Case Report of a Pressure Ulcer in an Infant Receiving Extracorporeal Life Support

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, CI = [8.95%-17.28%]). The cumulative incidence in the intermediate care units was 1.90% (CI = [0.39%-5.45%]), while it was 28.18% (CI = [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; CI = [0.66-0.97]), the use of non-invasive mechanical ventilation (RR 12.24; CI = [4.02-37.32]), and the length of stay (RR 1.08; CI = [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; CI = [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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Pressure ulcers in paediatric patients on extracorporeal membrane oxygenation

Tam

Mobargha

Tobias

et al. 2018

International Wound Journal

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It has been shown that pressure ulcer formation in critically ill paediatric patients increases morbidity and mortality. We sought to identify factors associated with pressure ulcer formation in paediatric patients on extracorporeal membrane oxygenation (ECMO). From December 2014 to 2015, we identified patients at our institution who developed a pressure ulcer to create two cohorts: ulcer and no ulcer. Variables of interest included: type of ECMO, ECMO indication, hours on ECMO, location of cannulas, volume of crystalloid and blood products received during the first 7 days or during the length of the ECMO run, albumin and lactate levels on the day of cannulation, and presence of vasopressor support or steroid therapy. Of 43 patients studied, 11 (25.5%) developed a pressure ulcer. Patients that developed ulcers were older (P = 0.001) and weighed more (P = 0.006). Femoral cannulation was more frequent in the ulcer group (36.4% vs 6.3%, P = 0.029), and duration of ECMO was longer (P = 0.007). Age, weight, duration of ECMO, and femoral cannulation may contribute to the development of pressure ulcers in children who require ECMO support. Further analysis is imperative to identify specific techniques and protocols that will prevent pressure ulcers in this critically ill population.

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Case Report of a Pressure Ulcer in an Infant Receiving Extracorporeal Life Support

Cited by 5 publications

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Paciente encamado/inmovilizado

Paciente encamado/inmovilizado

Pressure ulcers’ incidence, preventive measures, and risk factors in neonatal intensive care and intermediate care units

Pressure ulcers in paediatric patients on extracorporeal membrane oxygenation

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