Improved Outcome of Extremely Low Birth Weight Infants with Tegaderm® Application to Skin

Abstract

Significant fluid and electrolyte disturbances occur in extremely low birth weight (ELBW) infants in the first few days of life. We investigated the effect of semipermeable polyurethane membrane (Tegaderm s ) applied to the skin shortly after birth on fluid and electrolyte status and the clinical outcome in these infants. STUDY DESIGN:We reviewed charts of ELBW infants (BW<1.0 kg) born during 24 months prior to Tegaderm s application and 19 months after starting Tegaderm s . Data were collected daily from the first week of life and additional clinical morbidities were compared. RESULTS:A total of 39 infants from pre-Tegaderm s period (NOTEG) (mean±SD, BW 756±158 g, GA 26.1±1.9 weeks) were compared to 30 infants with extensive Tegaderm s application to chest, abdomen and extremities (TEG) (BW 802±160 g, GA 26.3±1.8 weeks). The groups were similar in maternal demographics as well as postnatal surfactant use. Throughout the first week of life, serum Na levels, daily fluid intake and daily weight loss were significantly higher in the NOTEG infants (all Pr0.04) while BUN/Serum creatinine levels were similar. Hypernatremia (Na>150 mEq/ l) developed in 51% of NOTEG infants compared to 17% of TEG (P ¼ 0.0005) and daily fluid intake Z170 ml/kg/day was required in 54 vs 13% (P ¼ 0.0008), respectively. The mean time to regain BW was significantly longer in NOTEG vs TEG infants, 20.7±7.4 vs 15.8±6.3 days, respectively (P<0.02). There were no statistical significant differences among the groups in incidence of IVH, NEC, PDA or nosocomial sepsis; however, respiratory outcome was better in TEG infants. They had significantly less BPD (58% in NOTEG vs 22% TEG (P ¼ 0.01)) and fewer infants in the TEG group required supplemental oxygen at discharge (58% vs 22% (P ¼ 0.01)). Survival was significantly higher in TEG 90% vs 64% in NOTEG infants (P ¼ 0.02). CONCLUSIONS:Semipermeable polyurethane membrane application to skin of ELBW infants shortly after birth decreased postnatal fluid and electrolyte disturbances and significantly improved their outcome by reducing severity of lung disease and decreasing mortality.

Site-specific characteristics of infants developing bronchopulmonary dysplasia

“…[19][20][21][22] The importance of weight loss having an impact on the pathogenesis of BPD is further highlighted by the fact that babies who had not regained BW on day 14 had higher odds (by a factor of 2.3) of developing BPD than those who had regained their BW, after controlling for confounding variables.…”

Effect of chlorhexidine gluconate on the skin integrity at PICC line sites

“…On removal the skin had matured without irritation. 18 Semipermeable films (Opsite, Tegaderm) were placed on chest and abdomen for 2 to 4 h (25 to 36 weeks GA) and, following removal, TEWL was comparable to pre-application values. 19 TEWL for sites with dressings in place for 4 days were similar to untreated values, indicating no interference with barrier maturation.…”

Eficácia do uso de membrana semipermeável em neonatos pré-termo na redução de perdas transepidérmicas

“…The pellicle is a thin, semipermeable membrane of polyurethane and self-adhesive in one of the sides, which when applied to the newborn's skin, significantly reduces transpidermal water loss without interfering with the skin's integrity and natural development (2) . These findings are in agreement with those found in this study.…”

“…Such lesions can result from the removal of adhesives, monitors or exposure of skin to disinfectant solutions, as well as skin birth defects such as those found in omphalocele, gastroschisis, and neural tube defects (2) .…”

“…The first experience was in 1989 to reduce water loss, through the application of a transparent adhesive dressing on the skin of PTNB weighting from 770g to 1,450g (4) . Various studies reveal that transparent adhesive dressings can be used to impede excessive water loss from PTNBs' skin (1)(2)5) . However, Brazilian research addressing care provided to infants' skin and the use of the semipermeable membrane is still incipient.…”