) Y1068, Y1045 and 854 residues but not the proto‐oncogene tyrosine‐protein kinase c‐Src. Drug affinity responsive target stability assay revealed that 4‐PP directly binds to c‐Src and inhibits pronase c‐proteolysis. Knockdown of c‐Src inhibited UVB‐induced COX‐2 expression and phosphorylation of MAPKs and EGFR in HaCaT cells. Dorsal treatment of 4‐PP prevented UVB (0.5 J/cm2)‐induced skin thickness, phosphorylation of EGFR and COX‐2 expression in mouse skin. Our findings suggest that 4‐PP can be used as anti‐inflammatory agent with an effect of skin inflammation by inhibiting the COX‐2 expression via suppressing the c‐Src/EGFR/MAPKs signalling pathway.
Collapse
Affiliation(s)
- Ju Gyeong Kim
- School of Food Science and Biotechnology, Kyungpook National University, Daegu, Korea
| | - Ha Yeong Kang
- School of Food Science and Biotechnology, Kyungpook National University, Daegu, Korea
| | - Min Jeong Kim
- School of Food Science and Biotechnology, Kyungpook National University, Daegu, Korea
| | - Seokwon Lim
- Department of Food Science and Biotechnology, Gachon University, Seongnam-si, Gyeonggi-do, Korea
| | - Chang Joo Lee
- Department of Food Science and Biotechnology, Wonkwang University, Iksan, Korea
| | - Kyung-Min Kim
- School of Applied Biosciences, Kyungpook National University, Daegu, Korea
| | - Sung Keun Jung
- School of Food Science and Biotechnology, Kyungpook National University, Daegu, Korea.,Research Institute of Tailored Food Technology, Kyungpook National University, Daegu, Korea
| |
Collapse
|
7
|
de Bengy AF, Lamartine J, Sigaudo-Roussel D, Fromy B. Newborn and elderly skin: two fragile skins at higher risk of pressure injury. Biol Rev Camb Philos Soc 2022; 97:874-895. [PMID: 34913582 DOI: 10.1111/brv.12827] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
Skin is a key organ maintaining internal homeostasis by performing many functions such as water loss prevention, body temperature regulation and protection from noxious substance absorption, microorganism intrusion and physical trauma. Skin ageing has been well studied and it is well known that physiological changes in the elderly result in higher skin fragility favouring the onset of skin diseases. For example, prolonged and/or high-intensity pressure may suppress local blood flow more easily, disturbing cell metabolism and inducing pressure injury (PI) formation. Pressure injuries (PIs) represent a significant problem worldwide and their prevalence remains too high. A higher PI prevalence is correlated with an elderly population. Newborn skin evolution has been less studied, but some data also report a higher PI prevalence in this population compared to older children, and several authors also consider this skin as physiologically fragile. In this review, we compare the characteristics of newborn and elderly skin in order to determine common features that may explain their fragility, especially regarding PI risk. We show that, despite differences in appearance, they share many common features leading to higher fragility to shear and pressure forces, not only at the structural level but also at the cellular and molecular level and in terms of physiology. Both newborn and elderly skin have: (i) a thinner epidermis; (ii) a thinner dermis containing a less-resistant collagen network, a higher collagen III:collagen I ratio and less elastin; (iii) a flatter dermal-epidermal junction (DEJ) with lower anchoring systems; and (iv) a thinner hypodermis, resulting in lower mechanical resistance to skin damage when pressure or shear forces are applied. At the molecular level, reduced expression of transforming growth factor β (TGFβ) and its receptor TGFβ receptor II (TβRII) is involved in the decreased production and/or increased degradation of various dermal extracellular matrix (ECM) components. Epidermal fragility also involves a higher skin pH which decreases the activity of key enzymes inducing ceramide deficiency and reduced barrier protection. This seems to be correlated with higher PI prevalence in some situations. Some data also suggest that stratum corneum (SC) dryness, which may disturb cell metabolism, also increases the risk of PI formation. Besides this structural fragility, several skin functions are also less efficient. Low applied pressures induce skin vessel vasodilation via a mechanism called pressure-induced vasodilation (PIV). Individuals lacking a normal PIV response show an early decrease in cutaneous blood flow in response to the application of very low pressures, reflecting vascular fragility of the skin that increases the risk of ulceration. Due to changes in endothelial function, skin PIV ability decreases during skin ageing, putting it at higher risk of PI formation. In newborns, some data lead us to hypothesize that the nitric oxide (NO) pathway is not fully functional at birth, which may partly explain the higher risk of PI formation in newborns. In the elderly, a lower PIV ability results from impaired functionality of skin innervation, in particular that of C-fibres which are involved in both touch and pain sensation and the PIV mechanism. In newborns, skin sensitivity differs from adults due to nerve system immaturity, but the role of this in PIV remains to be determined.
Collapse
Affiliation(s)
| | - Jérôme Lamartine
- Univ. Lyon, Université Claude Bernard Lyon 1, CNRS, LBTI UMR5305, 7 Passage du Vercors, Lyon Cedex 7, F- 69367, France
| | - Dominique Sigaudo-Roussel
- Univ. Lyon, Université Claude Bernard Lyon 1, CNRS, LBTI UMR5305, 7 Passage du Vercors, Lyon Cedex 7, F- 69367, France
| | - Bérengère Fromy
- Univ. Lyon, Université Claude Bernard Lyon 1, CNRS, LBTI UMR5305, 7 Passage du Vercors, Lyon Cedex 7, F- 69367, France
| |
Collapse
|
8
|
Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care 2022; 31:S1-S72. [PMID: 35616340 DOI: 10.12968/jowc.2022.31.sup3a.s1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Guido Ciprandi
- Chief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Peter Worsley
- Associate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor, College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Clinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, Sweden
| | | | | | - Nils A Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, Switzerland
| |
Collapse
|
9
|
Branagan A, Costigan CS, Stack M, Slagle C, Molloy EJ. Management of Acute Kidney Injury in Extremely Low Birth Weight Infants. Front Pediatr 2022; 10:867715. [PMID: 35433560 PMCID: PMC9005741 DOI: 10.3389/fped.2022.867715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 12/11/2022] Open
Abstract
Acute kidney injury (AKI) is a common problem in the neonatal intensive care unit (NICU). Neonates born at <1,000 g (extremely low birth weight, ELBW) are at an increased risk of secondary associated comorbidities such as intrauterine growth restriction, prematurity, volume restriction, ischaemic injury, among others. Studies estimate up to 50% ELBW infants experience at least one episode of AKI during their NICU stay. Although no curative treatment for AKI currently exists, recognition is vital to reduce potential ongoing injury and mitigate long-term consequences of AKI. However, the definition of AKI is imperfect in this population and presents clinical challenges to correct identification, thus contributing to under recognition and reporting. Additionally, the absence of guidelines for the management of AKI in ELBW infants has led to variations in practice. This review summarizes AKI in the ELBW infant and includes suggestions such as close observation of daily fluid balance, review of medications to reduce nephrotoxic exposure, management of electrolytes, maximizing nutrition, and the use of diuretics and/or dialysis when appropriate.
Collapse
Affiliation(s)
- Aoife Branagan
- Paediatrics, Trinity Research in Childhood Centre (TRICC), Trinity College Dublin, Dublin, Ireland.,Neonatology, Coombe Women's and Infants University Hospital, Dublin, Ireland
| | - Caoimhe S Costigan
- Nephrology, Children's Health Ireland (CHI) at Crumlin & Temple Street, Dublin, Ireland
| | - Maria Stack
- Paediatrics, Trinity Research in Childhood Centre (TRICC), Trinity College Dublin, Dublin, Ireland.,Nephrology, Children's Health Ireland (CHI) at Crumlin & Temple Street, Dublin, Ireland
| | - Cara Slagle
- Division of Neonatology & Pulmonary Biology and the Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,The University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Eleanor J Molloy
- Paediatrics, Trinity Research in Childhood Centre (TRICC), Trinity College Dublin, Dublin, Ireland.,Neonatology, Coombe Women's and Infants University Hospital, Dublin, Ireland.,Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland.,Neonatology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| |
Collapse
|
10
|
Abstract
BACKGROUND Breakdown of the developmentally immature epidermal barrier may permit entry for micro-organisms leading to invasive infection in preterm infants. Topical emollients may improve skin integrity and barrier function and thereby prevent invasive infection, a major cause of mortality and morbidity in preterm infants. OBJECTIVES To assess the effect of topical application of emollients (ointments, creams, or oils) on the risk of invasive infection and mortality in preterm infants. SEARCH METHODS We searched CENTRAL via Cochrane Register of Studies (CRS) Web and MEDLINE via Ovid (updated 08 January 2021) and the reference lists of retrieved articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials that assessed the effect of prophylactic application of topical emollient on the risk of invasive infection, mortality, other morbidity, and growth and development in preterm infants. DATA COLLECTION AND ANALYSIS We used the standard methods of Cochrane Neonatal. Two review authors separately evaluated trial quality, extracted data, and synthesised effect estimates using risk ratio (RR), risk difference (RD), and mean difference. We used the GRADE approach to assess the certainty of evidence for effects on mortality and invasive infection. MAIN RESULTS We included 22 trials with a total of 5578 infant participants. The main potential sources of bias were lack of clarity on the methods used to generate random sequences and conceal allocation in half of the trials, and lack of masking of parents, caregivers, clinicians, and investigators in all of the trials. Eight trials (2086 infants) examined the effect of topical ointments or creams. Most participants were very preterm infants cared for in healthcare facilities in high-income countries. Meta-analyses suggested that topical ointments or creams may have little or no effect on invasive infection (RR 1.13, 95% confidence interval (CI) 0.97 to 1.31; low certainty evidence) or mortality (RR 0.94, 95% CI 0.82 to 1.08; low certainty evidence). Fifteen trials (3492 infants) assessed the effect of topical plant or vegetable oils. Most of these trials were undertaken in low- or middle-income countries and were based in healthcare facilities. One large (2249 infants) community-based trial occurred in a rural field practice in India. Meta-analyses suggested that topical oils may reduce invasive infection (RR 0.71, 95% CI 0.52 to 0.96; I² = 52%; low certainty evidence) but have little or no effect on mortality (RR 0.94, 95% CI 0.82 to 1.08, I² = 3%; low certainty evidence). One trial (316 infants) that compared petroleum-based ointment versus sunflower seed oil in very preterm infants in Bangladesh showed little or no effect on invasive infection (RR 0.91, 95% CI 0.57 to 1.46; low certainty evidence), but suggested that ointment may lower mortality slightly (RR 0.82, 95% CI 0.68 to 0.98; RD -0.12, 95% CI -0.23 to -0.01; number needed to treat for an additional beneficial outcome 8, 95% CI 4 to 100; low certainty evidence). One trial (64 infants) that assessed the effect of coconut oil versus mineral oil in preterm infants with birth weight 1500 g to 2000 g in India reported no episodes of invasive infection or death in either group (very low certainty evidence). AUTHORS' CONCLUSIONS The level of certainty about the effects of emollient therapy on invasive infection or death in preterm infants is low. Since these interventions are mostly inexpensive, readily accessible, and generally acceptable, further good-quality randomised controlled trials in healthcare facilities, and in community settings in low- or middle-income countries, may be justified.
Collapse
Affiliation(s)
- Jemma Cleminson
- Centre for Reviews and Dissemination, University of York, York, UK
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, UK
| |
Collapse
|
11
|
Visscher MO, Carr AN, Winget J, Huggins T, Bascom CC, Isfort R, Lammers K, Narendran V. Biomarkers of neonatal skin barrier adaptation reveal substantial differences compared to adult skin. Pediatr Res 2021; 89:1208-1215. [PMID: 32599611 PMCID: PMC8119241 DOI: 10.1038/s41390-020-1035-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND The objective of this study was to measure skin characteristics in premature (PT), late preterm (LPT), and full-term (FT) neonates compared with adults at two times (T1, T2). METHODS Skin samples of 61 neonates and 34 adults were analyzed for protein biomarkers, natural moisturizing factor (NMF), and biophysical parameters. Infant groups were: <34 weeks (PT), 34-<37 weeks (LPT), and ≥37 weeks (FT). RESULTS Forty proteins were differentially expressed in FT infant skin, 38 in LPT infant skin, and 12 in PT infant skin compared with adult skin at T1. At T2, 40 proteins were differentially expressed in FT infants, 38 in LPT infants, and 54 in PT infants compared with adults. All proteins were increased at both times, except TMG3, S100A7, and PEBP1, and decreased in PTs at T1. The proteins are involved in filaggrin processing, protease inhibition/enzyme regulation, and antimicrobial function. Eight proteins were decreased in PT skin compared with FT skin at T1. LPT and FT proteins were generally comparable at both times. Total NMF was lower in infants than adults at T1, but higher in infants at T2. CONCLUSIONS Neonates respond to the physiological transitions at birth by upregulating processes that drive the production of lower pH of the skin and water-binding NMF components, prevent protease activity leading to desquamation, and increase the barrier antimicrobial properties. IMPACT Neonates respond to the transitions at birth by upregulating processes that drive the production of lower pH of the skin and NMF, prevent protease activity leading to desquamation, and increase the antimicrobial properties of the barrier. The neonatal epidermal barrier exhibits a markedly different array of protein biomarkers both shortly after birth and 2-3 months later, which are differentially expressed versus adults. The major biomarker-functional classes included filaggrin processing, protease inhibitor/enzyme regulators, antimicrobials, keratins, lipids, and cathepsins. The findings will guide improvement of infant skin care practices, particularly for the most premature infants with the ultimate goals mitigating nosocomial infection.
Collapse
Affiliation(s)
- Marty O Visscher
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA.
| | | | - Jason Winget
- The Procter & Gamble Company, Cincinnati, OH, USA
| | | | | | | | - Karen Lammers
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Vivek Narendran
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
12
|
Visscher MO, Carr AN, Narendran V. Premature infant skin barrier maturation: status at full-term corrected age. J Perinatol 2021; 41:232-239. [PMID: 32493903 DOI: 10.1038/s41372-020-0704-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/02/2020] [Accepted: 05/22/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the effects of gestational age (GA) and postnatal age on skin barrier integrity by comparing premature infants at full-term corrected age with infants born at term. STUDY DESIGN Parallel comparison of chest skin in 36 premature infants with 39 full-term infants using daily measures of transepidermal water loss (TEWL), skin pH, erythema and rash, over 2 weeks. RESULT Chest skin pH was significantly lower for premature infants, indicating that acid mantle formation had occurred in the premature versus full-term infants. Chest TEWL was significantly higher for premature versus full-term infants over 2 weeks, suggesting that even 7-8 weeks after birth, skin integrity is poorer in premature infants. CONCLUSION Skin barrier properties of premature infants at adjusted full-term age differ from full-term infants, suggesting that epidermal barrier development depends on GA and time from birth. These maturational differences may influence premature infant response to topical agents.
Collapse
Affiliation(s)
- Marty O Visscher
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | | | - Vivek Narendran
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
13
|
Pressure Injuries of the Nose and Columella in Preterm Neonates Receiving Noninvasive Ventilation via a Specialized Nasal Cannula: A Retrospective Comparison Cohort Study. J Wound Ostomy Continence Nurs 2020; 47:111-116. [PMID: 32084101 DOI: 10.1097/won.0000000000000616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this study were to measure the incidence and severity of nasal septum injury in premature infants receiving continuous positive airway pressure (CPAP) via a noninvasive thin-walled cannula, and to evaluate the effect of a polyvinyl chloride foam barrier dressing in reducing these injuries. DESIGN Retrospective chart review, comparison cohort study. SUBJECTS AND SETTING The sample comprised 235 neonates with a gestational age of 28 weeks or younger. Their mean gestational age was 26 weeks (range 22-28 weeks) and mean birth weight was 840 g (range 430-1320 g). The study setting was a level 4, regional neonatal intensive care unit housed in a 200-bed freestanding children's hospital located in the Northeastern United States. METHODS Data were collected during 3 periods. During all 3 data collection periods, we used a soft, thin-walled nasal cannula, with a relatively short, binasal prong interphase and small diameter tubing connected to a ventilator circuit capable of transmitting positive airway pressure in neonates. During data collection periods 1 and 3, we used a polyvinyl foam barrier dressing as a preventive intervention against nasal skin damage; specifically, we placed a precut barrier on the prongs to protect the nasal skin. One side of the barrier foam has an adhesive surface, which was placed against the prongs. Study period 2 differed; during this period neonates were treated with the nasal cannula without the foam barrier based on manufacturer experience suggesting the foam barrier is not needed for prevention of skin damage. Pressure injuries (PIs) that occurred during each study period were staged according to National Pressure Ulcer Advisory Panel definitions. RESULTS Eighty neonates were evaluated during study period 1 (thin-walled nasal cannula plus foam barrier). We evaluated 27 neonates during period 2 (thin-walled nasal cannula and no foam barrier) and 128 were evaluated during study period 3 (thin-walled nasal cannula plus foam barrier). Six neonates (7%) developed PIs during period 1, and 2 (1.5%) developed during study period 3. All were stage 1 and 2 PIs, no full-thickness injuries, also referred to as columella necrosis developed during use of the thin-walled nasal cannula in combination with the foam barrier dressings. In contrast, 13 PIs (48%) of neonates managed during data collection period 2 (thin-walled nasal cannula with no foam barrier) developed PI, and 40% experienced stage 3 PI or columella necrosis. This difference reflects a 6-fold increase in nasal injury occurred when nasal continuous positive airway pressure (NCPAP) was administered without use of the protective barrier dressing. CONCLUSION We found clinically relevant difference in the occurrences of nasal PI in neonates managed with NCPAP; occurrences of stage 3 PI were 6-fold higher when a thin-walled cannula was used without a protective foam barrier dressing.
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. J Wound Care 2020; 29:S1-S52. [DOI: 10.12968/jowc.2020.29.sup2a.s1] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, the Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator Wounds Research Laboratory, Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Portugal
| | - Guido Ciprandi
- Chief Wound Care Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu’ Children’s Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing, Joint appointment, Intensive Care Services, Royal Brisbane and Women’s Hospital and School of Nursing, Queensland University of Technology, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Japan
| | - Nicola Waters
- Associate Professor, School of Nursing, thompson Rivers University, Kamloops, British Columbia, Canada
| | - Peter Worsley
- Assistant Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor at College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Skin Integrity Lead, Sydney Local Health District; Clinical Senior Lecturer, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor of Skin Integrity and Clinical Nursing, Ghent University, Ghent, Belgium
| | | | | | - Nils A. Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, University Grenoble Alps, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner in Paediatric Skin and Wound Management and Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children’s Hospital Zurich, Switzerland
| |
Collapse
|
16
|
Summers A, Visscher MO, Khatry SK, Sherchand JB, LeClerq SC, Katz J, Tielsch JM, Mullany LC. Impact of sunflower seed oil versus mustard seed oil on skin barrier function in newborns: a community-based, cluster-randomized trial. BMC Pediatr 2019; 19:512. [PMID: 31870338 PMCID: PMC6927111 DOI: 10.1186/s12887-019-1871-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/03/2019] [Indexed: 01/26/2023] Open
Abstract
Background Natural vegetable oils are widely used for newborn massage in many low resource settings. Animal models indicated that sunflower seed oil (SSO) can accelerate skin barrier recovery following damage, while other oils, including mustard oil (MO), may cause further skin barrier damage. The objective was to compare the effects of two SSO and MO used for routine massage on skin integrity in premature and full-term neonates. Methods This community-based cluster randomized controlled trial included 995 neonates assigned to full body massage with sunflower seed oil (SSO, intervention) or mustard seed oil (MO, standard practice) from July 2012–May 2014 in Sarlahi, Nepal. Skin integrity measures were evaluated over 28 days, including skin condition (erythema, rash, dryness), skin surface pH, stratum corneum (SC) cohesion/protein concentration, and transepidermal water loss (TEWL). Overall means and rates of change in these skin measures were compared between oil groups using bivariate random-effects models. Results 500 and 495 live born neonates received repeated massage with MO and SSO, respectively. Skin pH decreased more quickly for SSO than MO in the first week of life, with a difference in mean daily reductions of 0.02 (95% CI: 0.002–0.040). Erythema, rash and dryness increased (worsened) over days 1–14 then decreased by day 28, with no significant oil group differences. TEWL increased over time, with no significant oil group differences. Gestational age did not modify the effect; the slightly faster decrease in skin pH among SSO infants was similar in magnitude between term and preterm infants. Conclusions Oil type may contribute to differences in skin integrity when neonates are massaged regularly. The more rapid acid mantle development observed for SSO may be protective for neonates in lower resource settings. Trial registration ClinicalTrials.gov (NCT01177111); registered August 6th, 2010.
Collapse
Affiliation(s)
- Aimee Summers
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W5009, Baltimore, MD, 21205, USA
| | - Marty O Visscher
- Skin Sciences Program, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Subarna K Khatry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W5009, Baltimore, MD, 21205, USA.,Nepal Nutrition Intervention Project-Sarlahi (NNIPS), Kathmandu, Nepal
| | - Jeevan B Sherchand
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj Rd, Kathmandu, 44600, Nepal
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W5009, Baltimore, MD, 21205, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W5009, Baltimore, MD, 21205, USA
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W5009, Baltimore, MD, 21205, USA.
| |
Collapse
|
17
|
McCarthy R, Martin-Fairey C, Sojka DK, Herzog ED, Jungheim ES, Stout MJ, Fay JC, Mahendroo M, Reese J, Herington JL, Plosa EJ, Shelton EL, England SK. Mouse models of preterm birth: suggested assessment and reporting guidelines. Biol Reprod 2019; 99:922-937. [PMID: 29733339 PMCID: PMC6297318 DOI: 10.1093/biolre/ioy109] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/30/2018] [Indexed: 02/03/2023] Open
Abstract
Preterm birth affects approximately 1 out of every 10 births in the United States, leading to high rates of mortality and long-term negative health consequences. To investigate the mechanisms leading to preterm birth so as to develop prevention strategies, researchers have developed numerous mouse models of preterm birth. However, the lack of standard definitions for preterm birth in mice limits our field's ability to compare models and make inferences about preterm birth in humans. In this review, we discuss numerous mouse preterm birth models, propose guidelines for experiments and reporting, and suggest markers that can be used to assess whether pups are premature or mature. We argue that adoption of these recommendations will enhance the utility of mice as models for preterm birth.
Collapse
Affiliation(s)
- Ronald McCarthy
- Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carmel Martin-Fairey
- Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dorothy K Sojka
- Rheumatology Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Erik D Herzog
- Department of Biology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Emily S Jungheim
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Molly J Stout
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Justin C Fay
- Department of Biology, University of Rochester, Rochester, New York, USA
| | - Mala Mahendroo
- Department of Obstetrics and Gynecology University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jeff Reese
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer L Herington
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Erin J Plosa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elaine L Shelton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah K England
- Center for Reproductive Health Sciences, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
18
|
Topical application of coconut oil to the skin of preterm infants: a systematic review. Eur J Pediatr 2019; 178:1317-1324. [PMID: 31267223 DOI: 10.1007/s00431-019-03407-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Abstract
Preterm infants are at risk of increased trans-epidermal water loss and infections due to epidermal immaturity. The emollient and anti-infective properties of coconut oil make it a potentially beneficial topical agent for this population. We aimed to systematically review randomised trials assessing the effects of topical coconut oil in preterm infants. Medline, EMBASE, Cochrane Central Register of Controlled Trials and CINAHL were searched. Seven trials (n = 727 infants) were included. The majority of trials included relatively mature infants (gestation > 32 weeks, birth weight > 1200 g). The duration of intervention (5-31 days) and outcomes of interest varied among included studies. Meta-analysis using random effects model found significantly lower incidence of hospital-acquired blood stream infections (HABSI) in the coconut oil group (11/164 vs 32/166; relative risk 0.35, 95% confidence interval 0.18, 0.67, p = 0.001; I2 = 0%, two RCTs). Overall, infants in the coconut oil group had decreased water loss, decreased infection rates, better growth and skin condition. There were no significant adverse effects associated with coconut oil application. The overall quality of evidence was considered moderate for the outcome of HABSI and low for the outcome of physical growth based on GRADE guidelines.Conclusion: Topical coconut oil application to the skin may be beneficial in preterm infants, but the quality of evidence is low to moderate. Adequately powered randomised controlled trials, especially in very preterm (< 32 weeks) and extremely preterm (< 28 weeks) infants, are needed. What is Known: • Coconut oil has been used traditionally for topical application in terms of infants in Asian countries What is New: • This systematic review found that topical application of coconut oil may reduce the risk of infection and improve weight gain and skin condition in preterm infants. However, the quality of evidence was considered to be moderate to low based on GRADE guidelines.
Collapse
|
19
|
Naha N, Pournami F, Prabhakar J, Jain N. Nasal Injury with Continuous Positive Airway Pressure: Need for "Privileging" Nursing Staff. Indian J Pediatr 2019; 86:595-598. [PMID: 31020593 DOI: 10.1007/s12098-019-02960-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 04/09/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Use of continuous positive airway pressure (CPAP) in neonates is associated with nasal injury (NI) for which various risk factors related to the neonatal characteristics and properties of interfaces used have been reported. "Privileging" of nursing staff may influence safety and incidence of adverse events. In this prospective cohort study, authors studied the incidence of NI and risk factors for NI in babies requiring CPAP after privileging staff for CPAP care bundles. METHODS All neonates on CPAP over a 6-mo period were included. Standard operating procedures were formulated and staff of NICU (nurses and doctors) were educated at the start of the study and periodically in 6 comprehensive areas of care- encompassing position of head, prongs and cap; nasal suctioning and interruptions in pressure on the nose. The staff who completed the training and evaluation were declared as "privileged". NI (measured by a standard staging) and risk factors were predefined and studied. RESULTS Of the 51 babies who required respiratory supports, 35 required CPAP care. Nine babies (25%) out of 35 who required CPAP had NI (2, 4, 3 babies had stages 1, II and III of NI respectively). Seventy seven percent of babies were cared for by privileged nurses. NI was significantly higher when cared for by non-privileged staff (66% vs. 11%, unadjusted RR = 6.75, 95%CI 2.16-21.09). All other risk factors were not significant. CONCLUSIONS NI was noted in 25% neonates on CPAP, and those cared for by non-privileged staff had higher chances of NI. Quality processes and emphasis on continued monitoring and evaluation of nursing skills may help prevent these untoward complications.
Collapse
Affiliation(s)
- Nihaz Naha
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, 695029, India
| | - Femitha Pournami
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, 695029, India.
| | - Jyothi Prabhakar
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, 695029, India
| | - Naveen Jain
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, 695029, India
| |
Collapse
|
20
|
Vongsa R, Rodriguez K, Koenig D, Cunningham C. Benefits of Using an Appropriately Formulated Wipe to Clean Diapered Skin of Preterm Infants. Glob Pediatr Health 2019; 6:2333794X19829186. [PMID: 30815515 PMCID: PMC6381433 DOI: 10.1177/2333794x19829186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022] Open
Abstract
The skin of premature infants is underdeveloped rendering it more prone to break down and irritation. Therefore, special care is needed to protect premature skin and ensure it is not adversely affected. Many health care professionals advise using just water and cloth to clean diapered skin after a bowel movement despite evidence that shows improved infant skin health with the use of modern appropriately formulated baby wipes. This article describes the unique physiology of premature infant skin, reviews clinical evidence comparing use of baby wipes to water and cloth, and describes attributes of appropriately formulated baby wipes.
Collapse
|
21
|
Aredes NDA, Dias DMV, Fonseca LMM, Campbell SH, Martins JCA, Rodrigues MA. E-baby skin integrity: evidence-based technology innovation for teaching in neonatal nursing. ESCOLA ANNA NERY 2018. [DOI: 10.1590/2177-9465-ean-2017-0424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To develop and validate the serious game e-Baby: skin integrity along with a panel of experts. Method: Methodological research approaching the following development steps: scope definition, game format and functions, script and communication with software developers, creation of prototype with evaluation and production; and validation by four experts using the tool Heuristic Evaluation for Digital Educational Game. Results: The serious game was built in a 3D technology with multimedia including animation and scientific-based content. The educational technology was validated by the experts in all heuristics, and among the all 36 analyzed items. 18 (50%) presented no errors, and regarding the remaining items with any error, none had more than 25% errors within levels 3 and 4, according to Nielsen's classification. Conclusion and implications for the practice: The validated serious game is a virtual simulation educational technology with potential to contribute with learning in nursing and with evidence-based clinical practice.
Collapse
|
22
|
Kusari A, Sprague J, Eichenfield LF, Matiz C, Barrio VR. Primary cutaneous aspergillosis at the site of cyanoacrylate skin adhesive in a neonate. Pediatr Dermatol 2018; 35:494-497. [PMID: 29766554 DOI: 10.1111/pde.13528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary cutaneous aspergillosis is a rare but potentially life-threatening disease. We present the case of a premature infant who developed primary cutaneous aspergillosis with Aspergillus niger at the site of a skin abrasion that had been treated with a purple-colored cyanoacrylate product. The infection was treated successfully with gentle debridement of the cyanoacrylate product, followed by intravenous voriconazole and topical fluconazole. To our knowledge, this is the first reported case of primary cutaneous aspergillosis occurring at the site of cyanoacrylate-based skin adhesive.
Collapse
Affiliation(s)
- Ayan Kusari
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA, USA.,Department of Dermatology, School of Medicine University of California, San Diego, San Diego, CA, USA.,Department of Pediatrics, School of Medicine University of California, San Diego, San Diego, CA, USA
| | - Jessica Sprague
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA, USA.,Department of Dermatology, School of Medicine University of California, San Diego, San Diego, CA, USA.,Department of Pediatrics, School of Medicine University of California, San Diego, San Diego, CA, USA
| | - Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA, USA.,Department of Dermatology, School of Medicine University of California, San Diego, San Diego, CA, USA.,Department of Pediatrics, School of Medicine University of California, San Diego, San Diego, CA, USA
| | - Catalina Matiz
- Department of Dermatology, Southern California Permanente Medical Group, San Diego, CA, USA
| | - Victoria R Barrio
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA, USA.,Department of Dermatology, School of Medicine University of California, San Diego, San Diego, CA, USA.,Department of Pediatrics, School of Medicine University of California, San Diego, San Diego, CA, USA
| |
Collapse
|
23
|
Janssen LMA, Tostmann A, Hopman J, Liem KD. 0.2% chlorhexidine acetate as skin disinfectant prevents skin lesions in extremely preterm infants: a preliminary report. Arch Dis Child Fetal Neonatal Ed 2018; 103:F97-F100. [PMID: 28468901 DOI: 10.1136/archdischild-2017-312694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/05/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The skin disinfectant '0.5% chlorhexidine gluconate in 70% alcohol' (0.5% CHG-70% alc) may cause skin lesions in extremely preterm infants (gestational age <26 weeks). In April 2013, 0.2% chlorhexidine gluconate solution in acetate (0.2% CHG-acetate) was introduced as skin disinfectant for extremely preterm infants in our neonatal intensive care units. We aimed to compare the incidence of skin lesions and central line-associated bloodstream infection (CLABSI) among extremely preterm infants when using 0.5% CHG-70% alc and 0.2% CHG-acetate. DESIGN Retrospective pre-post comparison cohort study. PATIENTS All electronic patient records of extremely preterm infants born between January 2011-March 2013 ('0.5% CHG-70% alc' cohort) and April 2013-October 2015 ('0.2% CHG-acetate' cohort) were reviewed. MAIN OUTCOME MEASURES The incidence of skin lesions and CLABSI. Skin lesions were defined as the presence of erythema, blisters, excoriation, oedema or induration. CLABSI was defined according to the definition of the US Centers for Disease Control and Prevention. RESULTS The incidence of skin lesions was 22% (95% CI 11% to 37%) in the '0.5% CHG-70% alc' cohort (n=41) and 5% (95% CI 1% to 15%; p=0.02) in the '0.2% CHG-acetate' cohort (n=41). The incidence of CLABSI was the same in both groups (28%; 95% CI 14% to 46% in '0.5% CHG-70% alc' vs 27%; 95% CI 14% to 44% in '0.2% CHG-acetate'; p=0.98). CONCLUSIONS Using 0.2% CHG-acetate as skin disinfectant in extremely preterm infants resulted in statistically significant reduction of skin lesions, without increasing the risk of CLABSI as compared with 0.5% CHG-70% alc.
Collapse
Affiliation(s)
- Lisanne M A Janssen
- Department of Neonatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alma Tostmann
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joost Hopman
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kian D Liem
- Department of Neonatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
24
|
Khan J, Sundaram V, Murki S, Bhatti A, Saini SS, Kumar P. Nasal injury and comfort with jet versus bubble continuous positive airway pressure delivery systems in preterm infants with respiratory distress. Eur J Pediatr 2017; 176:1629-1635. [PMID: 28914355 DOI: 10.1007/s00431-017-3016-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 12/01/2022]
Abstract
UNLABELLED Nasal injuries with use of nasal continuous positive airway pressure (CPAP) range from blanching of nasal tip to septal necrosis and septal drop. This analysis was done in preterm neonates of < 34-week gestation, who received nasal CPAP as primary support as part of a randomized trial comparing Jet device with Bubble device for delivery of CPAP, both through nasal prongs of different structure, make and fixation methods. Nasal injury was assessed using a validated nasal injury score. Out of 170 neonates enrolled, 103 (61%) had nasal injuries; moderate and severe injuries were observed in 18 (11%) and 8 (5%) infants, respectively. Septum was the most common site injured. The incidence and severity of nasal injury were significantly lesser in Jet group compared to Bubble group [RR 0.6 (95% C.I. 0.5-0.8); p < 0.001]. Similarly, neonates in Jet group had lesser average [median (IQR): 3 (3,4) vs. 4 [8, 14]; p = 0.04] as well as peak N-PASS pain scores [median (IQR): 4 [8, 14] vs. 5 [13, 16]; p = 0.01] in comparison to Bubble group. However, Jet group neonates had significantly more common prong displacements. CONCLUSION Bubble CPAP device with its nasal interface had higher and more serious incidence of nasal injuries in comparison to Jet CPAP device. What is known: • Nasal injuries are becoming increasingly common with use of nasal CPAP low gestational age, low birth weight, longer use of CPAP and longer NICU stay are risk factors for such injuries • Validated nasal injury scores have been created for assessment of nasal trauma in neonates What is new: • Bubble device with its interface had higher and more serious incidence of nasal injuries in comparison to Jet device • Even though pain assessed by N-PASS was less with Jet device, prong displacements were more frequent with its system.
Collapse
Affiliation(s)
- Jafar Khan
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | - Venkataseshan Sundaram
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | - Anuj Bhatti
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shiv Sajan Saini
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Praveen Kumar
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| |
Collapse
|
25
|
Badr LK, Zeineddine MH, Abbas H, Charafeddine L. NeoSeal to Prevent Nasal Injury in Preterm Infants Receiving Oxygen Therapy. Neonatal Netw 2017; 35:228-33. [PMID: 27461201 DOI: 10.1891/0730-0832.35.4.228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine if a foam septum protector prevents nasal injury in preterm infants receiving nasal heated humidified oxygen. DESIGN A retrospective before and after comparative design was used. SAMPLE Medical records of 101 preterm infants receiving either nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV) were reviewed; 50 were in the control group and 51 were in the intervention group that had the NeoSeal septum protector applied. The groups were not different in terms of gender, birth weight, gestational age, days intubated, or on days on NCPAP/NIPPV. Skin condition of nares was scored daily using the Neonatal Skin Risk Assessment Scale (NSRAS). RESULTS Infants who had the NeoSeal applied had significantly less nasal injuries, OR = 4.08; 95% confidence interval (CI), 1.22-9.59; p = .01. The best predictors of nasal injury were gestational age and whether the NeoSeal was applied or not.
Collapse
Affiliation(s)
- Lina Kurdahi Badr
- Azusa Pacific University, 700 E. Foothill Ave., Azusa, CA 91701, USA
| | | | | | | |
Collapse
|
26
|
Abstract
The immune system of preterm infants is immature, placing them at increased risk for serious immune-related complications. Human milk provides a variety of immune protective and immune maturation factors that are beneficial to the preterm infant's poorly developed immune system. The most studied immune components in human milk include antimicrobial proteins, maternal leukocytes, immunoglobulins, cytokines and chemokines, oligosaccharides, gangliosides, nucleotides, and long-chain polyunsaturated fatty acids. There is growing evidence that these components contribute to the lower incidence of immune-related conditions in the preterm infant. Therefore, provision of these components in human milk, donor milk, or formula may provide immunologic benefits.
Collapse
|
27
|
Hamza AM, Omar SS, Abo El-Wafa RAH, Elatrash MJ. Expression levels of transcription factor PU.1 and interleukin-9 in atopic dermatitis and their relation to disease severity and eruption types. Int J Dermatol 2017; 56:534-539. [PMID: 28229452 DOI: 10.1111/ijd.13579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 12/03/2016] [Accepted: 01/09/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The role of immunological factors in atopic dermatitis (AD) pathogenesis is well established. T-helper (TH) cells are central in AD pathogenesis. A relatively new subset of T cells, Th9 cells, was shown to be involved in the development of allergic asthma and allergic rhinitis, while its role in AD is still to be investigated. This study aimed to measure gene expression levels of interleukin-9 (IL-9) and PU.1, and to examine relationships with disease severity, serum IgE, and eruption types in AD patients. METHODS The study enrolled 30 AD patients, 30 psoriasis patients, and 30 healthy subjects. The severity of AD was assessed using the SCORAD index. IL-9 and PU.1 expressions were measured by using real-time quantitative polymerase chain reaction (RQ-PCR). Serum IgE was measured by IgE (human) enzyme-linked immunosorbent assay (ELISA) Kit. RESULTS IL-9 and PU.1 gene expressions were significantly higher in AD patients than in controls (P1 = 0.007, P2 < 0.001, respectively). In the atopic dermatitis patients, expression of IL-9 and PU.1 were significantly positively correlated with SCORAD index (P1 = 0.004, P2 = 0.002) and clinically with erythema and edema scores. IL-9 and PU.1 expressions were positively significantly correlated (P = 0.005) and positively correlated with serum IgE in the AD group (P1 = 0.017, P2 = 0.023). No significant difference was noted between AD patients with or without histories of other atopies regarding expression levels of IL-9 and PU.1 (P1 = 0.677, P2 = 0.135). CONCLUSIONS PU.1 and IL-9 may play a role in AD pathogenesis and relate to disease severity and clinical eruption types.
Collapse
Affiliation(s)
- Ashraf M Hamza
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Salma S Omar
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Reham A H Abo El-Wafa
- Department of Clinical Pathology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Marwa J Elatrash
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| |
Collapse
|
28
|
Ottinger D, Hicks J, Wilson S, Sperber K, Power K. The Pressure Is On!: Neonatal Skin and Nasal Continuous Positive Airway Pressure. Adv Neonatal Care 2016; 16:420-423. [PMID: 27750265 DOI: 10.1097/anc.0000000000000348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Premature infants have an increased risk for developing skin breakdown. Perceivably noninvasive interventions may have detrimental effects on the infant's skin. PURPOSE This case presentation describes an extreme case of nasal breakdown associated with nasal continuous positive airway pressure (nCPAP). METHODS Highlighted is the vital importance of proper placement, along with appropriate apparatus size, in the efforts to prevent skin breakdown. Ensuring that pressure points are avoided is imperative to prevent nCPAP-related injuries, along with treating the area in the event of skin denudation. A literature search was conducted to determine best practice options to prevent these injuries. FINDINGS There is little information in the literature to guide treatment and prevention of this type of breakdown. IMPLICATIONS FOR PRACTICE Avoidance of pressure in a localized area is the most commonly found recommendation. IMPLICATIONS FOR RESEARCH There are extensive opportunities for adding to our current knowledge in terms of prevention and treatment of skin breakdown associated with device utilization in the neonatal intensive care unit, especially with the increasing use of nCPAP.
Collapse
|
29
|
Abstract
PURPOSE Fetal repair of spina bifida results in improved outcomes and has therefore become a standard clinical procedure in some highly specialized centers. However, optimization of the procedure technique and timing is needed. Both might be achieved by facilitating the procedure using laboratory-grown fetal skin substitutes. The aim of this study was therefore to test in vivo the suitability of such a fetal skin substitute for an in utero application. METHODS Collagen-based hydrogels containing fetal ovine fibroblasts were seeded with fetal ovine keratinocytes and transplanted on immuno-incompetent nu/nu rats. After 3 weeks, grafts were harvested and analyzed histologically and by immunohistochemistry. RESULTS Laboratory-grown fetal ovine dermo-epidermal skin substitutes showed successful engraftment at 3 weeks. Histologically, grafts revealed a neo-dermis populated by fibroblasts and with ingrowth of vessels, and an epidermis with an adult-like, mature appearance depicting clearly basal, spinous, granular, and a corneal layer. Immunostaining confirmed a physiologically organized epidermis. CONCLUSION Fetal dermo-epidermal skin substitutes of ovine origin can successfully be grafted in vivo. In a next step, we will have to test whether favorable results can also be obtained when grafts are used in utero. If so, then human fetal spina bifida repair using laboratory-grown autologous fetal skin for defect closure may be envisaged.
Collapse
|
30
|
The Implementation of an Evidence-Based Bundle for Bloodstream Infections in Neonatal Intensive Care Units in Germany: A Controlled Intervention Study to Improve Patient Safety. Infect Control Hosp Epidemiol 2016; 37:798-804. [DOI: 10.1017/ice.2016.72] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVETo improve the patient safety of very-low-birthweight infants in neonatal departments in Germany.DESIGNMulticenter cohort study with a baseline (24 months), an intervention (12 months), and a postinterventional follow-up period (12 months) and time series analysis.STUDY POPULATIONVery-low-birthweight patients from 32 neonatal departments in Germany.METHODSNeonatal departments showing a standardized infection ratio of bloodstream infection 10% higher than the expected number (standardized infection ratio ≥1.1) were invited to participate in the study. To reduce the occurrence of primary bloodstream infections, evidence-based bundles to improve catheter maintenance routines, insertion practice, and hand-hygiene compliance were implemented in the participating infirmaries.RESULTSThirty-four departments participated in the study and 32 reported data. In total, 6,222 very-low-birthweight infants with 231,868 patient-days and 1,405 cases of bloodstream infections were analyzed. In the baseline period the pooled mean bloodstream infection rate was 6.63 (95% CI, 6.17–7.12) per 1,000 patient-days. The bloodstream infection rate decreased in the intervention period to 5.68 (relative risk, 0.86 [95% CI, 0.76–0.97]) and in the 1-year follow-up period to 5.31 per 1,000 patient-days (relative risk, 0.80 [95% CI, 0.70–0.92]). The multivariable time series analysis of monthly aggregated data showed a significant change in the slope for the frequency of bloodstream infections from the start to the end of the intervention (change in slope incidence rate ratio, 0.97; P=.001).CONCLUSIONThe implementation of an intervention bundle is feasible and can reduce bloodstream infections in neonatal departments.Infect Control Hosp Epidemiol 2016;37:798–804
Collapse
|
31
|
Abstract
BACKGROUND Breakdown of the developmentally immature epidermal barrier may permit entry for micro-organisms leading to invasive infection in preterm infants. Topical emollients may improve skin integrity and barrier function and thereby prevent invasive infection, a major cause of mortality and morbidity in preterm infants. OBJECTIVES To assess the effect of topical application of emollients (ointments, creams, or oils) on the incidence of invasive infection, other morbidity, and mortality in preterm infants. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), MEDLINE via PubMed (1966 to August 2015), EMBASE (1980 to August 2015), and CINAHL (1982 to August 2015). We also searched clinical trials databases, conference proceedings, previous reviews and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised or quasi-randomised controlled trials that assessed the effect of prophylactic application of topical emollient (ointments, creams, or oils) on the incidence of invasive infection, mortality, other morbidity, and growth and development in preterm infants. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. We analysed the treatment effects in the individual trials and reported the risk ratio and risk difference for dichotomous data and mean difference for continuous data, with respective 95% confidence intervals. We used a fixed-effect model in meta-analyses and explored the potential causes of heterogeneity in subgroup analyses. MAIN RESULTS We identified 18 eligible primary publications (21 trial reports). A total of 3089 infants participated in the trials. The risk of bias varied with lack of clarity on methods to conceal allocation in half of the trials and lack of blinding of caregivers or investigators in all of the trials being the main potential sources of bias.Eight trials (2086 infants) examined the effect of topical ointments or creams. Most participants were very preterm infants cared for in health-care facilities in high-income countries. Meta-analyses did not show evidence of a difference in the incidence of invasive infection (typical risk ratio (RR) 1.13, 95% confidence interval (CI) 0.97 to 1.31; low quality evidence) or mortality (typical RR 0.87, 95% CI 0.75 to 1.03; low quality evidence).Eleven trials (1184 infants) assessed the effect of plant or vegetable oils. Nine of these trials were undertaken in low- or middle-income countries and all were based in health-care facilities rather than home or community settings. Meta-analyses did not show evidence of a difference in the incidence of invasive infection (typical RR 0.71, 95% CI 0.51 to 1.01; low quality evidence) or mortality (typical RR 0.94, 95% CI 0.81 to 1.08; moderate quality evidence). Infants massaged with vegetable oil had a higher rate of weight gain (about 2.55 g/kg/day; 95% CI 1.76 to 3.34), linear growth (about 1.22 mm/week; 95% CI 1.01 to 1.44), and head growth (about 0.45 mm/week; 95% CI 0.19 to 0.70). These meta-analyses contained substantial heterogeneity. AUTHORS' CONCLUSIONS The available data do not provide evidence that the use of emollient therapy prevents invasive infection or death in preterm infants in high-, middle- or low-income settings. Some evidence of an effect of topical vegetable oils on neonatal growth exists but this should be interpreted with caution because lack of blinding may have introduced caregiver or assessment biases. Since these interventions are low cost, readily accessible, and generally acceptable, further randomised controlled trials, particularly in both community- and health care facility-based settings in low-income countries, may be justified.
Collapse
Affiliation(s)
- Jemma Cleminson
- University of YorkAcademic Clinical Fellow in Child Health NIHR Centre for Reviews & DisseminationYorkUK
| | - William McGuire
- Hull York Medical School & Centre for Reviews and Dissemination, University of YorkYorkY010 5DDUK
| | | |
Collapse
|
32
|
de Lima EL, de Brito MJA, de Souza DMST, Salomé GM, Ferreira LM. Cross-cultural adaptation and validation of the neonatal/infant Braden Q risk assessment scale. J Tissue Viability 2016; 25:57-65. [PMID: 26777790 DOI: 10.1016/j.jtv.2015.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 11/27/2015] [Accepted: 12/21/2015] [Indexed: 12/30/2022]
Abstract
AIM To translate into Brazilian Portuguese and cross-culturally adapt the Neonatal/Infant Braden Q Risk Assessment Scale (Neonatal/Infant Braden Q Scale), and test the psychometric properties, reproducibility and validity of the instrument. There is a lack of studies on the development of pressure ulcers in children, especially in neonates. METHODS Thirty professionals participated in the cross-cultural adaptation of the Brazilian-Portuguese version of the scale. Fifty neonates of both sexes were assessed between July 2013 and June 2014. Reliability and reproducibility were tested in 20 neonates and construct validity was measured by correlating the Neonatal/Infant Braden Q Scale with the Braden Q Risk Assessment Scale (Braden Q Scale). Discriminant validity was assessed by comparing the scores of neonates with and without ulcers. RESULTS The scale showed inter-rater reliability (ICC = 0.98; P < 0.001) and intra-rater reliability (ICC = 0.79; P < 0.001). A strong correlation was found between the Neonatal/Infant Braden Q Scale and Braden Q Scale (r = 0.96; P < 0.001). CONCLUSION The cross-culturally adapted Brazilian version of the Neonatal/Infant Braden Q Scale is a reliable instrument, showing face, content and construct validity.
Collapse
Affiliation(s)
- Edson Luiz de Lima
- Professional Master's Degree Program in Sciences Applied to Health, Sapucaí Valley University (UNIVÁS), Pouso Alegre, MG, Brazil
| | - Maria José Azevedo de Brito
- Professional Master's Degree Program in Sciences Applied to Health, Sapucaí Valley University (UNIVÁS), Pouso Alegre, MG, Brazil; Division of Plastic Sugery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Diba Maria Sebba Tosta de Souza
- Professional Master's Degree Program in Sciences Applied to Health, Sapucaí Valley University (UNIVÁS), Pouso Alegre, MG, Brazil
| | - Geraldo Magela Salomé
- Professional Master's Degree Program in Sciences Applied to Health, Sapucaí Valley University (UNIVÁS), Pouso Alegre, MG, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Sugery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
33
|
Mathanda TR, M Bhat R, Hegde P, Anand S. Transepidermal Water Loss in Neonates: Baseline Values Using a Closed-Chamber System. Pediatr Dermatol 2016; 33:33-7. [PMID: 26758089 DOI: 10.1111/pde.12704] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transepidermal water loss (TEWL) is the normal, constitutive loss of water vapor from the skin in the absence of sweat gland activity. It is regarded as one of the most important parameters for characterizing skin barrier function, and the values are dependent on multiple variables. The objective of this study was to evaluate TEWL in neonates using a closed- chamber system, and determine if there is a variation of TEWL with the mode of delivery, pre-term birth, low birthweight or phototherapy. METHODS This prospective study was conducted in 104 healthy neonates, 30 neonates in the Neonatal Intensive Care Unit (NICU) and 40 adults using a noninvasive, closed- chamber system (VapoMeter™). RESULTS A statistically significant difference in TEWL was noted between newborns and adults. No remarkable difference in TEWL was seen between boys or men and girls or women or those born via normal vaginal birth and caesarean section, but TEWL was significantly higher in preterm and low birthweight neonates. Significantly higher TEWL was noted from the antecubital fossa of the neonates who received phototherapy when compared with six other sites. CONCLUSIONS The closed- chamber system is an acceptable alternative to the more widely used open-chamber system. The higher mean TEWL in neonates suggests that the epidermal barrier is still adapting to extrauterine life, making newborn skin more sensitive and requiring appropriate, age adapted care.
Collapse
Affiliation(s)
- Teena R Mathanda
- Departments of Dermatology, Venereology, and Leprosy, Father Muller Medical College Hospital, Kankanady, Mangalore, India
| | - Ramesh M Bhat
- Departments of Dermatology, Venereology, and Leprosy, Father Muller Medical College Hospital, Kankanady, Mangalore, India
| | - Pavan Hegde
- Department of Pediatrics, Father Muller Medical College Hospital, Kankanady, Mangalore, India
| | - Shivaraja Anand
- Department of Pediatrics, Father Muller Medical College Hospital, Kankanady, Mangalore, India
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Gord A, Holmes WR, Dai X, Nie Q. Computational modelling of epidermal stratification highlights the importance of asymmetric cell division for predictable and robust layer formation. J R Soc Interface 2015; 11:rsif.2014.0631. [PMID: 25100322 DOI: 10.1098/rsif.2014.0631] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Skin is a complex organ tasked with, among other functions, protecting the body from the outside world. Its outermost protective layer, the epidermis, is comprised of multiple cell layers that are derived from a single-layered ectoderm during development. Using a new stochastic, multi-scale computational modelling framework, the anisotropic subcellular element method, we investigate the role of cell morphology and biophysical cell-cell interactions in the formation of this layered structure. This three-dimensional framework describes interactions between collections of hundreds to thousands of cells and (i) accounts for intracellular structure and morphology, (ii) easily incorporates complex cell-cell interactions and (iii) can be efficiently implemented on parallel architectures. We use this approach to construct a model of the developing epidermis that accounts for the internal polarity of ectodermal cells and their columnar morphology. Using this model, we show that cell detachment, which has been previously suggested to have a role in this process, leads to unpredictable, randomized stratification and that this cannot be abrogated by adjustment of cell-cell adhesion interaction strength. Polarized distribution of cell adhesion proteins, motivated by epithelial polarization, can however eliminate this detachment, and in conjunction with asymmetric cell division lead to robust and predictable development.
Collapse
Affiliation(s)
- Alexander Gord
- Center for Mathematical and Computational Biology, Department of Mathematics, University of California, Irvine, CA 92617, USA Center for Complex Biological Systems, University of California, Irvine, CA 92617, USA
| | - William R Holmes
- Center for Mathematical and Computational Biology, Department of Mathematics, University of California, Irvine, CA 92617, USA Center for Complex Biological Systems, University of California, Irvine, CA 92617, USA
| | - Xing Dai
- Center for Complex Biological Systems, University of California, Irvine, CA 92617, USA Department of Biological Chemistry, School of Medicine, University of California, Irvine, CA 92617, USA
| | - Qing Nie
- Center for Mathematical and Computational Biology, Department of Mathematics, University of California, Irvine, CA 92617, USA Center for Complex Biological Systems, University of California, Irvine, CA 92617, USA
| |
Collapse
|
36
|
Hossain MM, Jones JM, Dey S, Carr GJ, Visscher MO. Quantitation of baby wipes lotion transfer to premature and neonatal skin. Food Chem Toxicol 2015; 84:106-14. [DOI: 10.1016/j.fct.2015.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/06/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
|
37
|
|
38
|
Wang HMD, Chen CC, Huynh P, Chang JS. Exploring the potential of using algae in cosmetics. BIORESOURCE TECHNOLOGY 2015; 184:355-362. [PMID: 25537136 DOI: 10.1016/j.biortech.2014.12.001] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/30/2014] [Accepted: 12/01/2014] [Indexed: 05/18/2023]
Abstract
The applications of microalgae in cosmetic products have recently received more attention in the treatment of skin problems, such as aging, tanning and pigment disorders. There are also potential uses in the areas of anti-aging, skin-whitening, and pigmentation reduction products. While algae species have already been used in some cosmetic formulations, such as moisturizing and thickening agents, algae remain largely untapped as an asset in this industry due to an apparent lack of utility as a primary active ingredient. This review article focuses on integrating studies on algae pertinent to skin health and beauty, with the purpose of identifying serviceable algae functions in practical cosmetic uses.
Collapse
Affiliation(s)
- Hui-Min David Wang
- Department of Fragrance and Cosmetic Science, Kaohsiung Medical University, Kaohsiung 807, Taiwan; Graduate Institute of Natural Products, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ching-Chun Chen
- Department of Fragrance and Cosmetic Science, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Pauline Huynh
- Ecole de Biologie Industrielle, École de Biologie Industrielle, 95094, France
| | - Jo-Shu Chang
- Department of Chemical Engineering, National Cheng Kung University, Tainan 701, Taiwan; Center for Biosciences and Biotechnology, National Cheng Kung University, Tainan 701, Taiwan; Research Center for Energy Technology and Strategy, National Cheng Kung University, Tainan 701, Taiwan.
| |
Collapse
|
39
|
SanMiguel A, Grice EA. Interactions between host factors and the skin microbiome. Cell Mol Life Sci 2015; 72:1499-515. [PMID: 25548803 PMCID: PMC4376244 DOI: 10.1007/s00018-014-1812-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 01/12/2023]
Abstract
The skin is colonized by an assemblage of microorganisms which, for the most part, peacefully coexist with their hosts. In some cases, these communities also provide vital functions to cutaneous health through the modulation of host factors. Recent studies have illuminated the role of anatomical skin site, gender, age, and the immune system in shaping the cutaneous ecosystem. Alterations to microbial communities have also been associated with, and likely contribute to, a number of cutaneous disorders. This review focuses on the host factors that shape and maintain skin microbial communities, and the reciprocal role of microbes in modulating skin immunity. A greater understanding of these interactions is critical to elucidating the forces that shape cutaneous populations and their contributions to skin homeostasis. This knowledge can also inform the tendency of perturbations to predispose and/or bring about certain skin disorders.
Collapse
Affiliation(s)
- Adam SanMiguel
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, 421 Curie Blvd, 1007 Biomedical Research Building II/III, Philadelphia, PA 19104 USA
| | - Elizabeth A. Grice
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, 421 Curie Blvd, 1007 Biomedical Research Building II/III, Philadelphia, PA 19104 USA
| |
Collapse
|
40
|
Winget JM, Watts JD, Hoopmann MR, DiColandrea T, Robinson MK, Huggins T, Bascom CC, Isfort RJ, Moritz RL. Quantitative proteogenomic profiling of epidermal barrier formation in vitro. J Dermatol Sci 2015; 78:173-80. [PMID: 25862149 DOI: 10.1016/j.jdermsci.2015.02.013] [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: 01/14/2015] [Revised: 02/13/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The barrier function of the epidermis is integral to personal well-being, and defects in the skin barrier are associated with several widespread diseases. Currently there is a limited understanding of system-level proteomic changes during epidermal stratification and barrier establishment. OBJECTIVE Here we report the quantitative proteogenomic profile of an in vitro reconstituted epidermis at three time points of development in order to characterize protein changes during stratification. METHODS The proteome was measured using data-dependent "shotgun" mass spectrometry and quantified with statistically validated label-free proteomic methods for 20 replicates at each of three time points during the course of epidermal development. RESULTS Over 3600 proteins were identified in the reconstituted epidermis, with more than 1200 of these changing in abundance over the time course. We also collected and discuss matched transcriptomic data for the three time points, allowing alignment of this new dataset with previously published characterization of the reconstituted epidermis system. CONCLUSION These results represent the most comprehensive epidermal-specific proteome to date, and therefore reveal several aspects of barrier formation and skin composition. The limited correlation between transcript and protein abundance underscores the importance of proteomic analysis in developing a full understanding of epidermal maturation.
Collapse
Affiliation(s)
- Jason M Winget
- Institute for Systems Biology, 401 Terry Ave N., Seattle, WA 98109, USA
| | - Julian D Watts
- Institute for Systems Biology, 401 Terry Ave N., Seattle, WA 98109, USA
| | | | - Teresa DiColandrea
- The Procter & Gamble Company, Mason Business Center, Cincinnati, OH 45040, USA
| | - Michael K Robinson
- The Procter & Gamble Company, Mason Business Center, Cincinnati, OH 45040, USA
| | - Tom Huggins
- The Procter & Gamble Company, Mason Business Center, Cincinnati, OH 45040, USA
| | - Charles C Bascom
- The Procter & Gamble Company, Mason Business Center, Cincinnati, OH 45040, USA
| | - Robert J Isfort
- The Procter & Gamble Company, Mason Business Center, Cincinnati, OH 45040, USA
| | - Robert L Moritz
- Institute for Systems Biology, 401 Terry Ave N., Seattle, WA 98109, USA.
| |
Collapse
|
41
|
Visscher M, Taylor T. Pressure ulcers in the hospitalized neonate: rates and risk factors. Sci Rep 2014; 4:7429. [PMID: 25502955 PMCID: PMC5377020 DOI: 10.1038/srep07429] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/20/2014] [Indexed: 11/09/2022] Open
Abstract
Pressure ulcers (PU) are serious, reportable events causing pain, infection and prolonged hospitalization, particularly among critically ill patients. The literature on PUs in neonates is limited. The objective was to determine the etiology, severity and influence of gestational age on PUs among hospitalized infants. A two-year prospective study was conducted among 741 neonatal intensive care patients over 31,643 patient-days. Risk factors were determined by comparing the characteristics of infants who developed PUs with those who did not. There were 1.5 PUs per 1000 patient days with 1.0 PU per 1000 days in premature infants and 2.7 per 1000 days in term infants. The number of PUs associated with devices was nearly 80% overall and over 90% in premature infants. Infants with PUs had longer hospitalizations and weighed more than those who did not. Infants with device-related PUs were younger, of lower gestational age and developed the PU earlier than patients with PUs due to conventional pressure. The time to PU development was longer in prematurely born versus term infants. Hospitalized neonates are susceptible to device-related injury and the rate of stage II injury is high. Strategies for early detection and mitigation of device-related injury are essential to prevent PUs.
Collapse
Affiliation(s)
- Marty Visscher
- 1] Skin Sciences Program, Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH [2] Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Teresa Taylor
- Newborn Intensive Care Unit, Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| |
Collapse
|
42
|
Abstract
Infant skin is critical to the newborn child's transition from the womb environment to the journey to self-sufficiency. This review provides an integrative perspective on the skin development in full term and premature infants. There is a particular focus on the role of vernix caseosa and on the implications of skin development for epidermal penetration of exogenous compounds. Healthy full-term newborn skin is well-developed and functional at birth, with a thick epidermis and well-formed stratum corneum (SC) layers. Transepidermal water loss is very low at birth, equal to, or lower than adults, indicating a highly effective skin barrier. Vernix facilitates SC development in full-term infants through a variety of mechanisms including physical protection from amniotic fluid and enzymes, antimicrobial effects, skin surface pH lowering, provision of lipids, and hydration. Premature infants, particularly those of very low birth weight, have a poor skin barrier with few cornified layers and deficient dermal proteins. They are at increased risk for skin damage, increased permeability to exogenous agents and infection. The SC barrier develops rapidly after birth but complete maturation requires weeks to months. The best methods for caring for infant skin, particularly in the diaper region, are described and related to these developmental changes.
Collapse
Affiliation(s)
- Marty O Visscher
- Skin Sciences Program, Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Ralf Adam
- The Procter & Gamble Company, Schwalbach, Germany
| | | | | |
Collapse
|
43
|
|
44
|
|
45
|
|
46
|
Xie LH. Hydrocolloid dressing in preventing nasal trauma secondary to nasal continuous positive airway pressure in preterm infants. World J Emerg Med 2014; 5:218-22. [PMID: 25225588 DOI: 10.5847/wjem.j.issn.1920-8642.2014.03.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/12/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) with nasal devices (nCPAP) is widely used in the respiratory management of newborns. The present study aimed to compare the incidence of nasal trauma secondary to nasal continuous positive airway pressure (nCPAP) protected with or without hydrocolloid dressing in preterm infants. METHODS This prospective controlled study was performed in the neonatal intensive care unit (NICU) of the Children's Hospital of Hunan Province from March 1, 2010 to June 31, 2010. A total of 65 infants, 46 males and 19 females, were recruited in this study. Their average gestational age was 32.6 weeks (range 28-37 weeks). The infants were randomly divided into clinical trial group (group A, n=33) and control group (group B, n=32). Paraffin oil was smeared around the nostrils before inserting prongs in group B; the infants in group A were covered on the infant's nostrils surface with hydrocolloid dressing (hydrocolloid dressing, 1.8 mm thick, 90029T, 3M Company, Minnesota, USA) with a size of 2-3 cm cutting two holes adapted to the nose and nostrils. The nostrils of those infants were inspected daily during nCPAP support until they were weaned off nCPAP. RESULTS Nine infants (2 in group A and 7 in group B) developed nasal injury during nCPAP support. The Chi-square test revealed that there was a statistically significant difference (P=0.01) in the incidence of nasal injury between groups A and B. CONCLUSION The study demonstrated that hydrocolloid dressing significantly decreased the incidence and the severity of nasal injury.
Collapse
Affiliation(s)
- Li-Hua Xie
- Hunan Children's Hospital, Changsha 410007, China
| |
Collapse
|
47
|
Csoma ZR, Doró P, Tálosi G, Machay T, Szabó M. Neonatal skin care in tertiary Neonatal Intensive Care Units in Hungary. Orv Hetil 2014; 155:1102-7. [DOI: 10.1556/oh.2014.29910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: Skin physiology of neonates and preterm infants and evidence-based skin care are not well explored for health care providers. Aim: The aim of our present study was to investigate the skin care methods of the tertiary Neonatal Intensive Care Units in Hungary. Method: A standardized questionnaire was distributed among the 22 tertiary Neonatal Intensive Care Units with questions regarding skin care methods, bathing, emollition, skin disinfection, umbilical cord care, treatment of diaper dermatitis, and use of adhesive tapes. Results: The skin care methods of the centres were similar in several aspects, but there were significant differences between the applied skin care and disinfectant products. Conclusions: The results of this survey facilitate the establishment of a standardized skin care protocol for tertiary Neonatal Intensive Care Units with the cooperation of dermatologists, neonatologists and pharmacists. Orv. Hetil., 2014, 155(28), 1102–1107.
Collapse
Affiliation(s)
- Zsanett Renáta Csoma
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Bőrgyógyászati és Allergológiai Klinika Szeged Korányi fasor 6. 6720
| | - Péter Doró
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Gyula Tálosi
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Gyermekgyógyászati Klinika és Gyermek Egészségügyi Központ Szeged
| | - Tamás Machay
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest
| | - Miklós Szabó
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest
| |
Collapse
|
48
|
Visscher M, Narendran V. The Ontogeny of Skin. Adv Wound Care (New Rochelle) 2014; 3:291-303. [PMID: 24761361 DOI: 10.1089/wound.2013.0467] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 06/21/2013] [Indexed: 12/25/2022] Open
Abstract
Significance: During gestation, fetal skin progresses from a single layer derived from ectoderm to a complex, multi-layer tissue with the stratum corneum (SC) as the outermost layer. Innate immunity is a conferred complex process involving a balance of pro- and anti-inflammatory cytokines, structural proteins, and specific antigen-presenting cells. The SC is a part of the innate immune system as an impermeable physical barrier containing anti-microbial lipids and host defense proteins. Postnatally, the epidermis continually replenishes itself, provides a protective barrier, and repairs injuries. Recent Advances: Vernix caseosa protects the fetus during gestation and facilitates development of the SC in the aqueous uterine environment. The anti-infective, hydrating, acidification, and wound-healing properties post birth provide insights for the development of strategies that facilitate SC maturation and repair in the premature infant. Critical Issues: Reduction of infant mortality is a global health priority. Premature infants have an incompetent skin barrier putting them at risk for irritant exposure, skin compromise and life-threatening infections. Effective interventions to accelerate skin barrier maturation are compelling. Future Directions: Investigations to determine the ontogeny of barrier maturation, that is, SC structure, composition, cohesiveness, permeability, susceptibility to injury, and microflora, as a function of gestational age are essential. Clinicians need to know when the premature skin barrier becomes fully competent and comparable to healthy newborn skin. This will guide the development of innovative strategies for optimizing skin barrier development.
Collapse
Affiliation(s)
- Marty Visscher
- Skin Sciences Program, Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Vivek Narendran
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| |
Collapse
|
49
|
Abstract
IMPORTANCE There are substantial shortfalls in nurse staffing in US neonatal intensive care units (NICUs) relative to national guidelines. These are associated with higher rates of nosocomial infections among infants with very low birth weights. OBJECTIVE To study the adequacy of NICU nurse staffing in the United States using national guidelines and analyze its association with infant outcomes. DESIGN Retrospective cohort study. Data for 2008 were collected by web survey of staff nurses. Data for 2009 were collected for 4 shifts in 4 calendar quarters (3 in 2009 and 1 in 2010). SETTING Sixty-seven US NICUs from the Vermont Oxford Network, a national voluntary network of hospital NICUs. PARTICIPANTS All inborn very low-birth-weight (VLBW) infants, with a NICU stay of at least 3 days, discharged from the NICUs in 2008 (n = 5771) and 2009 (n = 5630). All staff-registered nurses with infant assignments. EXPOSURES We measured nurse understaffing relative to acuity-based guidelines using 2008 survey data (4046 nurses and 10 394 infant assignments) and data for 4 complete shifts (3645 nurses and 8804 infant assignments) in 2009-2010. MAIN OUTCOMES AND MEASURES An infection in blood or cerebrospinal fluid culture occurring more than 3 days after birth among VLBW inborn infants. The hypothesis was formulated prior to data collection. RESULTS Hospitals understaffed 31% of their NICU infants and 68% of high-acuity infants relative to guidelines. To meet minimum staffing guidelines on average would require an additional 0.11 of a nurse per infant overall and 0.34 of a nurse per high-acuity infant. Very low-birth-weight infant infection rates were 16.4% in 2008 and 13.9% in 2009. A 1 standard deviation-higher understaffing level (SD, 0.11 in 2008 and 0.08 in 2009) was associated with adjusted odds ratios of 1.39 (95% CI, 1.19-1.62; P < .001) in 2008 and 1.40 (95% CI, 1.19-1.65; P < .001) in 2009. CONCLUSIONS AND RELEVANCE Substantial NICU nurse understaffing relative to national guidelines is widespread. Understaffing is associated with an increased risk for VLBW nosocomial infection. Hospital administrators and NICU managers should assess their staffing decisions to devote needed nursing care to critically ill infants.
Collapse
Affiliation(s)
- Jeannette A Rogowski
- Department of Health Systems and Policy, School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ 08854, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Ahn Y, Sohn M, Lee S, Lee M. [pH, temperature, hydration of the stratum corneum of the dorsal hand and the cord area, and acid mantle formation during early days of life in high-risk newborns]. J Korean Acad Nurs 2013; 43:30-8. [PMID: 23563066 DOI: 10.4040/jkan.2013.43.1.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The study was done to explore variations in physiologic parameters of the stratum corneum (SC) of the dorsal hand and cord area during early days of life in high-risk newborns. METHODS In this longitudinal study, a total of 77 high-risk newborns were assessed for pH, temperature and hydration of the SC of the dorsal hand and the cord area on the 1st, 2nd, 3rd, 5th and 7th days of life. RESULTS Results showed that an acid mantle (AM) was formed in 57.1% for dorsal hand and 35.1% for cord area, implying significant delay regardless of decrease in pH (F=103.60, p<.001), and hydration (F=4.00, p=.003) across days in both areas. Peripheral hypothermia with low hydration level was also observed in both areas. There was a positive relation between hydration and temperature (.14<r<.27, p<.010), and negative relation between hydration and pH in both areas (-.23<r<-.15, p<.010). Antibiotics may play a positive role in AM formation. CONCLUSION High-risk newborns may experience delay in acid mantle formation on SC, hypothermia and decreases in hydration on peripheral sites during the first 7 days of life.
Collapse
Affiliation(s)
- Youngmee Ahn
- Department of Nursing, College of Medicine, Inha University, Incheon, Korea.
| | | | | | | |
Collapse
|