Overview of Dermatologic Disorders of Neonates in a Central Regional Intensive Care Unit in Hungary

Abstract

The immaturity and vulnerability of the skin and epidermal barrier function and the frequent iatrogenic complications following diagnostic and therapeutic procedures are often associated with skin manifestations in infants in neonatal intensive care units (NICUs). The aim of the current study was to investigate dermatologic disorders in neonates in our NICU. A prospective cohort study was conducted in the NICU at the Department of Pediatrics at the University of Szeged between January 2012 and January 2013. All full- and preterm infants hospitalized in the NICU underwent whole-body skin examinations and all dermatologic disorders and treatment modalities were recorded. Eighty-nine dermatologic conditions were detected in 64 of the 211 neonates admitted to the NICU. A wide variety of clinical symptoms accompanied these conditions in these preterm and severely ill full-term infants. A considerable proportion of the disorders that were seen resulted from the immaturity of the skin and various iatrogenic complications. Dermatologic disorders are frequent in neonates requiring intensive care. Prevention, early detection, and optimal treatment of these disorders with modern, standardized skin care management strategies can result in significant improvements in barrier function and in the integrity of the skin, increasing the overall efficacy of neonatal intensive care.

Neonatal skin assessments and injuries: Nomenclature, workplace culture and clinical opinions—Method triangulation a qualitative study

“… g Csoma et al., 2015; Gordon & Montgomery, 1996; Irving, 2001a, 2001b; Lund, 2014; Malloy & Perez‐Woods, 1990; Ness et al., 2013. …”

Neonatal wounds, neonatal scars

“…A bőr-sérülések általában minor problémák voltak, míg a súlyos szö-vődményeket elsősorban a nosocomiális fertőzések és a lég-zőszervi komplikációk jelentették (22). Saját vizsgálatainkban azt tapasztaltuk, hogy a NIC-en egy év alatt észlelt bőrgyó-gyászati elváltozások 75,3 százaléka a bőr éretlenségével ösz-szefüggésben kialakult iatrogén elváltozás volt, illetve 39,3 százalékuk igényelt speciális sebkezelési ellátást (25,26).…”

Pharmacological Targeting of the Epidermal Barrier

“…[56][57][58][59] The basic structural differences between the skin of a preterm neonate, a term neonate and an adult are of considerable importance in clinical practice. The structure of the skin of a fullterm neonate is similar to that of an adult, but it is much thinner and more vulnerable [60,61].…”

“…Septic complications occur mainly in the first few days or the first 2 weeks of life and are the most common cause of mortality in this special population. The compromised epidermal barrier function results in an enhanced susceptibility to severe invasive infections, high rates of TEWL, thermal instability, electrolyte imbalance, increased percutaneous absorption of chemicals and drugs, and easily induced skin traumas; these clinical complications are relevant determinants of the high morbidity and mortality rates for preterm infants [56][57][58]61]. In extremely premature infants, the TEWL can be as much as 10-15 times higher than in full-term infants; a neonate born at 24 weeks of gestation can lose 13% body weight on the first day of life as a consequence of the high fluid loss due to the virtual absence of the epidermal barrier [57,58,60].…”

“…Due to the immaturity of the dermoepidermal junction, the epidermis and dermis can easily separate from each other; moreover, bullae can develop much more easily after thermal or mechanical impact. The skin is therefore fragile and prone to inadvertent cutaneous injury [56,57,61]. The dermis is also thinner, less collagenized and more gelatinous, and this gives rise to an increased risk of oedema, resulting in the risk of ischaemic injury.…”