Iatrogenic skin injury in the neonatal intensive care unit

Abstract

Although neonatal care has become more and more meticulous with significant changes in technology in the neonatal intensive care unit (NICU) in the past 50 years, iatrogenic cutaneous injuries continue to occur. Although the incidence of severe injuries is decreasing because the more difficult procedures are being replaced by improved techniques, skin injuries have not yet been completely eliminated. However, the nature and causes of cutaneous injuries have changed, and the injuries are frequent but generally minor. The major risk factors are low birth weight, gestational age, length of stay, a central venous line, mechanical ventilation, and support with continuous positive airway pressure. The rate of iatrogenic events is about 57% at gestational ages of 24-27 weeks, compared with 3% at term. There are no current comprehensive reviews of iatrogenic cutaneous injury. The purpose of this review is to describe the iatrogenic cutaneous injuries that may occur in the newborns as a consequence of perinatal and postnatal medical procedures. With increased survival of extremely-low-birth-weight (ELBW) infants and changing modes of management in the NICU, neonatologists must make every effort to recognize injuries and prevent their occurrence in the NICU.

Treatment of skin lesions in newborn children: meeting the needs of nursing staff

“…Based on the literature (12) , it is clear that the occurrence of nasal lesions due to CPAP use is common; however, prevention of these lesions is not limited to the protection of the nostrils. Nursing staff should also be attentive to the selection, suitability, fixing and maintenance of this device in the fragile skin of preterm infants.…”

“…The use of CPAP to treat secondary nasal lesions has been reported since 1980 and its incidence ranges from 20 to 60%. The factors that contribute to its onset are related to the choice, application and maintenance of the device (12) .…”

“…Its incidence ranges from 23-63% and it can cause the partial or total loss of skin and muscle. It can also cause nerve damage and have an adverse effect on functional and aesthetic aspects (12) .…”

“…The use of alcohol or iodine-based products for skin antisepsis before invasive procedures can cause irritation, extensive burns and poisoning in newborn children (12) . The most recommended product is chlorhexidine gluconate, an antiseptic widely used in adults and children that can be prepared in aqueous or alcoholic form (10) .…”

“…The most common adverse occurrence in newborn children is intravenous extravasation, in which there is inadvertent leakage of fluids or medications into the surrounding tissue, rather than the intended vascular area (10,12) . Its incidence ranges from 23-63% and it can cause the partial or total loss of skin and muscle.…”