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      Prevención de úlceras por presión en neonatos con ventilación mecánica no invasiva Translated title: Prevention of pressure ulcers in neonates with non-invasive mechanical ventilation

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          Abstract

          RESUMEN Objetivo: Determinar el apósito con mayor efectividad (hidrocoloide o espuma de poliuretano) en neonatos ingresados en las unidades de cuidados intensivos neonatal y pediátrica del Hospital Clínico Universitario de Valencia, sometidos a ventilación mecánica no invasiva para la prevención de úlceras por presión nasales y/o faciales. Material y métodos: Proyecto de investigación de tipo observacional, prospectivo y analítico cuya muestra estaba formada por 13 neonatos con ventilación mecánica no invasiva, hospitalizados en la unidad de cuidados intensivos neonatales y pediátrica. Los neonatos fueron divididos en dos grupos: en el grupo A (7 pacientes) se empleó el apósito de espuma de poliuretano y en el grupo B se utilizó el hidrocoloide (6 pacientes). La recogida de datos se realizó durante el período comprendido entre abril y mayo de 2018. Resultados: De los neonatos incluidos en el estudio, 5 (38,5%) presentaron úlceras por presión nasales; el resto (62%) no presentó úlceras. Además, se obtuvo que, del total de pacientes con lesión, un 60% llevaba el apósito hidrocoloide y un 40% el de espuma de poliuretano. Conclusiones: Tras el estudio, se determinó que el apósito de espuma de poliuretano presentaba un menor porcentaje de aparición de UPP en comparación con el hidrocoloide. Sin embargo, sería recomendable valorar la posibilidad de emplear alguno de ellos como medida de protección.

          Translated abstract

          ABSTRACT Objective: To determine the most effective dressing (hydrocolloid or polyurethane foam) in neonates admitted by the Neonatal and Pediatric Intensive Care Unit of the Hospital Clínico Universitario de Valencia, subjected to non-invasive mechanical ventilation for the prevention of pressure ulcers nasal and/or facial. Material and methods: observational, prospective and analytical research project whose sample considered of 13 neonates with non-invasive mechanical ventilation hospitalized in the Neonatal and Pediatric Intensive Care Unit. They were divided into two groups, where group A (7 patients) used the polyurethane foam dressing and group B used the hydrocolloid dressing (6 patients). The data collection was carried out during the period from April to May 2018. Results: Of the neonates included in the study, 5 presented nasal pressure ulcers (38.5%) and the rest did not (62%). In addition, it was obtained that, of the total of patients with injury, 60% wore the hydrocolloid dressing and 40% that of polyurethane foam. Conclusions: After the study, it was determined that the polyurethane foam dressing had a lower percentage of appearance of pressure ulcers compared to the hydrocolloid. However, it would be advisable to appraise the possibility of using any of them as a protection measure.

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          Most cited references5

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          Effect of silicon gel sheeting in nasal injury associated with nasal CPAP in preterm infants.

          We conducted this study to investigate the efficacy of the silicon gel application on the nares in prevention of nasal injury in preterm infants ventilated with nasal continuous positive airway pressure (NCPAP). Patients (n=179) were randomized into two groups: Group 1 (n=87) had no silicon gel applied to nares, and in Group 2 (n=92), the silicon gel sheeting was used on the surface of nares during ventilation with NCPAP. Nasal injury developed in 13 (14.9%) neonates in Group 1 and 4 (4.3%) newborns in Group 2 (OR:3.43; 95% CI: 1.1-10.1; P<0.05). The incidence of columella necrosis was also significantly higher in the Group 1 (OR: 6.34; 95% CI: 0.78-51.6; P<0.05). We conclude that the silicon gel application may reduce the incidence and the severity of nasal injury in preterm infants on nasal CPAP.
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            Pressure ulcers' incidence, preventive measures, and risk factors in neonatal intensive care and intermediate care units.

            Epidemiological studies on pressure ulcers (PUs) in hospitalised infants are scarce. Spain lacks comprehensive research studies providing data on the prevalence or incidence in this population. This work was developed to determine the incidence of PUs in hospitalised infants admitted to intensive and intermediate care units, along with relevant risk factors and preventive measures. A prospective study appraising the incidence of PUs in infants was performed. The risk factors and preventive measures were evaluated using a multivariate logistic regression model. A sample of 268 infants was included. The cumulative incidence of PUs was 12.70% (95% confidence interval, CI95% = [8.95%-17.28%]). The cumulative incidence in the intermediate care units was 1.90% (CI95% = [0.39%-5.45%]), while it was 28.18% (CI95% = [20.02%-37.56%]) in the intensive care units. The PUs were categorised as stage I, 57.10%; stage II, 31.70%; and stage III, 11.10%. The multivariate analysis found the following to be risk factors: low scores in the Spanish version of the Neonatal Skin Risk Assessment Scale (e-NSRAS) (Relative Risk (RR) 0.80; CI95% = [0.66-0.97]), the use of non-invasive mechanical ventilation (RR 12.24; CI95% = [4.02-37.32]), and the length of stay (RR 1.08; CI95% = [1.02-1.15]), suggesting a direct impact of these factors on PU development in infants. Kangaroo care influenced the prevention of PUs (RR 0.26; CI95% = [0.09-0.71]). The infants admitted in intermediate care units suffered PUs. In the case of intensive care units, the incidence is even higher. The risk increases with the length of stay, while the presence of medical devices, particularly non-invasive mechanical ventilation, is the main causal relationship. Kangaroo care has been shown to be an important preventive measure.
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              Hydrocolloid to Prevent Breakdown of Nares in Preterm Infants

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                Author and article information

                Journal
                geroko
                Gerokomos
                Gerokomos
                Sociedad Española de Enfermería Geriátrica y gerontológica (Barcelona, Barcelona, Spain )
                1134-928X
                2020
                : 31
                : 2
                : 107-112
                Affiliations
                [2] orgnameHospital Clínico Universitario de Valencia orgdiv1Servicio de Pediatría Spain
                [6] Valencia orgnameUniversitat de Valencia orgdiv1Departamento de Enfermería Spain
                [5] orgnameHospital Clínico Universitario de Valencia orgdiv1Servicio Pediatría España
                [7] Valencia orgnameUniversitat de Valencia orgdiv1Departamento de Enfermería Spain
                [3] orgnameHospital Clínico Universitario de Valencia orgdiv1Servicio de Pediatría Spain
                [8] Valencia orgnameUniversitat de Valencia orgdiv1Departamento de Enfermería Spain
                [4] orgnameHospital Clínico Universitario de Valencia orgdiv1Servicio de Pediatría España
                [1] Valencia orgnameUniversitat de Valencia orgdiv1Departamento de Enfermería Spain
                Article
                S1134-928X2020000200107 S1134-928X(20)03100200107
                9817eeb3-7a0d-465a-9f9d-570fb025924c

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 14 June 2019
                : 24 April 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 6
                Product

                SciELO Spain

                Categories
                Helcos

                Neonato,apósitos,dressing,pressure ulcers,non-invasive mechanical ventilation,Infant,prevención,prevention,úlceras por presión,ventilación mecánica no invasiva

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