1
|
Tchignaha R, Restivo J, Szialta C, Nulman O, Parikh A. Infant with a hereditary blistering disorder: an interesting case in the NICU. Oxf Med Case Reports 2024; 2024:omae041. [PMID: 38784774 PMCID: PMC11110847 DOI: 10.1093/omcr/omae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/24/2023] [Accepted: 02/09/2024] [Indexed: 05/25/2024] Open
Abstract
This is a case of hereditary skin disorder in a full-term female newborn, with family history of epidermolysis bullosa (EB), who developed skin vesicles on the first day of life (DOL) without mucosal or ocular involvement. A multidisciplinary approach involving dermatology, wound care, and occupational therapy led to full recovery in our patient within six days of life. Special precautions were taken to prevent complications. Upon genetic testing, the patient was found to have a genetic variant of unknown significance (VUS). The goal of this case report is to give a detailed account of the patient's course, provide management recommendations which could be applied to similar cases and settings in the newborn period.
Collapse
Affiliation(s)
- Rifkatou Tchignaha
- Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Jessica Restivo
- Department of Rehabilitation Medicine, Occupational therapy, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Christina Szialta
- Department of Pediatric, Genetics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Oksana Nulman
- Department of Pediatrics, Research, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Abhinav Parikh
- Department of Pediatrics, Neonatology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| |
Collapse
|
2
|
Saad R, Duipmans J, Yerlett N, Plevey K, McCuaig C, Woolfe W, Steinau K, Phillips J, Azzopardi N, Thompson K, Ferreira da Rocha AC, Torres-Pradilla M, Ott H, Patton D, Moore Z, Murphy P, Mayre-Chilton K. Neonatal epidermolysis bullosa: a clinical practice guideline. Br J Dermatol 2024; 190:636-656. [PMID: 38175636 DOI: 10.1093/bjd/ljae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/05/2024]
Abstract
DEBRA International is undertaking a long-term initiative to develop clinical practice guidelines (CPGs) for epidermolysis bullosa (EB), to -improve the clinical care of people living with EB. Current neonatal care is based on evidence, clinical expertise and trial and error, with collaboration between the EB specialist team, parent or carer and patient, and is dependent on the neonate's individual presentation and type of EB. Early intervention based on research and clinical practice is needed to establish a foundation of knowledge to guide international practitioners to create and improve standards of care and to be able to work effectively with those newly diagnosed with EB. This CPG was created by an international panel with expertise working with persons with EB. The CPG focuses on neonatal care using a systematic review methodology covering four key areas: (i) diagnosis and parental psychosocial support; (ii) hospital management: medical monitoring, wound care and pain; (iii) feeding and nutrition; and (iv) discharge planning and EB education. These four areas highlight the importance of a multidisciplinary team approach, to provide a patient-specific holistic care model that incorporates the needs and wishes of the parents and carers. The Hospital Implementation Tool included promotes transfer of theory to clinical practice.
Collapse
Affiliation(s)
- Rebecca Saad
- Sydney Children's Hospital Randwick, Sydney, NSW, Australia
| | - José Duipmans
- Center for Blistering Diseases, Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Katie Plevey
- Great Ormond Street NHS Foundation Trust, London, UK
| | - Catherine McCuaig
- Sainte-Justine University Hospital Centre, and University of Montreal, Montreal, QC, Canada
| | - William Woolfe
- Sydney Children's Hospital Randwick, Sydney, NSW, Australia
| | - K Steinau
- Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA
| | | | | | - Kerry Thompson
- Person living with epidermolysis bullosa
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Maurico Torres-Pradilla
- Dermatology Department, Fundación Universitaria de Ciencias de la Salud, Hospital de San José, Bogotá, Colombia
- Dermatology Department, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Hagen Ott
- Division of Paediatric Dermatology and Centre for Rare Congenital Skin Diseases, Children's Hospital Auf der Bult, Hanover, Germany
| | - Declan Patton
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Murphy
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | |
Collapse
|
3
|
Abreu Molnar B, Levin L, Yun D, Morel K, Wiss K, Wieser J, Ward C, Trice H, Garcia-Romero MT, Stephenson A, Provost A, Price HN, Perman MJ, Moxon M, Moeves B, McCuaig CC, McCarthy C, Lucky AW, Levy ML, Lee M, Lara-Corrales I, Henner N, Halliburton N, Griffith E, Gorell E, Glick S, Eichenfield L, Collins C, Bruckner AL, Boulrice B, Bayliss S, Badger K, Paller AS. Inpatient management of epidermolysis bullosa: Consensus-based hands-on instructions for neonates and postneonates. J Am Acad Dermatol 2024:S0190-9622(24)00583-8. [PMID: 38604489 DOI: 10.1016/j.jaad.2024.04.014] [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: 01/26/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Epidermolysis bullosa (EB), characterized by skin fragility and blistering, often requires hospitalization. Training for inpatient management of EB is limited, with no unified recommendations available in North America. OBJECTIVE To develop consensus-derived best practices for hands-on inpatient management of EB in both the neonatal and postneonatal period. METHODS A modified Delphi method (expert-based input via 2 surveys and a final review) was implemented. Available guidelines from EB Clinical Research Consortium centers were analyzed to determine areas of focus and formulate statements to be voted on by EB Clinical Research Consortium members, experienced EB nurses, and select family members. Study participants evaluated statements using a Likert scale: statements with at least 70% agreement were accepted; statements with 30% or more disagreement were rejected. RESULTS Ten areas of focus were identified. Delphi participants included 15 dermatologists, 8 nurses, and 6 nonhealth care caregivers. Consensus was established on 103/119 neonatal statements and 105/122 postneonatal statements; no statements were rejected. Most recommendations applied to both age groups. LIMITATIONS Recommendations may require adjustment based on individual patient's clinical context. CONCLUSION Using the Delphi method, a consensus-derived resource for hospital-based health care professionals who manage patients with EB has been developed to improve the quality of inpatient care.
Collapse
Affiliation(s)
- Brenda Abreu Molnar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Dermatology, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Laura Levin
- Department of Dermatology, Columbia College of Physicians and Sumccrgeons, New York, New York
| | - Duri Yun
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Kimberly Morel
- Department of Dermatology, Columbia College of Physicians and Sumccrgeons, New York, New York
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Julie Wieser
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher Ward
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Haley Trice
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Allison Stephenson
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Adrienne Provost
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Harper N Price
- Division of Dermatology, Children's Hospital, Phoenix, Arizona
| | - Marissa J Perman
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Morgan Moxon
- Dell Medical School, University of Texas at Austin Dell Children's Medical Center, Austin, Texas
| | - Beth Moeves
- Division of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Christine McCarthy
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anne W Lucky
- Division of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Moise L Levy
- Dell Medical School, University of Texas at Austin Dell Children's Medical Center, Austin, Texas
| | - Michelle Lee
- Division of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Irene Lara-Corrales
- Division of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Natalia Henner
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nichole Halliburton
- Division of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Emily Griffith
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Gorell
- Division of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sharon Glick
- State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Lawrence Eichenfield
- University of California, San Diego and Rady Children's Hospital, San Diego, California
| | - Clara Collins
- Department of Dermatology, Columbia College of Physicians and Sumccrgeons, New York, New York
| | - Anna L Bruckner
- Departments of Dermatology and Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Brenda Boulrice
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Susan Bayliss
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Kellie Badger
- Division of Dermatology, Children's Hospital, Phoenix, Arizona
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| |
Collapse
|
4
|
Raoufinia R, Rahimi HR, Keyhanvar N, Moghbeli M, Abdyazdani N, Rostami M, Naghipoor K, Forouzanfar F, Foroudi S, Saburi E. Advances in Treatments for Epidermolysis Bullosa (EB): Emphasis on Stem Cell-Based Therapy. Stem Cell Rev Rep 2024:10.1007/s12015-024-10697-4. [PMID: 38430362 DOI: 10.1007/s12015-024-10697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
Epidermolysis bullosa (EB) is a rare genetic dermatosis characterized by skin fragility and blister formation. With a wide phenotypic spectrum and potential extracutaneous manifestations, EB poses significant morbidity and mortality risks. Currently classified into four main subtypes based on the level of skin cleavage, EB is caused by genetic mutations affecting proteins crucial for maintaining skin integrity. The management of EB primarily focuses on preventing complications and treating symptoms through wound care, pain management, and other supportive measures. However, recent advancements in the fields of stem cell therapy, tissue engineering, and gene therapy have shown promise as potential treatments for EB. Stem cells capable of differentiating into skin cells, have demonstrated positive outcomes in preclinical and early clinical trials by promoting wound healing and reducing inflammation. Gene therapy, on the other hand, aims to correct the underlying genetic defects responsible for EB by introducing functional copies of mutated genes or modifying existing genes to restore protein function. Particularly for severe subtypes like Recessive Dystrophic Epidermolysis Bullosa (RDEB), gene therapy holds significant potential. This review aims to evaluate the role of new therapeutic approaches in the treatment of EB. The review includes findings from studies conducted on humans. While early studies and clinical trials have shown promising results, further research and trials are necessary to establish the safety and efficacy of these innovative approaches for EB treatment.
Collapse
Affiliation(s)
- Ramin Raoufinia
- Department of Medical Genetics and Molecular Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Basic Medical Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Hamid Reza Rahimi
- Department of Medical Genetics and Molecular Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Keyhanvar
- Department of Biochemistry & Biophysics, University of California San Francisco, San Francisco, CA, 94107, USA
| | - Meysam Moghbeli
- Department of Medical Genetics and Molecular Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nima Abdyazdani
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Rostami
- Department of Clinical Biochemistry, Faculty of medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - Karim Naghipoor
- Department of Medical Genetics and Molecular Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Forouzanfar
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Foroudi
- Department of Biology, Faculty of Sciences, University of Ferdowsi, Mashhad, Iran
| | - Ehsan Saburi
- Department of Medical Genetics and Molecular Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
5
|
Gorrie A, Saad R, Garside L, Bailie C, Wargon O. Gross motor development in children with epidermolysis bullosa. Child Care Health Dev 2024; 50:e13194. [PMID: 38108617 DOI: 10.1111/cch.13194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/25/2023] [Accepted: 10/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a group of rare, congenital skin disorders, characterized by skin fragility and formation of blisters. The gross motor outcomes of children with EB are not known. OBJECTIVES The primary objective of the study was to measure the proportion of gross motor delay in children with EB. The secondary objectives were to measure the difference in gross motor outcomes between EB sub-types and change in gross motor outcomes over time. METHODS Children with EB, aged between one month and five and a half years of age, attending the Sydney Children's Hospital, Epidermolysis Bullosa Clinic, were eligible. Carers completed Ages and Stages Questionnaires, Third Edition, on behalf of their children. Questionnaires were scored, and outcomes were compared to age-expected norms. RESULTS There were 24 participants to complete a questionnaire. Eleven participants completed additional questionnaires over the 24 month study duration. The proportion of children with EB with gross motor delay was greater than age-expected norms (29.17% vs. 2.5%). The delay occurred in children with recessive dystrophic (80%) and epidermolysis bullosa simplex (33.33%) sub-types, but not dominant dystrophic (0%). No children with Junctional EB or Kindler EB joined this study. CONCLUSIONS This study demonstrates a difference in gross motor outcomes in children with EB. Children with recessive dystrophic and epidermolysis bullosa simplex should be prioritized for monitoring of, and intervention for, gross motor outcomes through multidisciplinary care. Further research investigating long-term outcomes for children with EB and the effectiveness of interventions would be beneficial.
Collapse
Affiliation(s)
- Andrew Gorrie
- School of Clinical Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Rebecca Saad
- Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
- School of Nursing and Midwifery, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Lydia Garside
- Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Claire Bailie
- Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Orli Wargon
- School of Clinical Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| |
Collapse
|
6
|
Prashanth RR, Kamble PD, Kumari A, Haribalakrishna A, Mahajan SA. Epidermolysis bullosa in a mother-infant dyad. Oxf Med Case Reports 2023; 2023:omad124. [PMID: 38033404 PMCID: PMC10686001 DOI: 10.1093/omcr/omad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/16/2023] [Accepted: 09/24/2023] [Indexed: 12/02/2023] Open
Abstract
Epidermolysis Bullosa is an inherited mechanobullous disorder which presents in the neonatal period as blistering skin lesions. In this case report, we describe an uncommon presentation of Epidermolysis Bullosa Simplex in a term infant, weighing 2640 g, born to a mother who was also diagnosed with Epidermolysis Bullosa Pruriginosa during the course of the evaluation of her newborn. The clinical situation presented us with a unique dilemma with regard to routine newborn care practices including handling, skin and diaper care. Though the presentation was typically characteristic of EB, we illustrate with images the diagnostic modalities and challenges faced in the hospital while caring for this fragile skin in a low and middle-income country's neonatal intensive care unit. This is the first reported case of a neonate with Epidermolysis Bullosa Simplex born to a mother with Epidermolysis Bullosa Pruriginosa.
Collapse
Affiliation(s)
- R R Prashanth
- Department of Neonatology, Seth G.S. Medical College and King Edward Memorial Hospital, Maharashtra, Mumbai, India
| | - Pramod Dhanraj Kamble
- Department of Dermatology, Seth G.S. Medical College and King Edward Memorial Hospital, Maharashtra, Mumbai, India
| | - Abhilasha Kumari
- Department of Neonatology, Seth G.S. Medical College and King Edward Memorial Hospital, Maharashtra, Mumbai, India
| | - Anitha Haribalakrishna
- Department of Neonatology, Seth G.S. Medical College and King Edward Memorial Hospital, Maharashtra, Mumbai, India
| | - Sunanda Arun Mahajan
- Department of Dermatology, Seth G.S. Medical College and King Edward Memorial Hospital, Maharashtra, Mumbai, India
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|