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Ji F, Li D, Lyu T, Yang T, Yuan H, Huang X, Hu X. Iatrogenic skin injuries in infants admitted to neonatal intensive care units: An investigation in 22 Chinese units. J Tissue Viability 2024:S0965-206X(24)00033-0. [PMID: 38561302 DOI: 10.1016/j.jtv.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/28/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To investigate the incidence of iatrogenic skin injuries in neonates across 22 neonatal intensive care units (NICUs) in China. DESIGN Prospective study. SETTING 22 NICUs in China. PATIENTS Infants admitted to NICU. INTERVENTIONS None. MEASUREMENTS The "Iatrogenic Skin Injuries Data Collection Form of infants" were used to collect the data during hospitalization. MAIN RESULTS A total of 8126 neonates who were hospitalized in 22 tertiary hospitals across 15 provinces, cities, and autonomous regions of China between December 1, 2019 and January 31, 2020 were analyzed. Five hundred and twenty-one infants had iatrogenic skin injuries, including 250 with diaper dermatitis (47.98%), 70 with physicochemical factor-related skin lesions (PCFRSIs) (13.44%), 81 with medical device-related pressure injuries (MDRPIs) (15.55%), and 69 with medical adhesive-related skin injuries (MARSIs) (13.24%), accounting for 91% of the total number of iatrogenic injuries. Among these, diaper dermatitis was closely related to the skin and feeding status. Furthermore, the risk was higher among neonates who had skin damage upon admission or were already fully fed orally. The influencing factors of MDRPIs and MARSIs were similar. They were negatively associated with gestational age and birth weight, and were closely related to the presence of various tubes. CONCLUSIONS Diaper dermatitis, PCFRSIs, MDRPIs, and MARSIs were the four common types of iatrogenic skin injuries in newborns. The various types of iatrogenic skin injuries were influenced by varying factors. Specialized nursing measurements can reduce the likelihood of these injuries.
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Affiliation(s)
- Futing Ji
- Fujian Key Laboratory of Neonatal Diseases, Xiamen, 361006, China; Children's Hospital of Fudan University, Shanghai, 201102, China; Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, 361006, China; Key Laboratory of Neonatal Diseases, Xiamen, 361006, China
| | - Dan Li
- Fujian Key Laboratory of Neonatal Diseases, Xiamen, 361006, China; Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, 361006, China; Key Laboratory of Neonatal Diseases, Xiamen, 361006, China
| | - Tianchan Lyu
- Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Tongling Yang
- Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Hao Yuan
- Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Xianghui Huang
- Fujian Key Laboratory of Neonatal Diseases, Xiamen, 361006, China; Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, 361006, China; Key Laboratory of Neonatal Diseases, Xiamen, 361006, China.
| | - Xiaojing Hu
- Fujian Key Laboratory of Neonatal Diseases, Xiamen, 361006, China; Children's Hospital of Fudan University, Shanghai, 201102, China; Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, 361006, China; Key Laboratory of Neonatal Diseases, Xiamen, 361006, China.
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Allen A, Zana-Taïeb E. Recommendations for use of adhesives on hospitalized newborns: A systematic review of the literature. Arch Pediatr 2023; 30:486-492. [PMID: 37604760 DOI: 10.1016/j.arcped.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/04/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The skin is the largest organ in the human body. It provides multiple barrier functions, tactile or defensive, and acts as a mediator allowing for the attachment of vital monitoring devices with medical adhesives. Adhesives consist of several layers with varying compositions and properties. We aimed to provide recommendations for their use in the care of hospitalized neonates on the basis of a systematic literature review. METHODS We searched PubMed for English or French articles published before May 29, 2020, using the keywords "adhesive," "tape,", "skin," and "neonat*." Recommendations were developed after review by a multidisciplinary group including 15 professionals and parent representatives. RESULTS We identified 295 studies, and from 30 eligible studies we developed six recommendations according to four perspectives: assessment of the skin condition to improve the methods of application of the different adhesives and their removal; use of adhesives as a platform; and discouraging the regular use of semi-permeable dressings to compensate for the immaturity of the skin barrier. CONCLUSION Skin lesions are common for hospitalized neonates. Use of adhesives may increase the occurrence of such lesions. Adhesives should be subject to good clinical practice guidelines. Health professionals caring for newborns should know the tools for screening and preventing skin lesions.
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Affiliation(s)
- Aurore Allen
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP, Paris, 75014, France; Group of Reflection and Evaluation of the Environment of Newborns (GREEN) study group from the French Neonatal Society
| | - Elodie Zana-Taïeb
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP, Paris, 75014, France; Group of Reflection and Evaluation of the Environment of Newborns (GREEN) study group from the French Neonatal Society
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Moss CR. Neonatal Fragile Skin: Novel Use of Simulation to Improve Knowledge and Confidence for Neonatal Nurse Practitioner Students. Nurse Educ 2023; 48:E122-E125. [PMID: 36728606 DOI: 10.1097/nne.0000000000001354] [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: 02/03/2023]
Abstract
BACKGROUND Infants with fragile skin pose challenges to neonatal providers, including the difficult nature of securing lifesaving devices. A paucity of information exists supporting best simulation practices in educating neonatal nurse practitioner (NNP) students on how to care for infants with fragile skin. PURPOSE To evaluate whether simulation improved student knowledge and self-confidence related to caring for infants with fragile skin. METHODS This quality improvement project included a pre/posttest survey with a sample of 14 NNP students. Participants practiced application of a multilayered dressing to secure a catheter to a neonatal manikin. Knowledge and self-confidence were measured before and after simulation. RESULTS Correct responses on posttest survey knowledge items increased along with students' confidence ratings following simulation. Students reported high levels of satisfaction with the simulation experience. CONCLUSIONS Simulation of caring for fragile skin allows NNP students the opportunity to improve self-confidence, knowledge, and performance of a necessary skill for NNPs.
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Affiliation(s)
- Colleen Reilly Moss
- Assistant Professor and Director, Neonatal Nurse Practitioner Specialty, Vanderbilt University School of Nursing, Nashville; and Neonatal Nurse Practitioner, Monroe Carell Jr Children's Hospital, Vanderbilt, Nashville
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Wei M, Yang D, Chen L, Wu L, Lu M, Wang J, Qiu T. The prevalence of medical adhesive-related skin injury caused by protective dressings among medical staff members during the 2019 coronavirus pandemic in China. J Tissue Viability 2023; 32:69-73. [PMID: 36639257 PMCID: PMC9827744 DOI: 10.1016/j.jtv.2023.01.003] [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: 07/03/2020] [Revised: 11/11/2020] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
AIM To explore the prevalence and risk factors for medical adhesive-related skin injury (MARSI) caused by protective dressings among medical staff members during the 2019 coronavirus disease pandemic (COVID-19) in China. MATERIALS AND METHODS A cross-sectional survey was conducted using a questionnaire. The questionnaire was released through the Questionnaire Star website and was completed online. The prevalence of MARSI was calculated and risk factors were analyzed using a multiple regression model. RESULTS A total of 414 front-line medical staff members treating COVID-19 patients were enrolled from 46 hospitals across four provinces and two municipalities. Overall, 83.1% used protective medical adhesive dressings applied to the head and face to prevent skin damage from personal protective equipment. The prevalence of MARSI caused by adhesive dressings was 41.9%. By multiple regression analysis, the type of dressing, duration of dressing usage, and pain score were risk factors for MARSI development. CONCLUSIONS The high prevalence indicates MARSI is common among front-line medical staff members, especially those using hydrocolloid dressings and longer durations of dressing usage. Pain upon dressing removal can be severe and increased the risk of MARSI. We call for paying more attention to MARSI and recommend multisite studies with larger sample sizes to enhance the generalizability of these findings.
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Affiliation(s)
- Min Wei
- Wound Care Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | | | - Lu Chen
- Nursing Department Office, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Ling Wu
- Wound Care Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Minyuan Lu
- Affiliated Hospital of YangZhou University, Nanjing, Jiangsu, China
| | - Jiandong Wang
- Department of Pathology, Jinglin Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ting Qiu
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
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Skelton H, Psaila K, Schmied V, Foster J. Systematic Review of the Effects of Positioning on Nonautonomic Outcomes in Preterm Infants. J Obstet Gynecol Neonatal Nurs 2023; 52:9-20. [PMID: 36309067 DOI: 10.1016/j.jogn.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/10/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To identify and synthesize the available evidence on the effect of different positions (prone, supine, and right and left lateral) on nonautonomic outcomes for preterm infants admitted to the NICU. DATA SOURCES We searched the CINAHL, MEDLINE, Scopus, and Cochrane databases for reports of primary research studies using a three-step strategy. We also searched for gray literature and reviewed the reference lists of retrieved articles. STUDY SELECTION We included reports of quantitative studies published in English from database inception through February 2022 that focused on positioning and nonautonomic outcomes (pain, comfort, skin integrity, behavioral state, and sleep quality and duration) for preterm infants in the NICU. Two authors independently screened titles and abstracts and assessed articles in full text against the inclusion criteria. DATA EXTRACTION Two authors independently extracted the data from the full-text articles using a standardized data extraction tool. We synthesized the data narratively because of the different designs and outcome measures among the included studies. DATA SYNTHESIS From a total of 550 records initially screened, we included 17 articles in our review. In the included articles, prone positioning improved sleep quality and duration, whereas supine positioning was associated with increased awakenings and activity. Infants demonstrated fewer self-regulatory behaviors in the prone position compared to supine or side-lying and were less stressed in the prone position. We found minimal evidence on the effect of positioning on skin integrity or pain. CONCLUSION There is limited good-quality evidence on the effect of positioning on nonautonomic outcomes in preterm infants. To inform clinical practice, high-quality randomized controlled trials focused on the positioning of premature infants are warranted.
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Metallinou D, Lazarou E, Lykeridou A. Pharmacological and Non-Pharmacological Brain-Focused Clinical Practices for Premature Neonates at High Risk of Neuronal Injury. MÆDICA 2021; 16:281-290. [PMID: 34621352 DOI: 10.26574/maedica.2020.16.2.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective:Disruption of smooth intrauterine brain development is a significant consequence of premature birth that may lead to adverse neurological outcomes. Although noteworthy progress has been made in the management of prematurity, the rates of neonatal morbidity and neurodevelopmental disorders remain high, underlining the need to find clinical practices that particularly protect the central nervous system. Aim:To identify recent articles regarding pharmacological and non-pharmacological brain-focused clinical practices (BFCP) for premature neonates at high risk of neuronal injury. Material and methods:We did an extensive search of PubMed and Google Scholar for relevant research published between 2000 and 2020. Results:Nineteen full-length original research papers fulfilled the inclusion criteria and were selected for the purpose of the present review. Non-pharmacological BFCP intend to improve the neonate's experience in the NICU environment and can be applied by a multidisciplinary team, while pharmacological ones are related to novel molecules that aim to quell apoptosis and inflammation or promote neurogenesis. Conclusion:In the future, a combination of pharmacological and non-pharmacological BFCP might be considered as the most promising protection and/or treatment provided in clinical practice to premature neonates at high risk of neuronal injury.
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Affiliation(s)
- Dimitra Metallinou
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Greece
| | | | - Aikaterini Lykeridou
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Greece
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Mactaggart E, Orchard D, Mui Tam M. Baby wipes and nappy rash - what is the relationship? A review. Australas J Dermatol 2021; 62:470-477. [PMID: 34523734 DOI: 10.1111/ajd.13715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Abstract
Baby wipes are a commonly used cleansing method for infants. A literature review has been performed to assess if using baby wipes is beneficial or harmful compared to water and cloth in terms of nappy rash. This includes a detailed analysis of baby wipe ingredients, as many skin irritants as well as allergens are identified. MedLine, Embase and PubMed were searched and after 420 titles and abstracts were screened, 21 studies remained for inclusion. Baby wipes are deemed as superior to water and cloth in the majority of the literature. However, no definitive conclusion can be drawn as many studies are also industry funded. The most notable allergens identified are fragrances, such as linalool, cocamidopropyl betaine (surfactant), formaldehyde-releasing preservatives and other preservatives, including methylisothiazolinone and methylchloroisothiazolinone. As not all allergens are listed on the label accurately, this can be misleading for the consumer.
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Affiliation(s)
| | - David Orchard
- Department of Dermatology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Mei Mui Tam
- Dermatologist, Skin Health Institute, Melbourne, VIC, Australia
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Jantsch LB, Bridi BPDL, Higashi GDC, Arrué AM, Oliveira DCD, Neves ET. Factors associated with the development of skin allergies in premature newborns in the first year of life. ACTA ACUST UNITED AC 2021; 42:e20200261. [PMID: 34287603 DOI: 10.1590/1983-1447.2021.20200261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/04/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify the factors associated with the development of skin allergies in the first year of life in moderate and late preterm infants. METHOD This is a cross-sectional study with 151 moderate and late preterm infants, born between May 2016 and May 2017. Participants were evaluated in the 3rd, 6th, 9th and 12th months of life, in telephone interviews. Statistical analyzes were performed in the SPSS software with frequency comparison tests and logistic regression. RESULTS The prevalence of skin allergy, in the perception of caregivers, among late and moderate preterm infants was 16%. Factors such as being admitted to neonatal intensive care (p = 0.006) and not being breastfed (p = 0.041) showed a significant association with the development of skin allergies in the 3rd and 12th months of life, respectively. CONCLUSION Skin allergy, in the perception of caregivers, is more severe in newborn infants who have clinical respiratory and gastrointestinal manifestations, be it conditioning or cause-effect. Breastfeeding proved to be a protective factor in the first year of life.
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Affiliation(s)
- Leonardo Bigolin Jantsch
- Universidade Federal de Santa Maria (UFSM), Departamento de Ciências da Saúde. Palmeira das Missões, Rio Grande do Sul, Brasil
| | - Bruna Paola de Lima Bridi
- Universidade Federal de Santa Maria (UFSM), Curso de Enfermagem. Palmeira das Missões, Rio Grande do Sul, Brasil
| | | | - Andrea Moreira Arrué
- Universidade Federal do Paraná (UFPR), Programa de Pós-Graduação em Enfermagem, Curitiba, Paraná, Brasil
| | | | - Eliane Tatsch Neves
- Universidade Federal de Santa Maria (UFSM), Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem, Santa Maria, Rio Grande do Sul, Brasil
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A Quality Improvement Approach to Perineal Skin Care: Using Standardized Guidelines and Novel Diaper Wipes to Reduce Diaper Dermatitis in NICU Infants. Adv Neonatal Care 2021; 21:189-197. [PMID: 33009153 DOI: 10.1097/anc.0000000000000795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Diaper dermatitis (DD) causes discomfort and emotional distress and creates possible sources of infection among newborn intensive care unit infants. Diaper dermatitis remains prevalent despite studies documenting an understanding of prevention and treatment modalities. Standardizing perineal skin care guidelines could reduce DD. PURPOSE Implement perineal skin care guidelines, while introducing novel diaper wipes, to decrease the incidence of DD by 20% within a 1-year period. METHODS Our unit reviewed evidence-based literature to develop a standardized perineal care guideline for prevention and treatment, encompassing the use of novel, preservative-free diaper wipes with grapefruit seed extract. The outcome measures were the incidence and duration of DD. Process compliances were monitored. The balancing measure was the rate of fungal skin infection while using preservative-free wipes. FINDINGS Between July 2017 and March 2019, 1070 infants were admitted for 1 or more days, with 11% of those being born at less than 30 weeks of gestational age. After guideline implementation in January 2018, the incidence of DD decreased by 16.7%. The incidence of severe cases dropped by 34.9%, with 3.5 days per 100 patient-days shortened duration. Process compliance was achieved. Neonates tolerated the novel wipes without increased fungal skin infection. IMPLICATIONS FOR PRACTICE The Perineal Skin Care Guidelines could reduce the rate and duration of DD. Newborn intensive care unit infants tolerated the novel diaper wipes. IMPLICATIONS FOR RESEARCH Additional research on wipes containing other types of extracts or ingredients.
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de Oliveira Marcatto J, Santos AS, Oliveira AJF, Costa ACL, Regne GRS, da Trindade RE, Couto DL, de Souza Noronha KVM, Andrade MV. Medical adhesive-related skin injuries in the neonatology department of a teaching hospital. Nurs Crit Care 2021; 27:583-588. [PMID: 33768691 DOI: 10.1111/nicc.12621] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Medical adhesives are used to affix components to the skin. They are part of procedures performed by medical specialties because of their participation as constituents of different products, such as tapes, dressings, and electrodes. AIM This study aims to assess the prevalence of, and factors associated with, the development of medical adhesive-related skin injuries (MARSIs) in patients treated with medical tapes in the neonatology department of a large teaching hospital in Brazil. STUDY DESIGN Cohort study. METHODS All premature newborns (gestational age from 28 to <37 weeks) admitted in the neonatal intensive care unit of a teaching hospital, from March to August 2019, were followed up. Neonate skin condition was assessed based on the Neonatal Skin Condition Scale (NSCS). Data analyses were conducted in R software. RESULTS In total, 46 premature newborns were included in the study; 552 evaluations were performed-mean of 11.7 per patient. Most neonates (n = 41; 89.1%) used adhesive tapes, either paper tape (n = 37; 80.4%) or transparent film dressing (n = 34; 73.9%). Newborns' face and head were the most affected body regions (n = 125; 50.2%). Eight patients had MARSIs (19.5% of patients who used tape). NSCS scores (P value <.001) and the adopted warming system (P value = .01302) were associated with the occurrence of MARSIs. Incubators seem to be a protective factor for MARSI (OR = 0.048; IC95% = 0.0008-0.75; P value = .013). CONCLUSION Adhesive tapes in premature newborns should be considered a risk factor for injuries. Although NSCS showed mild-to-moderate impairment and lesion severity was low, this event is relatively frequent in neonatal units. RELEVANCE TO CLINICAL PRACTICE Awareness of the risk associated with adhesive tape application and removal in newborns allow health services to better address the problem by enforcing good practices, elaborating better protocols, qualifying the health care professionals, and potentially selecting softer tapes for neonates.
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Affiliation(s)
- Juliana de Oliveira Marcatto
- Department of Maternal Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - André Soares Santos
- Centre for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Economics, School of Economics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Raquel Elias da Trindade
- Department of Maternal Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Débora Lara Couto
- Neonatal Intensive Care Unit, Hospital of Clinics of UFMG, Belo Horizonte, Brazil
| | | | - Mônica Viegas Andrade
- Department of Economics, School of Economics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Santos SV, Ramos FRS, Costa R, Batalha LMDC. Assessment of the quality of a software application for the prevention of skin lesions in newborns. Rev Lat Am Enfermagem 2020; 28:e3352. [PMID: 32901769 PMCID: PMC7478880 DOI: 10.1590/1518-8345.3711.3352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 05/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to assess the technical quality of a mobile application to support the nurse's decision to prevent skin lesions in hospitalized newborns, according to the Product Quality Model. METHOD a methodological study for technological assessment. The 20 evaluators, divided into two groups, 10 nurses and 10 information technology professionals, used the software, conducted tests based on two case studies, and evaluated six features and 23 sub-features of quality. The assessment was conducted by means of an online form. Data was analyzed through a specific formula and the items that obtained a concordance percentage over 70% were considered adequate. RESULTS the concordance percentages of the features in the groups of nurses and of information technology specialists were the following: functional adequacy (100%-98.9%), reliability (90%-100%), usability (93.2-85%), performance efficiency (100%-100%), compatibility (97.5-90%), and safety (94%-91%). In the assessment of the sub-features, only accessibility presented a percentage value below the desired one (70%-60%). CONCLUSION the software has excellent technical quality to meet the needs of nurses in planning the care for the prevention of skin lesions of hospitalized newborns, brings important advances to neonatal care, contributes to the work process, expands knowledge, and promotes the professional's clinical reasoning.
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Affiliation(s)
- Simone Vidal Santos
- Universidade Federal de Santa Catarina, Hospital Universitário, Florianópolis, SC, Brazil
| | | | - Roberta Costa
- Universidade Federal de Santa Catarina, Departamento de Enfermagem, Florianópolis, SC, Brazil
| | - Luís Manuel da Cunha Batalha
- Escola Superior de Enfermagem de Coimbra, Unidade de Investigação em Ciências da Saúde: Enfermagem, Coimbra, Portugal
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The Effect of Sunflower Seed and Almond Oil on Preterm Infant Skin: A Randomized Controlled Trial. Adv Skin Wound Care 2020; 33:1-6. [DOI: 10.1097/01.asw.0000672500.18525.2e] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Berry MJ, Port LJ, Gately C, Stringer MD. Outcomes of infants born at 23 and 24 weeks' gestation with gut perforation. J Pediatr Surg 2019; 54:2092-2098. [PMID: 31072679 DOI: 10.1016/j.jpedsurg.2019.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/25/2019] [Accepted: 03/24/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE The provision of neonatal intensive care to infants born at 23 or 24 weeks' gestation poses medical, surgical and ethical challenges. Gastrointestinal perforation is a well-recognized complication of preterm birth, occurring most often as a result of necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP). Given the risk of morbidity and mortality in these 'periviable' infants, this complication may prompt transition from active management to palliative care. In our institution, the surgical care of periviable infants with gut perforation has not been dictated by gestational age. This study reports our outcomes. METHODS A retrospective cohort analysis of integrated neonatal medical and surgical care of all infants born between 23+0 and 24+6 weeks' gestation admitted to a tertiary level neonatal intensive care unit (NICU) during a 16 year period (2002-2017). RESULTS A total of 198 periviable neonates (73 born at 23 weeks' gestation and 125 born at 24 weeks) were admitted during the 16-year period; most were inborn with only 26 retrieved from regional centers. Twenty-six of these infants developed gut perforation: 14 SIP, 8 NEC, 3 esophageal perforation and one after reduction of an incarcerated inguinal hernia. Twelve (46%) periviable infants with gut perforation survived to discharge home, seven of whom had no/mild disability at 2-3 years corrected gestational age. Of the 198 periviable infants admitted to NICU, 116 (58%) were alive at a corrected gestational age of 2-3 years and 29 of the 56 (51%) assessed had mild or no disability. CONCLUSIONS In the setting of combined medical and surgical care in a tertiary level NICU almost half of all periviable infants with a gut perforation survived, many with no/mild disability at 2-3 years corrected gestational age. Rigid protocols that rely on gestational age alone to guide treatment are not appropriate. These results support the contention that, when possible, extremely preterm infants should be born and cared for in units with combined medical and surgical expertise. LEVEL OF EVIDENCE Level III cohort study.
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Affiliation(s)
- Mary J Berry
- Neonatal Intensive Care Unit, Wellington Hospital and Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Laura J Port
- Neonatal Intensive Care Unit, Wellington Hospital and Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Callum Gately
- Neonatal Intensive Care Unit, Wellington Hospital and Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Mark D Stringer
- Neonatal Intensive Care Unit, Wellington Hospital and Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.
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Delgado BS, Costa R, Vesco SNPD, Santos FA, Santos SV. Estratégias de cuidado com a pele do recém-nascido em unidade de internação neonatal. ESTIMA 2019. [DOI: 10.30886/estima.v16.745_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: Identificar as estratégias de cuidado com a pele dos recém-nascidos (RNs) utilizadas nos centros de referência do Método Canguru (MC) do Brasil. Métodos: Estudo exploratório descritivo, de abordagem qualitativa, realizado com 13 enfermeiras atuantes nos diferentes centros de referência do MC no Brasil. Os dados foram coletados por meio de um formulário online. A análise foi feita de forma descritiva, comparando-se as diferentes realidades. Resultados: Elaboraram-se quatro categorias para o cuidado da pele do RN advindas da experiência dos participantes: estratégias adotadas pela equipe relacionadas aos cuidados com a pele do RN; manejo da equipe de saúde em relação ao banho e troca de fralda; cuidados com a fixação de dispositivos em RNs; e estratégias adotadas pela equipe no RN sob fototerapia. Conclusão: As enfermeiras mostraram-se capacitadas e aptas a atuar em seus campos de experiência e vivência. As respostas indicaram que existe preocupação em evitar a utilização de utensílios e materiais nocivos à pele do RN.
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Delgado BS, Costa R, Vesco SNPD, Santos FA, Santos SV. Newborn skin care strategies in neonatal unit. ESTIMA 2019. [DOI: 10.30886/estima.v16.745_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: To identify skin care strategies for newborns (NB) used in reference centers of the Kangaroo-Mother Care Method (KMC) in Brazil. Methods: Descriptive exploratory study, using a qualitative approach, performed with 13 nurses working in the different reference centers of the KMC in Brazil. Data were collected through an online form. Analysis was performed descriptively, comparing the different studies realities. Results: Four categories were described regarding skin care of NB through the experience of the nurses: strategies adopted by the team regarding skin care of NBs; dealing with the health team regarding bath and dipper disposal; care regarding fixation of devices in NBs, and strategies adopted by the NB team under phototherapy. Conclusion: The nurses presented capacity, and they were highly trained to act in their areas of experience and knowledge. The answers indicated that there is a great concern in avoiding the usage of materials and devices that could cause harm to NB skin.
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Medical Adhesive-Related Skin Injuries and Associated Risk Factors in a Pediatric Intensive Care Unit. Adv Skin Wound Care 2019; 32:176-182. [PMID: 30845071 DOI: 10.1097/01.asw.0000553601.05196.fb] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the prevalence of medical adhesive-related skin injuries (MARSIs) and associated risk factors in a pediatric ICU (PICU). METHODS A cross-sectional design was adopted in the PICU of a university-based children's hospital in eastern China. A total of 232 patients were enrolled, and 611 person-days were analyzed. MAIN OUTCOME MEASURES Researchers assessed all patients daily for 2 weeks. The use of adhesives and prevalence of MARSIs were recorded. The patients' clinical data were also collected. The prevalence of MARSIs was calculated daily, and the risk factors were examined statistically. MAIN RESULTS The MARSI prevalence ranged from 23.53% to 54.17% (mean, 37.15%). Multivariate analysis identified being female, age 2 years or younger, hospital stays longer than 5 days, infection, edema, and surgery as independent risk factors. Prevalence by product ranged from 19 to 53 per 1,000 product-days with a mean of 34 MARSIs per 1,000 product-days. The major MARSI types were epidermal stripping and skin tear. The face was the most common MARSI site, and tracheal intubation was the most common inciting condition. Implicated products were acrylate tapes with elastic cloth backings. CONCLUSIONS Researchers concluded that MARSI is common in the PICU. Skin stripping and skin tear were the most common types, and the face was the most vulnerable site for MARSI, typically attributable to the cloth tape used to affix tracheal intubation. Careful attention should be paid to children with identified risk factors (females, age 2 years or younger, longer hospital stays, edema, infection, or surgery).
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Broom M, Dunk AM, E Mohamed AL. Predicting Neonatal Skin Injury: The First Step to Reducing Skin Injuries in Neonates. Health Serv Insights 2019; 12:1178632919845630. [PMID: 31236011 PMCID: PMC6572893 DOI: 10.1177/1178632919845630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/28/2019] [Indexed: 11/17/2022] Open
Abstract
Background Skin injuries remain common in neonates admitted to neonatal intensive care units. While predicting neonates at risk of skin injury may assist in reducing the incidence of injury, currently there is limited evidence on which tool may be superior. Methods A prospective study was completed during November-December 2016 to evaluate the predictive value of the Skin Risk Assessment and Management Tool (SRAMT). Comparisons were made between SRAMT and Neonatal/Infant Braden-Q Scale (BQS) as well as staff's capacity to predict a neonate's risk of skin injury. Data collected included gestation, weight, day of assessment, injury types, causation, medical devices in situ and risk scores. Results In total, 248 assessments were completed with 38% (93) recorded skin injuries. Median (interquartile range) gestation and weight at assessment were 36.7 (26.86-56.86) weeks and 2.44 (0.99-4.06) kg, respectively. Receiver operating characteristic curve analysis showed the SRAMT had AUC (SE) of 0.94 (0.02) compared with 0.82 (0.03) for BQS (0.011, P < .001). The SRAMT and BQS had sensitivity of [(90.0 (80.5-95.9), 72.86 (60.9-82.8)] and specificity [(88.46 (81.7-93.4), 79.23 (71.2-85.8)], respectively. Conclusion In this study, the SRAMT's capacity to predict neonates at risk of injury was higher than the Neonatal BQS and staff. Predicting injuries remains complex and often multifactorial.
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Affiliation(s)
- Margaret Broom
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital and Health Services, Canberra, ACT, Australia.,Synergy: Nursing and Midwifery Research Centre, UC and ACT Health, University of Canberra, Canberra, ACT, Australia
| | - Ann Marie Dunk
- Synergy: Nursing and Midwifery Research Centre, UC and ACT Health, University of Canberra, Canberra, ACT, Australia.,Tissue Viability Unit, Canberra Hospital, University of Canberra, Canberra, ACT, Australia
| | - Abdel-Latif E Mohamed
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital and Health Services, Canberra, ACT, Australia.,Men, Women and Children's Health, The Medical School, College of Health and Medicine, Australian National University, Acton, ACT, Australia
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Vongsa R, Rodriguez K, Koenig D, Cunningham C. Benefits of Using an Appropriately Formulated Wipe to Clean Diapered Skin of Preterm Infants. Glob Pediatr Health 2019; 6:2333794X19829186. [PMID: 30815515 PMCID: PMC6381433 DOI: 10.1177/2333794x19829186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022] Open
Abstract
The skin of premature infants is underdeveloped rendering it more prone to break down and irritation. Therefore, special care is needed to protect premature skin and ensure it is not adversely affected. Many health care professionals advise using just water and cloth to clean diapered skin after a bowel movement despite evidence that shows improved infant skin health with the use of modern appropriately formulated baby wipes. This article describes the unique physiology of premature infant skin, reviews clinical evidence comparing use of baby wipes to water and cloth, and describes attributes of appropriately formulated baby wipes.
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Esser M, Dore S, Fitzgerald F, Kelley K, Kuller J, Ludwig S, Peterman D. Applying Developmentally Supportive Principles to Diapering in the NICU: What We Know. Neonatal Netw 2018; 37:149-154. [PMID: 29789054 DOI: 10.1891/0730-0832.37.3.149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Developmental care measures are integrated in the NICU, but these measures are largely overlooked when it comes to standard care activities such as diapering. This general review of developmental care in the NICU discusses how caregivers can apply appropriate, individualized developmental care measures to diapering regimens. Numerous opportunities to expand developmental care measures into diapering care are identified; these opportunities can protect and promote sleep for hospitalized infants, enhance the diapering environment, minimize stress that infants may experience with diapering, improve infant skin health outcomes through use of evidence-based skin care practices, and foster family involvement during diapering care in the NICU. A developmental approach to diapering offers hospitalized infants regular opportunities to reach their neurodevelopmental potential.
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Skin Injuries and Chlorhexidine Gluconate-Based Antisepsis in Early Premature Infants: A Case Report and Review of the Literature. J Perinat Neonatal Nurs 2018; 32:341-350. [PMID: 29782437 DOI: 10.1097/jpn.0000000000000334] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Early premature infants are subjected to many invasive procedures in neonatal intensive care units, and effective skin antisepsis is an essential step in caring for these vulnerable patients. Nevertheless, preterm infants have an anatomically and physiologically immature skin and preserving their skin integrity is essential to avoid the risk of local and systemic complications. Skin particularities of newborns reduce the list of available antiseptics in neonatology. Chlorhexidine gluconate (CHG) has excellent antiseptic properties and its antimicrobial efficacy cannot be understated, but there is great concern about its use for premature infants, referring to the risk of development skin injuries, such as skin erythema, burns, and blisters. Current guidelines do not recommend the use of CHG as antiseptic in the neonatal population, but despite the lack of safety data in premature infants, CHG is commonly used worldwide for off-label indications in neonatal intensive care units. A clinical case of an infant born at 26 weeks of gestation who sustained a CHG-related chemical burn after skin antisepsis was reported. A review of the literature was undertaken to evaluate the skin safety of CHG in infants born less than 32 weeks of gestation, to summarize clinical practice' recommendations, and to discuss the wound treatment options available.
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Availability and performance of image/video-based vital signs monitoring methods: a systematic review protocol. Syst Rev 2017; 6:217. [PMID: 29070063 PMCID: PMC5657080 DOI: 10.1186/s13643-017-0615-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/19/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND For many vital signs, monitoring methods require contact with the patient and/or are invasive in nature. There is increasing interest in developing still and video image-guided monitoring methods that are non-contact and non-invasive. We will undertake a systematic review of still and video image-based monitoring methods. METHODS We will perform searches in multiple databases which include MEDLINE, Embase, CINAHL, Cochrane library, IEEE Xplore and ACM Digital Library. We will use OpenGrey and Google searches to access unpublished or commercial data. We will not use language or publication date restrictions. The primary goal is to summarise current image-based vital signs monitoring methods, limited to heart rate, respiratory rate, oxygen saturations and blood pressure. Of particular interest will be the effectiveness of image-based methods compared to reference devices. Other outcomes of interest include the quality of the method comparison studies with respect to published reporting guidelines, any limitations of non-contact non-invasive technology and application in different populations. DISCUSSION To the best of our knowledge, this is the first systematic review of image-based non-contact methods of vital signs monitoring. Synthesis of currently available technology will facilitate future research in this highly topical area. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016029167.
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Medical Devices for Pediatric Apnea Monitoring and Therapy: Past and New Trends. IEEE Rev Biomed Eng 2017; 10:199-212. [DOI: 10.1109/rbme.2017.2757899] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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