Review of pressure ulcers management in pediatrics: assessment, prevention, and intervention

Abstract

Objective: This study did a thorough review of the literature and investigated the current evidence-based guidelines and information available for the incidence and prevalence, the identification of risk factors, which risk scales are valid and reliable, and examined the effectiveness and applicability of the different intervention and prevention options for the management of Pressure Ulcers (PUs) and skin breakdown in pediatric population in comparison to those found in adults literature.Results: PUs in the pediatric population has been poorly documented and has not received adequate attention in the literature compared to those in the adult population. The chronically ill children and the pediatric patient population with chronic conditions and severe neurological and sensory motor impairments such as cerebral palsy, spine bifida and Spinal Cord Injury (SCI), are at significant risk for the development of PUs. A comprehensive and thorough pediatric skin care program should emphasize the need for accurate, continuous assessment, including specific and detailed documentation of tissue damage. Early assessment and detection are essential because early stage PUs is far easier and less costly to treat. Currently, there are 10 published pediatric pressure ulcer risk assessment scales. Of these scales, only the Braden Q Scale, the Neonatal Skin Risk Assessment Scale (NSRAS), and the Glamorgan Scale have been tested for sensitivity and specificity. Conclusion:Most of the current evidence-based guidelines for prevention and management of pediatric PUs have been relatively limited and are largely modifications of adult practice guidelines. Healthcare professionals should keep in mind that pediatric patients are not just small adults, but deserve unique consideration in their medical and surgical care. Therefore, further future research studies and well designed randomized clinical trials (RCTs) are needed to examine the efficacy, effectiveness, the applicability, and safety of the available prevention and treatment options for the management of PUs and skin breakdown in pediatric population.

A Unique Case of Intrauterine Pressure Injury

“…Preterm neonates can be at risk for slow wound healing due to various factors including impaired perfusion and oxygenation, nonresolved inflammation, presence of proteases, prolonged immobility, and recurrent physical trauma 13 . Early intervention for skin injury is important because lower-stage PIs are less costly and easier to treat in general 14 . To treat PIs, providers should focus first on identifying early skin changes in neonates at risk for PI development, particularly in infants who present facially for an extended period during the labor process.…”

“…13 Early intervention for skin injury is important because lower-stage PIs are less costly and easier to treat in general. 14 To treat PIs, providers should focus first on identifying early skin changes in neonates at risk for PI development, particularly in infants who present facially for an extended period during the labor process.…”

Assessing Effectiveness of Regular Repositioning in Preventing Pressure Ulcers in Children

“…Regular repositioning can reduce pressure and the likelihood of prolonged ischemia. 13 Pressure ulcers can be prevented by reducing the pressure on bony prominences while paying attention to the children’s comfort, such as by using pillows, cotton, and hand folding. 16 Psychologically, children highly depend on their parents; therefore, good cooperation from parents is required to provide a safe and comfortable situation for child patients.…”

“…12 Regular repositioning could reduce pressure and prevent prolonged ischemia. 13 In addition, it could be the most effective way to prevent pressure ulcers because it could modify pressure sores. 5 Repositioning every two hours effectively reduced pressure ulcer incidences by 14%.…”