Pressure Injuries in Medically Complex Children: A Review

Freundlich, Katherine L.

doi:10.3390/children4040025

Cited by 26 publications

(22 citation statements)

References 30 publications

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“…Pressure injuries arise as a result of pressure and/ or shear and are often located over a bony prominence or related to a medical device. Risk factors include limited mobility, inability to reposition, loss of sensation, nutritional deficiency, cognitive impairment, or other pressure ulcers …”

Section: Resultsmentioning

confidence: 99%

“…Pressure injuries are a challenging problem in the care of medically complex children, and therapies are mainly based on adult data, while there are considerable differences in body composition. 26 Pressure injuries arise as a result of pressure and/ or shear and are often located over a bony prominence or related to a medical device. Risk factors include limited mobility, inability to reposition, loss of sensation, nutritional deficiency, cognitive impairment, or other pressure ulcers.…”

Section: Case 3: Bedsore Coccyxmentioning

confidence: 99%

“…Risk factors include limited mobility, inability to reposition, loss of sensation, nutritional deficiency, cognitive impairment, or other pressure ulcers. 26 An 8-year-old female child was admitted to the hospital with respiratory problems and presented with severe bedsore ulcer and inflammation of her buttocks. The patient suffered for 4 years from paraplegia and severe impairment in motility of the upper body due to viral encephalitis In addition, the child had a tracheostoma and suffered from chronic intestinal dysmotility for which she was previously received surgery.…”

Section: Case 3: Bedsore Coccyxmentioning

confidence: 99%

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Treating severe wounds in pediatrics with medical grade honey: A case series

Smaropoulos

Cremers²

2020

Clinical Case Reports

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Section: Resultsmentioning

confidence: 99%

Section: Case 3: Bedsore Coccyxmentioning

confidence: 99%

Section: Case 3: Bedsore Coccyxmentioning

confidence: 99%

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Treating severe wounds in pediatrics with medical grade honey: A case series

Smaropoulos

Cremers²

2020

Clinical Case Reports

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“…Contrary to the findings relating to pain, repositioning and epilepsy were both significant predictors for daytime sleepiness. Immobile pediatric patients need to be repositioned regularly to prevent pressure ulcers [ 42 , 43 , 44 ]. Repositioning is a care measure carried out by caregivers to increase a patient’s comfort [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

The Unfavorable Alliance of Pain and Poor Sleep in Children with Life-Limiting Conditions and Severe Psychomotor Impairment

et al. 2018

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A high prevalence of sleep problems exists in children and adolescents with life-limiting conditions (LLC) and severe psychomotor impairment (SPMI). This study aimed to compare the impacts of various child-related (pain, epilepsy, repositioning, medical care) and environment-related (light, noise, TV/radio, open door) factors on sleep in this vulnerable population. Data were obtained through the “Sleep Questionnaire for Children with Severe Psychomotor Impairment” (SNAKE) by proxy assessment. n = 212 children (mean age: 10.4 years) were included in the analyses. Logistic and linear regression models were used to compare child- and environment-related factors against the global rating of children’s sleep quality, five SNAKE scales, children’s sleep duration, and sleep efficacy. Pain increased the risk of sleeping poorly four-fold (OR (odds ratio) = 4.13; 95% CI (confidence interval): 1.87–9.13) and predicted four sleep problems as assessed by the SNAKE. Children who needed to reposition during the night were at three times greater risk of sleeping poorly (OR = 3.08; 95% CI: 1.42–6.69). Three of the five SNAKE scales were predicted through nocturnal repositioning. Repositioning and epilepsy predicted a reduced sleep duration and low sleep efficacy. None of the environment-related factors exhibited statistically significant results. This study emphasizes the urgent need for reliable pain detection in the context of sleep disturbances in severely ill children.

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“…Even if the literature search was not helpful on this topic and only two studies pertinent to black eschar treatment were retrieved, the prevalent opinion of the authors is that a conservative treatment, in these patients, is mandatory. [56][57][58] Evidence of spontaneous healing of transient damages due to heel prick needle injuries is something supporting the choice of a conservative treatment for black eschar. 59 RECOMMENDATION 17: In neonates and pediatric patients with infected HPIs any stage, the panel cannot recommend in favor or against an antimicrobial dressing to control the local bioburden.…”

Section: Recommendation 12mentioning

confidence: 99%

Heel Pressure Injuries: Consensus-Based Recommendations for Assessment and Management

Rivolo¹,

Dionisi²,

Olivari

et al. 2020

Advances in Wound Care

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Significance: A systematic approach to develop experts-based recommendations could have a favorable impact on clinical problems characterized by scarce and low-quality evidence as heel pressure ulcers. Recent Advances: A systematic approach was used to conduce a formal consensus initiative. A multidisciplinary panel of experts identified relevant clinical questions, performed a systematic search of the literature, and created a list of statements. GRADE Working Group guidelines were followed. An independent international jury reviewed and voted recommendations for clinical practice. Consent was developed according to Delphi rules and GRADE method was used to attribute grade of strength. Critical Issues: The extensive search of the literature retrieved 42 pertinent articles (26 clinical studies, 7 systematic reviews or meta-analysis, 5 other reviews, 2 consensus-based articles, and 2 in vitro studies). Thirty-five recommendations and statements were created. Only 1 of 35, concerning ankle-brachial pressure index reliability in diabetic patients, was rejected by the panel. No sufficient agreement was achieved on toe brachial index test to rule out the orphan heel syndrome, removing dry eschar in adult patients without vascular impairment, and using an antimicrobial dressing in children with infected heel pressure injuries. Eleven recommendations were approved with a weak grade of strength. Experts strongly endorsed 20 recommendations. Offloading, stages I and II pressure injuries, and referral criteria were areas characterized by higher level of agreement. Future Directions: We believe that the results of our effort could improve practice, especially in areas where clear and shared opinions emerged. Barriers and limits that could hinder implementation are also discussed in the article.

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Pressure Injuries in Medically Complex Children: A Review

Cited by 26 publications

References 30 publications

Treating severe wounds in pediatrics with medical grade honey: A case series

Treating severe wounds in pediatrics with medical grade honey: A case series

The Unfavorable Alliance of Pain and Poor Sleep in Children with Life-Limiting Conditions and Severe Psychomotor Impairment

Heel Pressure Injuries: Consensus-Based Recommendations for Assessment and Management

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