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Global variation in skin injures and skincare practices in extremely preterm infants

Jani P 1 , Mishra U 2 , Buchmayer J 3 , Maheshwari R 2 , D'Çruz D 4 , Walker K 2 Show all authors , Gözen D 5 , Lowe K 4 , Wright A 4 , Marceau J 4 , Culcer M 2 , Priyadarshi A 2 , Kirby A 6 , Moore JE 7 , Oei JL 8 , Shah V 9 , Vaidya U 10 , Khashana A 11 , Godambe S 12 , Cheah FC 13 , Zhou WH 14 , Hu XJ 15 , Satardien M 16

Affiliations 

  • 1 Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. Pranav.Jani@sydney.edu.au
  • 2 Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  • 3 Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
  • 4 Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
  • 5 Pediatric Nursing Department, Florence Nightingale Faculty of Nursing, İstanbul University-Cerrahpaşa, Istanbul, Turkey
  • 6 The National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
  • 7 Connecticut Children's Division of Neonatal-Perinatal Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
  • 8 The Royal Hospital for Women, Randwick, NSW, Australia
  • 9 Department of Paediatrics and Institute of Health Policy, Management and Evaluation, Mount Sinai Hospital, Toronto, Canada
  • 10 Department of Pediatrics, King Edward Memorial Hospital, Pune, India
  • 11 Pediatrics, Suez Canal University, Ismailia, Egypt
  • 12 Divisional Director for Clinical Governance, Women's, Children's and Clinical Support, Imperial College Healthcare NHS Trust, London, UK
  • 13 Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan, Bangi, Malaysia
  • 14 Department of Neonatology and Vice President, Children's Hospital of Fudan University, Shanghai, China
  • 15 Vice Director of Nursing Department, Children's Hospital of Fudan University, Shanghai, China
  • 16 Department of Paediatrics and Child Health, Tygerberg Hospital, Cape Town, South Africa
World J Pediatr, 2023 Feb;19(2):139-157.
PMID: 36372868 DOI: 10.1007/s12519-022-00625-2

Abstract

BACKGROUND: Globally, are skincare practices and skin injuries in extremely preterm infants comparable? This study describes skin injuries, variation in skincare practices and investigates any association between them.

METHODS: A web-based survey was conducted between February 2019 and August 2021. Quantifying skin injuries and describing skincare practices in extremely preterm infants were the main outcomes. The association between skin injuries and skincare practices was established using binary multivariable logistic regression adjusted for regions.

RESULTS: Responses from 848 neonatal intensive care units, representing all geographic regions and income status groups were received. Diaper dermatitis (331/840, 39%) and medical adhesive-related skin injuries (319/838, 38%) were the most common injuries. Following a local skincare guideline reduced skin injuries [medical adhesive-related injuries: adjusted odds ratios (aOR) = 0.63, 95% confidence interval (CI) = 0.45-0.88; perineal injuries: aOR = 0.66, 95% CI = 0.45-0.96; local skin infections: OR = 0.41, 95% CI = 0.26-0.65; chemical burns: OR = 0.46, 95% CI = 0.26-0.83; thermal burns: OR = 0.51, 95% CI = 0.27-0.96]. Performing skin assessments at least every four hours reduced skin injuries (abrasion: aOR = 0.48, 95% CI = 0.33-0.67; pressure: aOR = 0.51, 95% CI = 0.34-0.78; diaper dermatitis: aOR = 0.71, 95% CI = 0.51-0.99; perineal: aOR = 0.52, 95% CI = 0.36-0.75). Regional and resource settings-based variations in skin injuries and skincare practices were observed.

CONCLUSIONS: Skin injuries were common in extremely preterm infants. Consistency in practice and improved surveillance appears to reduce the occurrence of these injuries. Better evidence regarding optimal practices is needed to reduce skin injuries and minimize practice variations.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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