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Pflegerische Interventionen bei Kindern mit Windeldermatitis (inkontinenzassoziierter Dermatitis) – ein systematisches Review. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-019-0648-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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August DL, Ray RA, Kandasamy Y, New K. Neonatal skin assessments and injuries: Nomenclature, workplace culture and clinical opinions-Method triangulation a qualitative study. J Clin Nurs 2020; 29:3986-4006. [PMID: 32702143 DOI: 10.1111/jocn.15422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/19/2020] [Accepted: 07/10/2020] [Indexed: 11/26/2022]
Abstract
AIM AND OBJECTIVE To explore and establish the language, clinical opinions and workplace culture around neonatal skin injury nomenclature. Specifically, what nomenclature is used to describe, define, identity and communicate neonatal skin injuries including (a) terms, (b) locations, (c) associated risks and (d) mechanical forces. BACKGROUND Skin injuries are affirmed or denied based on visual assessment with findings reported by language rather than measurements. However, if language or nomenclature is ambiguous, assessments could be misinterpreted effecting healthcare delivery. DESIGN Qualitative enquiry including applied discourse analysis and between-method triangulation, within a larger exploratory mixed-methods study. METHODS Data were collected over two years from four sources: literature, documents, interviews/focus groups and free text injury assessments. Data analysis included content analysis, selective coding and thematic analysis. The collective data were further explored using discourse analysis and triangulation to achieve collective conclusions about opinions, emotions, feelings, perceptions and workplace cultures. The COREQ checklist provided structure for the reporting of study methods, analysis and findings. RESULTS A total of 427 data points were collected from literature, documentation and two clinical data sources. Data convergence revealed that neonatal skin injuries are described by numerous terms with preferences for "injury," "trauma" or "redness." Injuries occur in over 20 anatomical locations and risks for injuries included hospitalisation, specific treatments and prematurity. Essential medical devices, clinical condition, lack of clinician experience and overactive neonates were uniquely associated risks. There was incongruency between sources. The literature and documents empathise pressure as the primary force related to skin injury, while varied forces were identified within interviews, focus groups and free text injury assessments. CONCLUSIONS The variety of unique terms, locations and risks for injury indicate the need for updated neonatal skin injury frameworks. If frameworks and policies continue to be created without the empirical knowledge of neonatal clinicians, misrepresentation of neonatal skin injury locations and risk will continue to dominate the literature. RELEVANCE TO CLINICAL PRACTICE The recognition and management of neonatal skin injuries are related to language used to describe assessments in the absence of diagnostic confirmation, which has implications for both the neonate and the healthcare team.
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Affiliation(s)
- Deanne L August
- James Cook University, College of Medicine and Dentistry, Townsville, Qld, Australia
| | - Robin A Ray
- James Cook University, College of Medicine and Dentistry, Townsville, Qld, Australia
| | - Yoga Kandasamy
- James Cook University, College of Medicine and Dentistry, Townsville, Qld, Australia.,The Townsville Hospital and Health Service, Neonatology Townsville Hospital Townsville, Townsville, Qld, Australia
| | - Karen New
- School of Nursing, Midwifery and Social Work Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Qld, Australia
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Konar MC, Islam K, Roy A, Ghosh T. Effect of Virgin Coconut Oil Application on the Skin of Preterm Newborns: A Randomized Controlled Trial. J Trop Pediatr 2020; 66:129-135. [PMID: 31257430 DOI: 10.1093/tropej/fmz041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Preterm constitutes a major part of neonatal mortality, particularly in India. Due to dermal immaturity, preterm neonates are susceptible to various complications like infection, hypothermia, etc. Emollient application is a traditional practice in our subcontinent. AIMS To find out the efficacy of coconut oil application for skin maturity, prevention of sepsis, hypothermia and apnea, its effect on long-term neurodevelopment and adverse effect of it, if any. MATERIAL AND METHODS A randomized controlled trial was conducted in the rural field practice area of Department of Community Medicine, Burdwan Medical College from March 2014 to August 2018. Preterm born in the study period was divided into Group A (received virgin coconut oil application) and Group B (received body massage without any application). Neonatal skin condition was assessed on 7th, 14th, 21st and 28th day of life. Neurodevelopmental status was assessed on 3rd, 6th and 12th months. RESULTS A total of 2294 preterm were included in the study. Groups A and B consisted of 1146 and 1148 preterm infants, consecutively. Mean gestational age of the study population was 31.9 ± 3.4 weeks and 50.4% were male. Mean weight loss in first few days was less in group A but mean weight gain per day was higher in group B. Lesser incidences of hypothermia and apnea, and better skin maturity and neurodevelopmental outcome were noted in group A. No significant adverse effect was noted with coconut oil application. CONCLUSION Use of coconut oil helps in dermal maturity and better neurodevelopmental outcome. Further studies are warranted for universal recommendation.
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Affiliation(s)
- Mithun Chandra Konar
- Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal 713104, India
| | - Kamirul Islam
- Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal 713104, India
| | - Atanu Roy
- Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal 713104, India
| | - Taraknath Ghosh
- Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal 713104, India
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Strunk T, Pupala S, Hibbert J, Doherty D, Patole S. Topical Coconut Oil in Very Preterm Infants: An Open-Label Randomised Controlled Trial. Neonatology 2018; 113:146-151. [PMID: 29197867 DOI: 10.1159/000480538] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The immature fragile skin of preterm infants represents an inadequate protective barrier. The emollient and anti-infective properties of coconut oil make it a potentially beneficial topical agent for this population. OBJECTIVES Our aim was to evaluate feasibility, safety, and the effects of topical coconut oil on skin condition in very preterm infants. METHODS An open-label randomised controlled trial in preterm infants <30 weeks' gestation was conducted. Enrolled infants were randomised to receive either routine care or topical coconut oil (5 mL/kg) twice daily for 21 days, starting within 24 h of birth. The neonatal skin condition was the primary outcome, and was assessed using the Neonatal Skin Condition Score (NSCS) on days 1, 7, 14, and 21. The number of coconut oil applications was recorded to assess clinical feasibility and all enrolled infants were monitored for adverse effects of topical coconut application, such as skin irritation. RESULTS A total of 72 infants born <30 weeks' gestation were enrolled (36 infants per arm), with comparable demographic characteristics. Topical application of coconut oil was feasible and without adverse effects. The NSCS was maintained in the coconut oil group throughout the intervention period, but deteriorated from a median (IQR) of 3 (3-4) on day 1 to 4 (4-4) on day 21 in the control group (p = 0.01). There were no differences in common neonatal outcomes, including sepsis, necrotising enterocolitis, retinopathy of prematurity, chronic lung disease, and mortality. CONCLUSIONS Topical coconut oil maintained a better skin condition in very preterm infants without adverse effects. This simple, safe, and affordable intervention warrants further investigation.
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Affiliation(s)
- Tobias Strunk
- Neonatal Directorate, King Edward Memorial Hospital for Women, Subiaco, WA, Australia
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Çaka SY, Gözen D. Effects of swaddled and traditional tub bathing methods on crying and physiological responses of newborns. J SPEC PEDIATR NURS 2018; 23. [PMID: 29160925 DOI: 10.1111/jspn.12202] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/08/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to examine the effects of two bathing methods on crying duration and physiological measurements of newborns. DESIGN AND METHODS A randomized trial design was used in this study. The sample consisted of newborns (n = 80) who were admitted to neonatal intensive care unit of a university hospital located in a large city. The groups were determined as swaddled bathing (SB) (n = 40) and traditional tub bathing (TTB) (n = 40) by using random number table. All newborns were bathed 24 hours after the birth. Environmental variables were organised identically in both experimental and control groups. Duration of bathing was determined as maximum 5 min in both groups. Body temperature, heart rate (HR), and O2 saturation values were evaluated before bath, just after the bath and at 10 min after the bath. The groups were compared in terms of all vital symptoms and duration of crying during bath. Pre-bath and post-bath stress levels between newborns in both groups were compared by using the Newborn Infant Pain Scale (NIPS). RESULTS When the newborns were compared based on groups, it was observed that there was no statistically significant difference between SB and TTB groups in terms of the gestational week, APGAR score, postnatal age, and body weight. Body temperatures of the newborns in SB group just after the bath and 10 minutes after the bath were significantly higher than those in TTB group. HR was higher in TTB group in the post-bath period. NIPS scores of the newborns in SB group after bath decreased at a statistically significant level, but the scores of the newborns in TTB group increased. The results of the study indicated that SB was effective in maintaining body temperature, SpO2 level, and HR of newborns within normal limits and may decrease stress experienced during the bath. PRACTICE IMPLICATIONS Swaddled bathing decreases behavioural stress symptoms such as crying, agitation, and pulling arms and legs back unintentionally and thus the infants feel relaxed. Swaddled bathing can be recommended because swaddled bathing method decreases behavioural stress symptoms in infants.
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Affiliation(s)
- Sinem Yalnızoğlu Çaka
- Sakarya University, Faculty of Health Science, Department of Pediatric Nursing, Sakarya, Turkey
| | - Duygu Gözen
- Istanbul University Florence Nightingale Faculty of Nursing, Department of Pediatric Nursing, Istanbul, Turkey
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Skin care practices in newborn nurseries and mother-baby units in Maryland. J Perinatol 2017; 37:615-621. [PMID: 28005064 DOI: 10.1038/jp.2016.226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/06/2016] [Accepted: 09/12/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Skin provides several important homeostatic functions to the developing neonate. However, no consensus guidelines exist in the United States for skin care in the healthy term newborn. STUDY DESIGN We performed a study of skin and umbilical cord care (including bathing practices, vernix removal and antiseptic cord application) in newborn nurseries and mother-baby units throughout the state of Maryland to determine practices in a variety of clinical settings and assess if uniformity in skin care exists. These data were then assessed in the context of a review of the current literature. RESULTS We received responses from over 90% of nurseries across the state. In our cohort, practices varied widely between institutions and specific populations, and often were not evidence-based or were contrary to best practices discussed in the scientific literature. CONCLUSION The frequent departures from evidence that occur regarding the aforementioned practices are likely due to a lack of consensus on these issues as well as limited data on such practices, further highlighting the need for data-driven guidelines on newborn skin care.
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Lesions requiring wound management in a central tertiary neonatal intensive care unit. World J Pediatr 2017; 13:165-172. [PMID: 27878785 DOI: 10.1007/s12519-016-0070-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/22/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Most of the skin disorders that occur in neonatal intensive care units are due in part to the immaturity and vulnerability of the neonatal skin. Various iatrogenic diagnostic and therapeutic procedures are also conducive to iatrogenic damage. This study was to review the neonates admitted to our neonatal intensive care unit who needed wound management, and to assess the most common skin injuries and wounds, and their aetiology. METHODS Data were extracted from medical records of neonates who needed wound management in our Neonatal Intensive Care Unit between January 31, 2012 and January 31, 2013. Information about gestational age, sex, birth weight, area of involvement, wound aetiology, and therapy were collected. RESULTS Among the 211 neonates observed, wound management was required in 10 cases of diaper dermatitis, 7 epidermal stripping, 6 extravasation injuries, 5 pressure ulcers, 1 surgical wound and infection, 1 thermal burn, and 5 other lesions. CONCLUSIONS International guidelines in neonatal wound care practice are not available, and further research concerns are clearly needed. Dressings and antiseptic agents should be chosen with great care for application to neonates, with particular attention to the prevention of adverse events in this sensitive population. Team work among dermatologists, neonatologists and nurses is crucial for the successful treatment of neonates.
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Abstract
The skin of a term newborn differs both from preterm skin and that of an adult, and there is currently little consensus on the proper use of emollients in this population. The focus of most published literature is on preterm skin and the use of bathing products, with limited information regarding emollient use. Intact skin is the first line of defense against infection, allergens, and dehydration, and dry and compromised skin puts the infant at greater risk of harm from the aforementioned complications. Emollients are part of the front-line treatment for atopic dermatitis (AD), and, with the incidence of AD on the rise, it is imperative that further research be conducted to provide a guide for clinical practice.
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Walters RM, Anim-Danso E, Amato SM, Capone KA, Mack MC, Telofski LS, Mays DA. Hard water softening effect of a baby cleanser. Clin Cosmet Investig Dermatol 2016; 9:339-345. [PMID: 27789967 PMCID: PMC5072514 DOI: 10.2147/ccid.s111729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hard water is associated with atopic dermatitis (eczema). We wanted to determine if a baby cleanser and its individual components altered free ionized calcium (Ca2+) in a simulated hard water baby bath. For these studies, an in vitro determination of free Ca2+ in a simulated hard water baby bath, and an in vivo exploratory study of free Ca2+ absorption into skin from hard water were performed. METHODS Free Ca2+ was measured with an ion-sensitive electrode in vitro in hard water (100-500 ppm, Ca2+) before and after addition of the cleanser and/or its components. In an exploratory study, absorption of Ca2+ into skin from hard water was determined in three female participants (aged 21-29 years). RESULTS At an in-use dilution of 1%, the test cleanser reduced free Ca2+ from ~500 ppm to <200 ppm; a 10% in-use dilution bound virtually all free Ca2+. The anionic surfactant component contributed the most to this effect. In the exploratory in vivo study, we measured a reduction of ~15% in free Ca2+ from simulated hard water over 10 minutes. CONCLUSION Baby cleansers can bind free Ca2+ and reduce the effective water hardness of bath water. Reducing the amount of free Ca2+ in the water will reduce the availability of the ion for binding to the skin. Altering or reducing free Ca2+ concentrations in bath water may be an important parameter in creating the ideal baby bath.
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Affiliation(s)
- Russel M Walters
- Skin Care Research & Development, Johnson & Johnson Consumer Inc., Skillman, NJ, USA
| | - Emmanuel Anim-Danso
- Skin Care Research & Development, Johnson & Johnson Consumer Inc., Skillman, NJ, USA
| | - Stephanie M Amato
- Skin Care Research & Development, Johnson & Johnson Consumer Inc., Skillman, NJ, USA
| | - Kimberly A Capone
- Skin Care Research & Development, Johnson & Johnson Consumer Inc., Skillman, NJ, USA
| | - M Catherine Mack
- Skin Care Research & Development, Johnson & Johnson Consumer Inc., Skillman, NJ, USA
| | - Lorena S Telofski
- Skin Care Research & Development, Johnson & Johnson Consumer Inc., Skillman, NJ, USA
| | - David A Mays
- Skin Care Research & Development, Johnson & Johnson Consumer Inc., Skillman, NJ, USA
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Extremely Preterm Infant Skin Care: A Transformation of Practice Aimed to Prevent Harm. Adv Neonatal Care 2016; 16 Suppl 5S:S26-S32. [PMID: 27676111 DOI: 10.1097/anc.0000000000000335] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The skin of extremely preterm infants is underdeveloped and has poor barrier function. Skin maintenance interventions initiated in the neonatal intensive care unit (NICU) have immediate and lifelong implications when the potential for infection, allergen sensitization, and altered aesthetic outcomes are considered. In addition, the high-level medical needs of extremely preterm infants demand skin-level medical interventions that too often result in unintended skin harm. PURPOSE We describe the use of a harm prevention, or consequence-centered, approach to skin care, which facilitates safer practice for extremely premature infants. METHOD Neonatal and pediatric Advanced Practice Registered Nurses (APRN) came together for monthly meetings to review the evidence around best skin care practices for extremely preterm infants, with an emphasis on reduction of skin harm. Findings were focused on the population of interest and clinical implementation strategies. FINDINGS Skin care for extremely preterm infants remains overlooked by current literature. However, clinical practice pearls were extracted and applied in a manner that promotes safer skin care practices in the NICU. IMPLICATIONS FOR PRACTICE Gentle adhesives, such as silicone tapes and hydrogel-backed electrodes, can help to reduce medical adhesive-related skin injuries. Diaper wipes are not appropriate for use among extremely preterm infants, as many ingredients may contain potential allergens. Skin cleansers should be pH neutral to the skin and the prophylactic use of petrolatum-based emollients should be avoided. IMPLICATIONS FOR RESEARCH Further exploration and understanding of skin care practices that examine issues of true risk versus hypothetical risk of harm.
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Young DL, Chakravarthy D, Drower E, Reyna R. Skin care product evaluation in a group of critically ill, premature neonates: a descriptive study. J Wound Ostomy Continence Nurs 2016; 41:519-27. [PMID: 25377101 DOI: 10.1097/won.0000000000000083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Cleansing, moisturizing, and protecting neonatal skin is important, but literature evaluating specific product lines is limited. The purpose of this study was to measure the influence of a skin care product line on overall skin condition, perineal erythema, and pain when applied to neonates in a neonatal intensive care unit (NICU). DESIGN This was an open label, descriptive study. Comparisons were made between measurements taken at the beginning of the study to those at the end, on the same subjects. SUBJECTS AND SETTING The study was conducted in a 41-bed NICU at Driscoll Children's Hospital in Corpus Christi, Texas, that serves 31 counties in the region. This NICU treats children needing level 2 and 3 care, with a 1:1 or 2:1 nurse staffing ratio. This is not a birthing center; patients come from other community hospitals. Twenty-nine neonates participated in the study; their average body weight was 1.39 kg (3.06 lb) and their average gestation was 31.7 weeks. METHODS A skin care product line was introduced into a neonatal intensive care unit for 14 days. The products included 2 cleansers, 2 moisturizers, and a skin protectant with zinc oxide. Three outcome measures were tracked: Neonatal Skin Condition Score (NSCS), Skin Erythema Scale (SES), and pain. Nurses were also given a product evaluation survey. Descriptive statistics were used to report percentages and trends. Paired t tests were used to compare the mean NSCS, SES, and pain scores from the first 2 days a subject was in the study to the mean of the scores from the last 2 days they were in the study. RESULTS Subjects experienced approximately 1774 exposures to individual products during data collection. No differences were found in pain scores (P = .132), SES score (P = .059), or NSCS (P = .603) when mean values were compared at the beginning and end of the study. Analysis of the product evaluation survey for questions on cleaning, moisturizing, and reducing discomfort found that more than 90% of nurses ranked the new products as better than or equal to similar products used previously. CONCLUSIONS Use of a skin care product line was not associated with significant increases in overall neonatal skin condition measured with the NSCS, perineal erythema measured with the SES, or pain. The nurses caring for the subjects in this study prefer these products to others they have used in the past.
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Affiliation(s)
- Daniel L Young
- Daniel L. Young, PT, DPT, Associate Professor, Department of Physical Therapy, School of Allied Health Sciences, University of Nevada, Las Vegas. Debashish Chakravarthy, PhD, FAPWCA, Vice President, Clinical and Technical Strategy, Skin and Wound Care Division, Medline Industries, Inc, Mundelein, Illinois. Edward Drower, MS, Clinical Project Director, Research and Development, Medline Industries, Inc., Mundelein, Illinois. Roxana Reyna, BSN, RNC-NIC, WCC, Skin & Wound Prevention Specialist, Driscoll Children's Hospital, Corpus Christi, Texas
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Csoma Z, Meszes A, Mader K, Kemény L, Tálosi G. Overview of dermatologic disorders of neonates in a central regional intensive care unit in Hungary. Pediatr Dermatol 2015; 32:201-7. [PMID: 25529047 DOI: 10.1111/pde.12443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The immaturity and vulnerability of the skin and epidermal barrier function and the frequent iatrogenic complications following diagnostic and therapeutic procedures are often associated with skin manifestations in infants in neonatal intensive care units (NICUs). The aim of the current study was to investigate dermatologic disorders in neonates in our NICU. A prospective cohort study was conducted in the NICU at the Department of Pediatrics at the University of Szeged between January 2012 and January 2013. All full- and preterm infants hospitalized in the NICU underwent whole-body skin examinations and all dermatologic disorders and treatment modalities were recorded. Eighty-nine dermatologic conditions were detected in 64 of the 211 neonates admitted to the NICU. A wide variety of clinical symptoms accompanied these conditions in these preterm and severely ill full-term infants. A considerable proportion of the disorders that were seen resulted from the immaturity of the skin and various iatrogenic complications. Dermatologic disorders are frequent in neonates requiring intensive care. Prevention, early detection, and optimal treatment of these disorders with modern, standardized skin care management strategies can result in significant improvements in barrier function and in the integrity of the skin, increasing the overall efficacy of neonatal intensive care.
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Affiliation(s)
- Zsanett Csoma
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
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Ono S, Imai R, Ida Y, Shibata D, Komiya T, Matsumura H. Increased wound pH as an indicator of local wound infection in second degree burns. Burns 2014; 41:820-4. [PMID: 25468471 DOI: 10.1016/j.burns.2014.10.023] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/24/2014] [Accepted: 10/24/2014] [Indexed: 11/30/2022]
Abstract
Wound pH affects a number of important factors in wound healing. It is known that the pH of the skin surface of healthy adults and children is 4.2-5.6 and that it decreases with the lapse of epithelialization. We measured the pH of the exudates from second degree burns in 26 cases. Among these, local burn wound infection developed in 6 cases. The causative organisms were Staphylococcus aureus in 2 cases and Staphylococcus epidermidis in 4 cases. The maximum pH value measured was 10.0 and the minimum was 5.0 for all samples. There were no differences in the initial measurements of pH between the non-infected cases and the local-infected cases. In cases of local infection, the pH rose prior to the onset of clinical signs of local burn infection. By consecutive measurement of pH, early detection of local wound infection can be achieved and this is very beneficial in clinical practice. Moreover, measurement is very easy and results are available immediately. In conclusion, consecutive pH measurement of exudates is considered to be a useful indicator in the treatment of second degree burns.
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Affiliation(s)
- Sayaka Ono
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ryutro Imai
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yukiko Ida
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Dai Shibata
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takako Komiya
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hajime Matsumura
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan.
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So H, You M, Mun J, Hwang M, Kim H, Pyeon S, Shin M, Chang B. Effect of Trunk‐to‐Head Bathing on Physiological Responses in Newborns. J Obstet Gynecol Neonatal Nurs 2014; 43:742-51. [DOI: 10.1111/1552-6909.12496] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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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.
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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
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August DL, Edmonds L, Brown DK, Murphy M, Kandasamy Y. Pressure injuries to the skin in a neonatal unit: Fact or fiction. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jnn.2013.08.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Baby care product development: Artificial urine in vitro assay is useful for cosmetic product assessment. Toxicol In Vitro 2014; 28:3-7. [DOI: 10.1016/j.tiv.2013.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 05/17/2013] [Accepted: 06/26/2013] [Indexed: 11/21/2022]
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Altimier L, Phillips RM. The Neonatal Integrative Developmental Care Model: Seven Neuroprotective Core Measures for Family-Centered Developmental Care. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.nainr.2012.12.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fernandes JD, Machado MCR, Oliveira ZNPD. Children and newborn skin care and prevention. An Bras Dermatol 2012; 86:102-10. [PMID: 21437530 DOI: 10.1590/s0365-05962011000100014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Indexed: 11/22/2022] Open
Abstract
Neonatal skin suffers a progressive adaptation to the extrauterine environment and special care is needed during this period. This skin is very sensitive, thin and fragile. Immaturity of the epidermal barrier reduces the defense against the excessive proliferation of microbes and makes the skin more vulnerable to trauma and percutaneous drug toxicity. Because of the peculiar characteristics of newborn, infant and children's skin, the use of cosmetic products designed for hygiene and protection requires caution. In order to preserve the integrity of neonatal and child's skin, this article reviewed basic preventive care practices in relation to hygiene, bathing, cleansing agents, topical products and their percutaneous toxicity.
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Affiliation(s)
- Juliana Dumêt Fernandes
- Department of Dermatology, Clinics Hospital, Faculty of Medicine, University of Sao Paulo, SP, Brazil.
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Fontenele FC, Cardoso MVLML. Lesões de pele em recém-nascidos no ambiente hospitalar: tipo, tamanho e área afetada. Rev Esc Enferm USP 2011; 45:130-7. [DOI: 10.1590/s0080-62342011000100018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 05/05/2010] [Indexed: 11/22/2022] Open
Abstract
Lesões de pele podem ocorrer em recém-nascidos (RNs), na Unidade de Terapia Intensiva Neonatal (UTIN). Objetivou-se identificar lesões de pele em recém-nascidos internados em uma UTIN, considerando tipo, área afetada e tamanho. Estudo prospectivo, descritivo, quantitativo, realizado de março a maio de 2007, em uma instituição pública de Fortaleza-CE, Brasil. A amostra foi composta de 137 recém-nascidos, destes 36 (26%) apresentaram lesões. RESULTADOS: hematomas (24;46%), eritemas (9;18%), escoriações (6;12%), equimoses (5;10%), pústulas (3;6%) e outras (4;8%). Quanto à área: 40% eram < 1cm². Quanto ao tamanho: 68% tinham entre 1 e 2cm. Predominou a forma geográfica (38%) e distribuição localizada (92%). Quanto à região afetada: membros (27; 52%), tronco (12; 24%), cabeça (8; 16%) e outras (4;8%). Concluiu-se que as lesões de pele mais presentes são os hematomas e a área mais afetada é a dos membros.
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Abstract
Safe dressing techniques for neonatal peripherally inserted central catheters (PICCs) remain controversial in the literature. This article describes one unit's experience with the placement and management of 491 PICCs during a six-year period with more than 5,600 catheter days. The dressing technique described in this article differs from that seen in the literature with the addition of a protective base layer. Catheter complication rates are low, and catheter dressing changes are minimized with this dressing technique.
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Da Cunha ML, Procianoy RS, Franceschini DT, De Oliveira LL, Cunha ML. Effect of the first bath with chlorhexidine on skin colonization with Staphylococcus aureus in normal healthy term newborns. ACTA ACUST UNITED AC 2009; 40:615-20. [DOI: 10.1080/00365540801932447] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kiechl-Kohlendorfer U, Berger C, Inzinger R. The effect of daily treatment with an olive oil/lanolin emollient on skin integrity in preterm infants: a randomized controlled trial. Pediatr Dermatol 2008; 25:174-8. [PMID: 18429773 DOI: 10.1111/j.1525-1470.2008.00627.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To date, appropriate skin therapy for premature infants has not been clearly defined. Emollient creams are often used without solid evidence for a benefit to the neonate. The aim of the current study was to investigate the cutaneous effects of two different topical ointment therapies. Between October 2004 and November 2006 we prospectively enrolled 173 infants between 25 and 36 weeks of gestation admitted to a neonatal intensive care unit. Infants were randomly assigned to daily topical treatment with water-in-oil emollient cream (Bepanthen), olive oil cream (70% lanolin, 30% olive oil), or to a control group. Each neonate was continuously treated for a maximum of 4 weeks. Skin condition (skin score reflecting degree of dermatitis) in these groups was compared at weeks 1, 2, 3, and 4. Neonates treated with olive oil cream showed statistically less dermatitis than did neonates treated with emollient cream, and both had a better outcome than those in the control group (p < 0.001 in weeks 2-4). Treatment effects persisted throughout the study period and applied to infants of all gestational ages. This study demonstrates that topical skin therapy lowers the risk of dermatitis. Olive oil cream was superior to water-in-oil emollient cream.
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Affiliation(s)
- Ursula Kiechl-Kohlendorfer
- Division of Neonatology, Neuropediatrics and Metabolic Disorders, Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria.
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Darmstadt GL, Hussein MH, Winch PJ, Haws RA, Lamia M, El-Said MA, Gipson RF, Santosham M. Neonatal home care practices in rural Egypt during the first week of life. Trop Med Int Health 2007; 12:783-97. [PMID: 17550476 DOI: 10.1111/j.1365-3156.2007.01849.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To provide information about home care practices for newborns in rural Egypt, in order to improve neonatal home care through preventive measures and prompt recognition of danger signs. METHOD Survey of newborn home care practices during the first week of life in 217 households in three rural Egyptian Governorates. RESULTS Many practices met common neonatal care standards, particularly prompt initial breastfeeding, feeding of colostrum and continued breastfeeding, and most bathing practices. However, several practices could be modified to improve neonatal care and survival. Supplemental substances were given to 44% of newborns as pre-lacteal feeds, and to more than half during the first week. Nearly half (43%) of mothers reported that they did not wash their hands before neonatal care, and only 7% washed hands after diaper changes. Thermal control was not practiced, although mothers perceived 22% of newborns to be hypothermic. CONCLUSIONS The practices we observed, which are critical for newborn survival, could be improved with minor modifications. We provide a framework for communicating behaviour change and setting research priorities for improving neonatal health.
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Affiliation(s)
- Gary L Darmstadt
- Department of International Health, Bloomberg School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD 21205, USA.
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Clifton-Koeppel R. Wound Care After Peripheral Intravenous Extravasation: What Is the Evidence? ACTA ACUST UNITED AC 2006. [DOI: 10.1053/j.nainr.2006.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sawatzky-Dickson D, Bodnaryk K. Neonatal intravenous extravasation injuries: evaluation of a wound care protocol. Neonatal Netw 2006; 25:13-9. [PMID: 16514862 DOI: 10.1891/0730-0832.25.1.13] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate an evidence-based wound protocol for intravenous extravasation injuries in neonates. SAMPLE Nine newborns with intravenous extravasation injuries. Birth weight: 582-4,404 gm, gestational age: 24-40 weeks. RESULTS Five Wounds were colonized with coagulase-negative Staphylococcus species, two with diphtheroids, three with Enterococcus. There was no evidence of wound infection or systemic infection. Rates of wound healing ranged from one to six weeks.
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Abstract
BACKGROUND Awareness is increasing that the use of some commercial products on the premature neonatal skin may be beneficial, whereas the use of others may be harmful. The World Health Organization developed general postnatal care guidelines and the Association of Women's Health, Obstetric and Neonatal Nurses published specific evidence-based guidance relating to neonatal skin care. No systematic reviews on the topic have focused on the term newborn. The objective of this review was to determine, for the well term baby, if the use of soaps or detergents in bath water is associated with the development of dry, cracked, or flaking skin in the perinatal period, and short- and long-term consequences of the use of emollients, lotions, or moisturizers for dry skin. METHODS We conducted a structured systematic review of prospective studies involving term newborns. RESULTS No relevant studies were located. CONCLUSIONS No prospective studies of research in skin care involving the term newborn were found. Some recommendations for skin care may balance risk and benefit for the compromised infant, but this balance may be different for the healthy term newborn. Clinical practitioners should be aware that outcomes related to the use of soaps, detergents, emollients, and lotions on the term neonatal skin have not been formally investigated. Systematic reviews that yield no formal results provide insights into unresearched areas of practice, and should be reported to highlight these deficits, and to avoid duplication of effort by future investigators.
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Affiliation(s)
- Lynne Walker
- Fylde and Wyre National Health Service Hospital Trust, Blackpool, England
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Abstract
OBJECTIVE To assess the effect of bathing with water only or with mild pH neutral soap and water on skin flora of preterm newborns. METHOD Randomized blinded clinical trial that enrolled 73 preterm newborns whose gestational age was between 28 and 35 weeks and birth weight between 800 and 1800 g. At the age of 3 days the infants were randomly assigned to a group that was given daily baths either with water only, or with soap and water for 7 or more days. Antibiotic treatment delayed onset of the trial in some preterm infants. On the final day of bathing axillary bacterial cultures were obtained before and 30 minutes after bathing. RESULTS At the time of axillary culturing, the mean age of the newborns was 19 days. Coagulase-negative Staphylococcus was the most prevalent microorganism in both groups. No significant difference was found in the count of microorganism colonies between both groups. The comparison of the number of bacterial colonies between the time before and after bath, carried out by repeated-measures ANOVA showed a significant difference over time in the two groups, without a significant difference between the two groups. CONCLUSIONS Bathing preterm newborns with water only or with soap and water produces similar effects on skin colonization of a preterm neonate. Both are effective to decrease the number of colonies of Gram-positive and Gram-negative bacteria.
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Affiliation(s)
- Maria Luzia Chollopetz da Cunha
- Department of Pediatrics, Newborn Section, Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre, RS, Brazil
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McConnell TP, Lee CW, Couillard M, Sherrill WW. Trends in umbilical cord care: Scientific evidence for practice. ACTA ACUST UNITED AC 2004. [DOI: 10.1053/j.nainr.2004.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bryanton J, Walsh D, Barrett M, Gaudet D. Tub Bathing Versus Traditional Sponge Bathing for the Newborn. J Obstet Gynecol Neonatal Nurs 2004; 33:704-12. [PMID: 15561658 DOI: 10.1177/0884217504270651] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare selected effects of tub bathing versus traditional sponge bathing in healthy, term newborns and their mothers' ratings of pleasure and confidence with the bath. DESIGN Randomized controlled study. SETTING The maternity unit of an eastern Canadian hospital. PARTICIPANTS One hundred two mother-baby pairs were randomly assigned to an experimental tub bath or a sponge bath control group. INTERVENTIONS Fifty-one newborns were tub bathed and 51 sponge bathed according to the study protocols for their initial and one additional bath. MAIN OUTCOME MEASURES (a) Newborn temperature stability was assessed by recording axillary temperatures pre- and postbath, (b) umbilical cord healing was identified by daily observations and infection control surveillance, (c) infant contentment was quantified by applying the Brazelton Neonatal Behavioral Assessment Scale, and (d) maternal pleasure with the bath and confidence with bathing at discharge were self-rated on a 5-point scale. RESULTS Tub-bathed babies experienced significantly less temperature loss (t = 4.79, p = .00) and were significantly more content (t = -6.48, p = .00) than were those who were sponge bathed. No differences in cord healing scores were found. Mothers of tub bathed babies rated their pleasure with the bath significantly higher than did mothers of sponge bathed babies (t = 4.15, p = .00). No differences in maternal confidence were noted. CONCLUSIONS Tub bathing is a safe and pleasurable alternative to sponge bathing in healthy, term newborns.
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Affiliation(s)
- Janet Bryanton
- School of Nursing, 550 University Avenue, Charlottetown, Prince Edward Island, Canada, C1A 4P3.
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37
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Lund CH, Osborne JW. Validity and reliability of the neonatal skin condition score. J Obstet Gynecol Neonatal Nurs 2004; 33:320-7. [PMID: 15180195 DOI: 10.1177/0884217504265174] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To demonstrate the validity and reliability of the Neonatal Skin Condition Scale (NSCS) used in the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the National Association of Neonatal Nurses (NANN) neonatal skin care evidence-based practice project. SETTING NICU and well-baby units in 27 hospitals located throughout the United States. PARTICIPANTS Site coordinators (N = 27) and neonates (N = 1,006) observed during both the pre and postimplementation phases of the original neonatal skin care project. METHOD To assess reliability, two consecutive NSCS assessments on a single infant were analyzed. Site coordinators were contacted after the original project was concluded. Sites indicating that a single nurse scored all infant skin observations provided data that were used to evaluate intrarater reliability. Sites using more than one nurse to score skin observations provided data that were used to assess interrater reliability. To assess validity, the following variables were used from the original data set: the Neonatal Skin Condition Scale (NSCS), with three subscales for dryness, erythema, and breakdown; birth weight in grams; number of skin score observations for each infant; and the prevalence of infection, defined as a positive blood culture. RESULTS For intrarater reliability, 16 sites used a single nurse for all NSCS assessments; total NSCS assessments 475. For interrater reliability, 11 sites used multiple raters; total assessments 531. The NSCS demonstrated adequate reliability for each of the three subscales and for the total score, with the percent agreement between scores ranging from 68.7% to 85.4% (intrarater) and 65.9% to 89% (interrater); all Kappas were significant at p < .001 and were in the moderate range for reliability. The validity of the NSCS was demonstrated by the findings that smaller infants were 6 times more likely to have erythema (chi2(6) = 109.55, p < .0001), and approximately twice as likely to have the most severe breakdown (chi2(6) = 108.01, p < .0001). Infants with more observations (longer length of stay) had higher skin scores (odds ratio = 1.21, p < .0001), and an increased probability of infection was noted for infants with higher skin scores (odds ratio = 2.25, p < .0001). CONCLUSIONS The Neonatal Skin Condition Score (NSCS) is reliable when used by single and multiple raters to assess neonatal skin condition, even across weight groups and racial groups. Validity of the NSCS was demonstrated by confirmation of the relationship of the skin condition scores with birth weight, number of observations, and prevalence of infection.
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Clark R, Powers R, White R, Bloom B, Sanchez P, Benjamin DK. Nosocomial infection in the NICU: a medical complication or unavoidable problem? J Perinatol 2004; 24:382-8. [PMID: 15116140 DOI: 10.1038/sj.jp.7211120] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nosocomial sepsis is a serious problem for neonates who are admitted for intensive care. As it is associated with increases in mortality, morbidity, and prolonged length of hospital stay, both the human and fiscal costs of these infections are high. Although the rate of nosocomial sepsis increases with the degree of both prematurity and low birth weight, no specific lab test has been shown to be very useful in improving our ability to predict who has a "real" blood-stream infection and, therefore, who needs to be treated with a full course of antibiotics. As a result, antibiotic use is double the rate of "proven" sepsis and we are facilitating the growth of resistant organisms in the neonatal intensive care unit. The purpose of this article is to review the topic of nosocomial infections in neonates.
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Affiliation(s)
- Reese Clark
- Pediatrix Medical Group, Inc., 1301 Concord Terrace, Sunrise, FL 33323-2825, USA
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Pollock TR, Franklin C. Use of evidence-based practice in the neonatal intensive care unit. Crit Care Nurs Clin North Am 2004; 16:243-8. [PMID: 15145369 DOI: 10.1016/j.ccell.2004.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The process change described is an ongoing project in the HICN. Through this process we found that developmentally sensitive care can be accomplished as early as the time of birth by minimizing trauma to ELBW infants, keeping them nested with minimal handling. This also supports the goal for this population of minimizing cold stress and its effects. Gentle ventilation can be achieved in the delivery room by understanding physiology and the effects of ventilation on the ELBW lung tissue.
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Affiliation(s)
- Trudy R Pollock
- Hemby Intensive Care Nursery, Presbyterian Hospital, 200 Hawthorne Lane, Charlotte, NC 28204, USA.
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40
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Abstract
Irritant diaper dermatitis (IDD) is a form of contact dermatitis occurring in the diaper area as a consequence of disruption of the barrier function of the skin through prolonged contact with faeces and urine. Despite advances in diaper technology, it is a condition that still occurs regularly in young children. To combat this, barrier preparations can be used to protect the skin by coating the surface of the skin and/or by supplying lipids that can penetrate the intercellular spaces of the stratum corneum. In this review, the pathophysiology of IDD is outlined and its prevention and treatment are discussed, with particular reference to the role of emollients.
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Affiliation(s)
- David J Atherton
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
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41
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Wong CP, Chui PT, Karmakar MK. Facial skin injuries caused by adhesive tapes in a patient receiving cosmetic skin exfoliants. Anesth Analg 2003; 97:1310-1311. [PMID: 14570644 DOI: 10.1213/01.ane.0000085297.23359.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 39-yr-old woman underwent general anesthesia for laparoscopic sterilization. We used adhesive tapes to close her eyelids and to secure the tracheal tube. Removal of the tapes caused patchy areas of skin loss. We later discovered that the patient had fragile facial skin from cosmetics containing skin exfoliants. We recommend taking a detailed drug history before anesthesia and avoiding adhesive tapes to the patient's face under general anesthesia.
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Affiliation(s)
- Chau P Wong
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, The Prince of Wales Hospital, Sha Tin, NT, Hong Kong
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Abstract
Infant massage therapy is an inexpensive tool that should be utilized as part of the developmental care of the preterm infant. Nurses have been hesitant to begin massage therapy for fear of overstimulating the infant and because there has been insufficient research to prove its safety. Recent research, however, has shown that the significant benefits of infant massage therapy far outweigh the minimal risks. When infant massage therapy is properly applied to preterm infants, they respond with increased weight gains, improved developmental scores, and earlier discharge from the hospital. Parents of the preterm infant also benefit because infant massage enhances bonding with their child and increases confidence in their parenting skills. This article discusses the benefits and risks of massage for preterm infants and their families and explains how to implement massage therapy in the neonatal intensive care setting.
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Affiliation(s)
- Jodi M Beachy
- Children's Hospital Newborn Special Care Unit at Docters West, Columbus, Ohio 43228, USA.
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43
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Foster L, Wallis M, Paterson B, James H. A descriptive study of peripheral intravenous catheters in patients admitted to a pediatric unit in one Australian hospital. JOURNAL OF INFUSION NURSING 2002; 25:159-67. [PMID: 12023653 DOI: 10.1097/00129804-200205000-00003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over a 5-month period, 496 peripheral intravenous catheters (PIVs) inserted into neonates, infants, and children were prospectively studied. Data were collected on demographic patient characteristics, PIV indications for use, dwell time, and reasons for removal, together with nursing actions. The results showed that most PIVs were removed within 72 hours. In 6.6% of cases, some degree of phlebitis was present at PIV removal. The risk of phlebitis increased when the PIV remained in place longer, the child was younger, or medication was administered. The greatest risk was age, with neonates being 5(1/2) times more likely to have some degree of phlebitis than non-neonates.
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Sharek PJ, Benitz WE, Abel NJ, Freeburn MJ, Mayer ML, Bergman DA. Effect of an evidence-based hand washing policy on hand washing rates and false-positive coagulase negative staphylococcus blood and cerebrospinal fluid culture rates in a level III NICU. J Perinatol 2002; 22:137-43. [PMID: 11896519 DOI: 10.1038/sj.jp.7210661] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the effect of implementing an evidence-based hand washing policy on between-patient hand washing compliance and on blood and cerebrospinal fluid (CSF) culture rates in a level III neonatal intensive care unit (NICU). METHODS An evidence-based hand washing policy, supported by an intensive education program, was introduced in a regional NICU. A total of 2009 preintervention neonates (16,168 patient days) over 17 months were compared to 676 postintervention neonates (5779 patient days) over 6 months. Hand washing compliance and rates of blood and CSF cultures yielding coagulase negative staphylococci (CONS) were compared before and after intervention. RESULTS Compliance with appropriate between-patient hand washing improved (from 47.4% to 85.4%, p=0.001) after the hand washing policy was introduced. The rate of cultures positive for CONS declined from 6.1+/-2.3 to 3.2+/-1.6 per 1000 patient days (p=0.005). Most of this reduction was attributable to a reduction in false-positive cultures, from 4.2+/-2.4 to 1.9+/-1.8 per 1000 patient days (p=0.042), but there was a trend toward decreased true-positive cultures (from 2.1+/-1.2 to 1.2+/-1.0 per 1000 patient days, p=0.074) as well. Potential confounders and demographics factors were similar between the control and intervention subjects. CONCLUSION Implementation of an evidence-based hand washing policy resulted in a significant increase in hand washing compliance and a significant decrease in false-positive coagulase negative staphylococcal blood and CSF culture rates. Exploratory data analysis revealed a possible effect on true-positive coagulase negative staphylococcal blood and CSF culture rates, but these results need to be confirmed in future studies.
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Affiliation(s)
- Paul J Sharek
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
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45
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Donlon CR, Furdon SA, Clark DA. Look before you clamp: delivery room examination of the umbilical cord. Adv Neonatal Care 2002; 2:19-26. [PMID: 12903232 DOI: 10.1053/adnc.2002.31512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The umbilical cord is a critical connection between the embryo (and later, the fetus) and the placenta. The umbilical cord houses the blood vessels that are responsible for nourishing the fetus. Proper umbilical cord function is essential for growth and development before birth. A review of the embryologic origin of the umbilical cord aids in understanding abdominal wall and umbilical cord defects that can present in the newborn period. In the delivery room, inspection of the umbilical cord is an integral part of the first minutes of life. Any abnormality either within the cord structure or in the areas surrounding the base of the cord may necessitate a delay in shortening the cord. Surgical consultation may also be indicated. This issue of Focus on the Physical will provide a step-by-step guide to cord assessment in the delivery room setting. Pictures showing normal, atypical, and abnormal umbilical cords and common abdominal wall defects will be presented along with a brief discussion of the significance and clinical implications of each of these findings.
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Affiliation(s)
- Christine Reu Donlon
- Children's Hospital, Albany Medical Center, New Scotland, Albany, NY 12208, USA.
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46
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Gennaro S, Hodnett E, Kearney M. Making evidence-based practice a reality in your institution. MCN Am J Matern Child Nurs 2001; 26:236-44; quiz 245. [PMID: 11552573 DOI: 10.1097/00005721-200109000-00004] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are many barriers to ensuring that nursing practice is based on research evidence. This article provides several resources to help the practicing nurse identify what evidence is available upon which to make practice changes. Additionally, strategies for supporting change are discussed and a case study of one particular evidenced-based change--1:1 support by nurses for women in labor--is examined.
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Affiliation(s)
- S Gennaro
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
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47
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Johnson FE, Maikler VE. Nurses' adoption of the AWHONN/NANN Neonatal Skin Care Project. ACTA ACUST UNITED AC 2001. [DOI: 10.1053/nbin.2001.21831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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48
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Lund CH, Kuller J, Lane AT, Lott JW, Raines DA, Thomas KK. Neonatal Skin Care: Evaluation of the AWHONN/NANN Research-Based Practice Project on Knowledge and Skin Care Practices. J Obstet Gynecol Neonatal Nurs 2001. [DOI: 10.1111/j.1552-6909.2001.tb01519.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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50
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Lund CH, Osborne JW, Kuller J, Lane AT, Lott JW, Raines DA. Neonatal Skin Care: Clinical Outcomes of the AWHONN/NANN Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2001. [DOI: 10.1111/j.1552-6909.2001.tb01520.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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