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

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.

Elaboration and implementation of a protocol for the Golden Hour of premature newborns using an Implementation Science lens

“…Following the international recommendations, the protocol elaborated in this study was organized under four main pillars: cardiopulmonary stabilization, and prevention of hypothermia, hypoglycemia and infection. Actions such as setting the ambient temperature, using a heated field, equipment for fractional oxygen supply and agility in obtaining venous access are important to meet these pillars, as observed in other studies (3)(4)(9)(10) .…”

“…International studies highlight the importance of implementing protocols, bundles or checklists as a strategy for improving the care provided to PTNBs (3)(4)(5)(9)(10) .…”

“…of PTNBs and that it is a predictive factor of morbidity and mortality, regardless of gestational age. Heat loss cannot be overcome by heat production, mainly in premature infants, and the team must carry out interventions for thermal control while caring for the PTNB (4,6,(22)(23) .…”

“…The Golden Hour strategy proposes a more efficient service based on evidence, structuring multidisciplinary teamwork and effective communication; reinforcing integrated work through standardization of care and the use of clinical protocols (4)(5) . During the Golden Hour, care team actions are carried out to effectively stabilize the health of premature newborns, via preparation for delivery, timely umbilical cord clamping, maintenance of normothermia, monitoring and provision of adequate respiratory support, transfer to the neonatal unit, vascular access and prevention of hypoglycemia, among other clinical care measures (3)(4)(5) .…”

“…The effective integration of evidence-based interventions into neonatal care, including adoption of advanced technologies have contributed to a significant reduction in neonatal morbidity and mortality rates globally (1)(2) . Implementation settings which focus on continual improvements in quality have the potential for continually better survival outcomes in PTNBs (3)(4)(5)(6)(7)(9)(10)(11) .…”