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

Pranav Jani; Umesh Mishra; Julia Buchmayer; Rajesh Maheshwari; Daphne D'Çruz; Karen Walker; Duygu Gözen; Krista Lowe; Audrey Wright; James Marceau; Mihaela Culcer; Archana Priyadarshi; Adrienne Kirby; James E Moore; Ju Lee Oei; Vibhuti Shah; Umesh Vaidya; Abdelmoneim Khashana; Sunit Godambe; Fook Choe Cheah; Wen-Hao Zhou; Xiao-Jing Hu; Muneerah Satardien

doi:10.1007/s12519-022-00625-2

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

World J Pediatr. 2023 Feb;19(2):139-157. doi: 10.1007/s12519-022-00625-2. Epub 2022 Nov 13.

Authors

Pranav Jani^{1

2}, Umesh Mishra^{3

4}, Julia Buchmayer⁵, Rajesh Maheshwari^{3

4}, Daphne D'Çruz⁴, Karen Walker^{3

6

7

8

9}, Duygu Gözen¹⁰, Krista Lowe⁴, Audrey Wright⁴, James Marceau⁴, Mihaela Culcer^{3

4}, Archana Priyadarshi^{3

4}, Adrienne Kirby¹¹, James E Moore^{12

13}, Ju Lee Oei^{14

15}, Vibhuti Shah¹⁶, Umesh Vaidya¹⁷, Abdelmoneim Khashana¹⁸, Sunit Godambe¹⁹, Fook Choe Cheah^{20

21}, Wen-Hao Zhou²², Xiao-Jing Hu²³, Muneerah Satardien^{24

25}

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. Pranav.Jani@sydney.edu.au.
² Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia. Pranav.Jani@sydney.edu.au.
³ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁴ Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia.
⁵ Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria.
⁶ Department of Newborn Care, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
⁷ Council of International Neonatal Nurses, Boston, MA, USA.
⁸ The George Institute for Global Health, Sydney, NSW, Australia.
⁹ Sydney Institute for Women, Children and Their Families, Sydney, NSW, Australia.
¹⁰ Pediatric Nursing Department, Florence Nightingale Faculty of Nursing, İstanbul University-Cerrahpaşa, Istanbul, Turkey.
¹¹ The National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
¹² Connecticut Children's Division of Neonatal-Perinatal Medicine, Connecticut Children's Medical Center, Hartford, CT, USA.
¹³ UCONN School of Medicine, Farmington, CT, USA.
¹⁴ The Royal Hospital for Women, Randwick, NSW, Australia.
¹⁵ School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
¹⁶ Department of Paediatrics and Institute of Health Policy, Management and Evaluation, Mount Sinai Hospital, Toronto, Canada.
¹⁷ Department of Pediatrics, King Edward Memorial Hospital, Pune, India.
¹⁸ Pediatrics, Suez Canal University, Ismailia, Egypt.
¹⁹ Divisional Director for Clinical Governance, Women's, Children's and Clinical Support, Imperial College Healthcare NHS Trust, London, UK.
²⁰ Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan, Bangi, Malaysia.
²¹ Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia.
²² Department of Neonatology and Vice President, Children's Hospital of Fudan University, Shanghai, China.
²³ Vice Director of Nursing Department, Children's Hospital of Fudan University, Shanghai, China.
²⁴ Department of Paediatrics and Child Health, Tygerberg Hospital, Cape Town, South Africa.
²⁵ University of Stellenbosch, Cape Town, South Africa.

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.

Keywords: Extremely premature infants; Injuries; Neonatal intensive care unit; Skin care; Wounds.

MeSH terms

Dermatitis*
Humans
Infant
Infant, Extremely Premature*
Infant, Newborn
Intensive Care Units, Neonatal
Logistic Models
Skin Care