Pressure Ulcers in the Hospitalized Neonate: Rates and Risk Factors

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Abstract

Pressure ulcers (PU) are serious, reportable events causing pain, infection and prolonged hospitalization, particularly among critically ill patients. The literature on PUs in neonates is limited. The objective was to determine the etiology, severity and influence of gestational age on PUs among hospitalized infants. A two-year prospective study was conducted among 741 neonatal intensive care patients over 31,643 patient-days. Risk factors were determined by comparing the characteristics of infants who developed PUs with those who did not. There were 1.5 PUs per 1000 patient days with 1.0 PU per 1000 days in premature infants and 2.7 per 1000 days in term infants. The number of PUs associated with devices was nearly 80% overall and over 90% in premature infants. Infants with PUs had longer hospitalizations and weighed more than those who did not. Infants with device-related PUs were younger, of lower gestational age and developed the PU earlier than patients with PUs due to conventional pressure. The time to PU development was longer in prematurely born versus term infants. Hospitalized neonates are susceptible to device-related injury and the rate of stage II injury is high. Strategies for early detection and mitigation of device-related injury are essential to prevent PUs.

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Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life.

Georgios N. Stamatas, Nikiforos Kollias, Steffen B. Wiegand … (2008)

Skin water barrier development begins in utero and is believed to be complete by week 34 of gestational age. The goal of this investigation was to assess the dynamic transport and distribution of water of the stratum corneum of infants and compare it to those of adults. The interaction of water with the stratum corneum was assessed by measuring capacitance, transepidermal water loss (TEWL), rates of absorption-desorption as well as Raman spectra as a function of depth (a total of 124 infants (3-12 months) and 104 adults (14-73 years)). The results show that capacitance, TEWL, and absorption-desorption rates had larger values consistently for infant stratum corneum throughout the first year of life and showed greater variation than those of adults. The Raman spectra analyzed for water and for the components of natural moisturizing factor (NMF) showed the distribution of water to be higher and have a steeper gradient in infants than in adults; the concentration of NMF was significantly lower in infants. The results suggest that although the stratum corneum of infants may appear intact shortly after birth (<1 month), the way it stores and transports water becomes adult-like only after the first year of life.

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Medical device related pressure ulcers in hospitalized patients.

Joyce M Black, Janet Cuddigan, Maralyn Walko … (2010)

Most pressure ulcers occur over bony prominences such as heels and the sacrum. However, the National Pressure Ulcer Advisory Panel recognises that pressure ulcers can also occur on any tissue under pressure and thereby can develop beneath medical devices. This article reports on results from a secondary analysis of existing data collected by The Nebraska Medical Center on pressure ulcer quality improvement initiatives and outcomes. The purpose of this study was to quantify the extent of the problem and identify risk factors for medical device related (MDR) pressure ulcer development in hospitalised patients. A subset of data collected during eight quarterly pressure ulcer incidence and prevalence studies (N = 2178) was created and analysed. The overall rate of hospital-acquired pressure ulcers was 5·4% (113 of 2079). The proportion of patients with hospital-acquired ulcers related to medical devices was 34·5% (39 of 113). Findings indicate that if a patient had a medical device, they were 2·4 times more likely to develop a pressure ulcer of any kind. Numerous risk factors for pressure ulcer development were identified; however, none differentiated between those with MDR and traditional pressure ulcers.

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The etiology of pressure ulcers: skin deep or muscle bound?

Bernhard Bader, Carlijn V. C. Bouten, Frank P. T. Baaijens … (2003)

Pressure ulcers are areas of soft tissue breakdown that result from sustained mechanical loading of the skin and underlying tissues; they can affect the quality of life of many individuals. Despite considerable efforts to prevent pressure ulcers, data on prevalence are unacceptably high. This can at least partly be attributed to limited knowledge of the etiology of the clinical condition and the fact that identification and prevention of pressure ulcers mainly focus on skin tissue, even though the underlying muscle tissue may be more susceptible to mechanical loading. The present article proposes a new, hierarchical research approach to obtain improved insights into the basic pathways whereby mechanical loading leads to soft tissue breakdown. This approach investigates the relationships between (1) global mechanical loading at skin level, (2) the resulting local internal mechanical conditions within the soft tissue layers extending from skin to muscle tissue, and (3) the pathophysiologic response to loading. The latter response should be assessed from the various functional tissue units involved in soft-tissue breakdown-the cells, the interstitial space, and blood and lymph vessels. We predict that the proposed strategy will provide new fundamental knowledge about the etiology of pressure ulcers that can serve as a sound basis for effective clinical identification and prevention.

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Journal

Journal ID (nlm-ta): Sci Rep

Journal ID (iso-abbrev): Sci Rep

Title: Scientific Reports

Publisher: Nature Publishing Group

ISSN (Electronic): 2045-2322

Publication date (Electronic): 11 December 2014

Publication date Collection: 2014

Volume: 4

Electronic Location Identifier: 7429

Affiliations

[1 ]Skin Sciences Program, Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center , Cincinnati, OH

[2 ]Department of Surgery, College of Medicine, University of Cincinnati , Cincinnati, OH

[3 ]Newborn Intensive Care Unit, Patient Services, Cincinnati Children's Hospital Medical Center , Cincinnati, OH

Author notes

[a ] Marty.Visscher@ 123456cchmc.org

Article

Publisher Item ID: srep07429

DOI: 10.1038/srep07429

PMC ID: 5377020

PubMed ID: 25502955

SO-VID: 1292901e-c4fd-422f-ae8b-41c26f78115a

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder in order to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

Pressure Ulcers in the Hospitalized Neonate: Rates and Risk Factors

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Abstract

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Most cited references 50

Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life.

Medical device related pressure ulcers in hospitalized patients.

The etiology of pressure ulcers: skin deep or muscle bound?

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