Wound Healing and Wound Care in Neonates: Current Therapies and Novel Options

Abstract

GENERAL PURPOSE To provide wound care information that considers the specific physiology of neonates. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Differentiate the use of hydrocolloids, hydrogels, foam dressings, and barrier creams in the neonatal population. 2. Identify issues related to the use of solvents, alginates, collagen dressings, and negative-pressure wound therapy in neonates. OBJECTIVE To discuss what is known about the wound milieu in premature and full-term neonates, including the unique challenges pediatric clinicians face, the therapies that have proven effective, and the therapies contraindicated for use in neonatal wound healing to guide treatment that accounts for the specific physiological characteristics of this often overlooked population. DATA SOURCES Data were collected on neonatal wound healing from a wide variety of sources, including PubMed, Google Scholar, journals, and textbooks. STUDY SELECTION Selection criteria included publications focused on the differences and nuances of wound healing in neonates in comparison with all other age groups. DATA EXTRACTION Data were extracted based on articles covering wound healing therapies with proven effectiveness in neonates. Terms for neonatal wound care were compiled, and then a comprehensive literature search was performed by the authors. DATA SYNTHESIS Although many therapies are safe for treatment of older children and adolescents, most have not been explicitly tested for neonatal use. This article reviews therapies with proven effectiveness and/or specific concerns in the neonatal population. CONCLUSION This review sheds light on the advantages and disadvantages of current standards of care regarding wound healing for neonates to direct researchers and clinicians toward developing treatments specifically for this delicate population.

Cosmetic wound care in an extremely preterm neonate

“…However, in cases where the wounds are large or healing is slow, collagen dressings can be used. They are acellular tissue dressings produced from purified bovine connective tissues which supplement and stimulate the collagen of the newborn skin 4 . Later, Silicon gel sheets were applied to minimize residual scar tissue.…”

Validation of a Wound Tool for Assessment of Surgical Wounds in Infants

“…Recognizing depth of wound may be challenging to measure, given the presence of exudate and tissue slough, and of questionable significance in preterm or small for gestational age infants, we used visibility of fascia or bone as a measure of depth. Assessment of periwound skin was included, given evidence of infection may be anticipated by or associated with the presence of exudate and changes in the skin surrounding the wound in neonates 1–4. Compromised periwound skin was considered to be red, irritated, or white, or other concerning skin changes.…”

“…For example, on the basis of experimental and clinical studies, it has been proposed that transfusion of blood products may inhibit wound healing and yet the specific mechanism is unclear 5,9. Even with these gaps in our understanding, it is known that early recognition and initiation of appropriate treatment of wounds are imperative to facilitate healing and avoid complications such as secondary infection and wound dehiscence 1,3,10. Wound complications are associated with economic and patient burdens, such as increases in hospital costs and length of stay, highlighting the importance of infection control surveillance, preventive measures, and identification of modifiable risk factors 7,11…”

Guidelines for the skin care of premature infants (project)

“…Для поддержания целостности кожи у новорожденных рекомендуется проводить ежедневно оценку с использованием объективных признаков ее состояния [80,81].…”