Abstract:Neonates are easily suffering from local or systematic infections due to their vulnerable skin barrier function, which leads to the increasing risk of death. Therefore, it is important to protect neonatal skin integrity and prevent neonatal skin injury in the neonatal intensive care unit (NICU). Based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and current evidence, the guidelines for neonatal skin management in the NICU were developed to provide recommendations on routine skin care and prevention and treatment of iatrogenic skin injury of neonates for health care providers.
Afsar FS. Physiological skin conditions of preterm and term neonates[J]. Clin Exp Dermatol, 2010, 35(4):346-350. DOI:10.1111/j.1365-2230.2009.03562.x. PMID:19758381.
[2]
Fluhr JW, Darlenski R, Taieb A, et al. Functional skin adaptation in infancy-almost complete but not fully competent[J]. Exp Dermatol, 2010, 19(6):483-492. DOI:10.1111/j.1600-0625.2009.01023.x. PMID:20353516.
Csoma ZR, Meszes A, Ábrahám R, et al. Iatrogenic skin disorders and related factors in newborn infants[J]. Pediatr Dermatol, 2016, 33(5):543-548. DOI:10.1111/pde.12960. PMID:27595870.
[5]
Kugelman A, Inbar-Sanado E, Shinwell ES, et al. Iatrogenesis in neonatal intensive care units:observational and interventional, prospective, multicenter study[J]. Pediatrics, 2008, 122(3):550-555. DOI:10.1542/peds.2007-2729. PMID:18762525.
[6]
Guyatt GH, Oxman AD, Schünemann HJ, et al. GRADE guidelines:a new series of articles in the Journal of Clinical Epidemiology[J]. J Clin Epidemiol, 2011, 64(4):380-382. DOI:10.1016/j.jclinepi.2010.09.011. PMID:21185693.
[7]
World Health Organization. WHO recommendations on postnatal care of the mother and newborn[EB/OL].[2020-12-28]. https://apps.who.int/iris/bitstream/handle/10665/97603/9789241506649_eng.pdf.
[8]
Brandon D, Hill CM, Heimall L, et al. Neonatal skin care:evidence-based clinical practice guideline[M]. 4th ed. Washington DC:Association of Women's Health, Obstetric and Neonatal Nurses, 2018.
[9]
Colwell A. To bathe or not to bathe:the neonatal question[J]. Neonatal Netw, 2015, 34(4):216-219. DOI:10.1891/0730-0832.34.4.216. PMID:26802635.
[10]
Kuller JM. Update on newborn bathing[J]. Newborn Infant Nurs Rev, 2014, 14(4):166-170. DOI:10.1053/j.nainr.2014.10.006.
[11]
Lawn JE, Davidge R, Paul VK, et al. Born too soon:care for the preterm baby[J]. Reprod Health, 2013, 10(Suppl 1):S5. DOI:10.1186/1742-4755-10-S1-S5. PMID:24625233. PMCID:PMC3828583.
[12]
Loring C, Gregory K, Gargan B, et al. Tub bathing improves thermoregulation of the late preterm infant[J]. J Obstet Gynecol Neonatal Nurs, 2012, 41(2):171-179. DOI:10.1111/j.1552-6909.2011.01332.x. PMID:22375955.
[13]
Taşdemir Hİ, Efe E. The effect of tub bathing and sponge bathing on neonatal comfort and physiological parameters in late preterm infants:a randomized controlled trial[J]. Int J Nurs Stud, 2019, 99:103377. DOI:10.1016/j.ijnurstu.2019.06.008. PMID:31442786.
[14]
Ceylan SS, BolLşLk B. Effects of swaddled and sponge bathing methods on signs of stress and pain in premature newborns:implications for evidence-based practice[J]. Worldviews Evid Based Nurs, 2018, 15(4):296-303. DOI:10.1111/wvn.12299. PMID:29763976.
[15]
Edraki M, Paran M, Montaseri S, et al. Comparing the effects of swaddled and conventional bathing methods on body temperature and crying duration in premature infants:a randomized clinical trial[J]. J Caring Sci, 2014, 3(2):83-91. DOI:10.5681/jcs.2014.009. PMID:25276751. PMCID:PMC4134173.
[16]
Ccedil;aka SY, Gözen D. Effects of swaddled and traditional tub bathing methods on crying and physiological responses of newborns[J]. J Spec Pediatr Nurs, 2018, 23(1):e12202. DOI:10.1111/jspn.12202. PMID:29160925.
Finn M, Meyer A, Kirsten D, et al. Swaddled bathing in the neonatal intensive care unit[J]. Neoreviews, 2017, 18(8):e504-e506. DOI:10.1542/neo.18-8-e504.
[19]
Fernández D, Antolín-Rodríguez R. Bathing a premature infant in the intensive care unit:a systematic review[J]. J Pediatr Nurs, 2018, 42:e52-e57. DOI:10.1016/j.pedn.2018.05.002. PMID:29779763.
[20]
Heimall LM, Storey B, Stellar JJ, et al. Beginning at the bottom:evidence-based care of diaper dermatitis[J]. MCN Am J Matern Child Nurs, 2012, 37(1):10-16. DOI:10.1097/NMC.0b013e31823850ea. PMID:22072018.
[21]
Visscher M, Odio M, Taylor T, et al. Skin care in the NICU patient:effects of wipes versus cloth and water on stratum corneum integrity[J]. Neonatology, 2009, 96(4):226-234. DOI:10.1159/000215593. PMID:19407468.
[22]
Rowe J, McCall E, Kent B. Clinical effectiveness of barrier preparations in the prevention and treatment of nappy dermatitis in infants and preschool children of nappy age[J]. Int J Evid Based Healthc, 2008, 6(1):3-23. DOI:10.1111/j.1744-1609.2007.00095.x. PMID:21631812.
[23]
Klunk C, Domingues E, Wiss K. An update on diaper dermatitis[J]. Clin Dermatol, 2014, 32(4):477-487. DOI:10.1016/j.clindermatol.2014.02.003. PMID:25017459.
World Health Organization. Care of the umbilical cord:a review of the evidence[EB/OL].[2020-12-28].
[34]
Stewart D, Benitz W, Committee on Fetus and Newborn. Umbilical cord care in the newborn infant[J]. Pediatrics, 2016, 138(3):e20162149. DOI:10.1542/peds.2016-2149. PMID:27573092.
Sankar MJ, Chandrasekaran A, Ravindranath A, et al. Umbilical cord cleansing with chlorhexidine in neonates:a systematic review[J]. J Perinatol, 2016, 36(Suppl 1):S12-S20. DOI:10.1038/jp.2016.28. PMID:27109088. PMCID:PMC4848738.
[37]
Imdad A, Bautista RM, Senen KA, et al. Umbilical cord antiseptics for preventing sepsis and death among newborns[J]. Cochrane Database Syst Rev, 2013(5):CD008635. DOI:10.1002/14651858.CD008635.pub2. PMID:23728678.
Alkharfy T, Ba-Abbad R, Hadi A, et al. Use of topical petroleum jelly for prevention of sepsis in very low-birthweight infants:a prospective, randomised controlled trial[J]. Paediatr Int Child Health, 2014, 34(3):194-197. DOI:10.1179/2046905514Y.0000000117. PMID:24593664.
[40]
Darmstadt GL, Badrawi N, Law PA, et al. Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infants in Egypt:a randomized, controlled clinical trial[J]. Pediatr Infect Dis J, 2004, 23(8):719-725. DOI:10.1097/01.inf.0000133047.50836.6f. PMID:15295221.
[41]
Kiechl-Kohlendorfer U, Berger C, Inzinger R. The effect of daily treatment with an olive oil/lanolin emollient on skin integrity in preterm infants:a randomized controlled trial[J]. Pediatr Dermatol, 2008, 25(2):174-178. DOI:10.1111/j.1525-1470.2008.00627.x. PMID:18429773.
[42]
Salam RA, Darmstadt GL, Bhutta ZA. Effect of emollient therapy on clinical outcomes in preterm neonates in pakistan:a randomised controlled trial[J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100(3):F210-F215. DOI:10.1136/archdischild-2014-307157. PMID:25637007.
[43]
Cleminson J, McGuire W. Topical emollient for preventing infection in preterm infants[J]. Cochrane Database Syst Rev, 2016, 2016(1):CD001150. DOI:10.1002/14651858.CD001150.pub3. PMID:26824786. PMCID:PMC7027999.
[44]
National Association of Neonatal Nurses. Peripherally inserted central catheters:guideline for practice, 3rd edition[EB/OL].[2020-07-16].
[45]
Aitken J, Williams FL. A systematic review of thyroid dysfunction in preterm neonates exposed to topical iodine[J]. Arch Dis Child Fetal Neonatal Ed, 2014, 99(1):F21-F28. DOI:10.1136/archdischild-2013-303799. PMID:24105624.
[46]
Lund CH, Osborne JW, Kuller J, et al. Neonatal skin care:clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses[J]. J Obstet Gynecol Neonatal Nurs, 2001, 30(1):41-51. DOI:10.1111/j.1552-6909.2001.tb01520.x. PMID:11277161.
Marschall J, Mermel LA, Fakih M, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals:2014 update[J]. Infect Control Hosp Epidemiol, 2014, 35(7):753-771. DOI:10.1086/676533. PMID:24915204.
[49]
Beresford D. MHRA report chlorhexidine solutions:risk of chemical burn injury to skin in premature infants[J]. J Neonatal Nurs, 2015, 21(2):47-49. DOI:10.1016/j.jnn.2015.02.002.
[50]
Huang EY, Chen C, Abdullah F, et al. Strategies for the prevention of central venous catheter infections:an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review[J]. J Pediatr Surg, 2011, 46(10):2000-2011. DOI:10.1016/j.jpedsurg.2011.06.017. PMID:22008341.
Bringué Espuny X, Soria X, Solé E, et al. Chlorhexidine-methanol burns in two extreme preterm newborns[J]. Pediatr Dermatol, 2010, 27(6):676-678. DOI:10.1111/j.1525-1470.2010.01178.x. PMID:21510025.
[53]
Lashkari HP, Chow P, Godambe S. Aqueous 2% chlorhexidine-induced chemical burns in an extremely premature infant[J]. Arch Dis Child Fetal Neonatal Ed, 2012, 97(1):F64. DOI:10.1136/adc.2011.215145. PMID:21746795.
[54]
Mannan K, Chow P, Lissauer T, et al. Mistaken identity of skin cleansing solution leading to extensive chemical burns in an extremely preterm infant[J]. Acta Paediatr, 2007, 96(10):1536-1537. DOI:10.1111/j.1651-2227.2007.00376.x. PMID:17727692.
[55]
Neri I, Ravaioli GM, Faldella G, et al. Chlorhexidine-induced chemical burns in very low birth weight infants[J]. J Pediatr, 2017, 191:262-265.e2. DOI:10.1016/j.jpeds.2017.08.002. PMID:29173315.
[56]
Vanzi V, Pitaro R. Skin injuries and chlorhexidine gluconate-based antisepsis in early premature infants:a case report and review of the literature[J]. J Perinat Neonatal Nurs, 2018, 32(4):341-350. DOI:10.1097/JPN.0000000000000334. PMID:29782437.
[57]
Kutsch J, Ottinger D. Neonatal skin and chlorhexidine:a burning experience[J]. Neonatal Netw, 2014, 33(1):19-23. DOI:10.1891/0730-0832.33.1.19. PMID:24413032.
McCord H, Fieldhouse E, El-Naggar W. Current practices of antiseptic use in Canadian neonatal intensive care units[J]. Am J Perinatol, 2019, 36(2):141-147. DOI:10.1055/s-0038-1661406. PMID:29945280.
[60]
Upadhyayula S, Kambalapalli M, Harrison CJ. Safety of anti-infective agents for skin preparation in premature infants[J]. Arch Dis Child, 2007, 92(7):646-647. DOI:10.1136/adc.2007.117002. PMID:17588981. PMCID:PMC2083764.
[61]
McNichol L, Lund C, Rosen T, et al. Medical adhesives and patient safety:state of the science:consensus statements for the assessment, prevention, and treatment of adhesive-related skin injuries[J]. Orthop Nurs, 2013, 32(5):267-281. DOI:10.1097/NOR.0b013e3182a39caf. PMID:24022422.
[62]
Fumarola S, Allaway R, Callaghan R, et al. Overlooked and underestimated:medical adhesive-related skin injuries[J]. J Wound Care, 2020, 29(Sup3c):S1-S24. DOI:10.12968/jowc.2020.29.Sup3c.S1. PMID:32134695.
[63]
Campbell K, Woodbury MG, Whittle H, et al. A clinical evaluation of 3M no sting barrier film[J]. Ostomy Wound Manage, 2000, 46(1):24-30. PMID:10732633.
[64]
Shannon RJ, Chakravarthy D. Effect of a water-based no-sting, protective barrier formulation and a solvent-containing similar formulation on skin protection from medical adhesive trauma[J]. Int Wound J, 2009, 6(1):82-88. DOI:10.1111/j.1742-481X.2008.00559.x. PMID:19291121.
[65]
Oʼneil A, Schumacher B. Application of a pectin barrier for medical adhesive skin injury (epidermal stripping) in a premature infant[J]. J Wound Ostomy Continence Nurs, 2014, 41(3):219-221. DOI:10.1097/WON.0000000000000029. PMID:24805172.
[66]
Denyer J. Reducing pain during the removal of adhesive and adherent products[J]. Br J Nurs, 2011, 20(15):S28, S30-S35. DOI:10.12968/bjon.2011.20.Sup8.S28. PMID:21841648.
[67]
Barton A. Medical adhesive-related skin injuries associated with vascular access:minimising risk with Appeel Sterile[J]. Br J Nurs, 2020, 29(8):S20-S27. DOI:10.12968/bjon.2020.29.8.S20. PMID:32324453.
[68]
Collier M. Minimising pain and medical adhesive related skin injuries in vulnerable patients[J]. Br J Nurs, 2019, 28(15):S26-S32. DOI:10.12968/bjon.2019.28.15.S26. PMID:31393764.
Fox MD. Wound care in the neonatal intensive care unit[J]. Neonatal Netw, 2011, 30(5):291-303. DOI:10.1891/0730-0832.30.5.291. PMID:21846624.
[71]
Hasegawa M, Inoue Y, Kaneko S, et al. Wound, pressure ulcer and burn guidelines-1:guidelines for wounds in general, second edition[J]. J Dermatol, 2020, 47(8):807-833. DOI:10.1111/1346-8138.15401. PMID:32614097.
[72]
Bolton L. Operational definition of moist wound healing[J]. J Wound Ostomy Continence Nurs, 2007, 34(1):23-29. DOI:10.1097/00152192-200701000-00003. PMID:17228202.
[73]
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries:clinical practice guideline[EB/OL].[2020-12-29]. https://internationalguideline.com/static/pdfs/Quick_Reference_Guide-10Mar2019.pdf.
[74]
Günlemez A, Isken T, Gökalp AS, et al. Effect of Silicon gel sheeting in nasal injury associated with nasal CPAP in preterm infants[J]. Indian Pediatr, 2010, 47(3):265-267. DOI:10.1007/s13312-010-0047-9. PMID:19430064.
[75]
Xie LH. Hydrocolloid dressing in preventing nasal trauma secondary to nasal continuous positive airway pressure in preterm infants[J]. World J Emerg Med, 2014, 5(3):218-222. DOI:10.5847/wjem.j.issn.1920-8642.2014.03.011. PMID:25225588. PMCID:PMC4163817.
[76]
King BC, Gandhi BB, Jackson A, et al. Mask versus prongs for nasal continuous positive airway pressure in preterm infants:a systematic review and meta-analysis[J]. Neonatology, 2019, 116(2):100-114. DOI:10.1159/000496462. PMID:31163418.
[77]
Razak A, Patel W. Nasal mask vs binasal prongs for nasal continuous positive airway pressure in preterm infants:a systematic review and meta-analysis[J]. Pediatr Pulmonol, 2020, 55(9):2261-2271. DOI:10.1002/ppul.24878. PMID:32478923.
Wound, Ostomy and Continence Nurses Society-Wound Guidelines Task Force. WOCN 2016 guideline for prevention and management of pressure injuries (ulcers):an executive summary[J]. J Wound Ostomy Continence Nurs, 2017, 44(3):241-246. DOI:10.1097/WON.0000000000000321. PMID:28472816.
[81]
Ho CH, Bensitel T, Wang XF, et al. Pulsatile lavage for the enhancement of pressure ulcer healing:a randomized controlled trial[J]. Phys Ther, 2012, 92(1):38-48. DOI:10.2522/ptj.20100349. PMID:21949432.
[82]
Fernandez R, Griffiths R. Water for wound cleansing[J]. Cochrane Database Syst Rev, 2012(2):CD003861. DOI:10.1002/14651858.CD003861.pub3. PMID:22336796.
[83]
Fujiwara H, Isogai Z, Irisawa R, et al. Wound, pressure ulcer and burn guidelines-2:guidelines for the diagnosis and treatment of pressure ulcers, second edition[J]. J Dermatol, 2020, 47(9):929-978. DOI:10.1111/1346-8138.14587. PMID:30194884.
[84]
Kim JT, Park JY, Lee HJ, et al. Guidelines for the management of extravasation[J]. J Educ Eval Health Prof, 2020, 17:21. DOI:10.3352/jeehp.2020.17.21. PMID:32668826. PMCID:PMC7431942.
[85]
Wickham R, Engelking C, Sauerland C, et al. Vesicant extravasation part II:evidence-based management and continuing controversies[J]. Oncol Nurs Forum, 2006, 33(6):1143-1150. DOI:10.1188/06/ONF.1143-1150. PMID:17149397.
[86]
Vandeweyer E, Deraemaecker R. Early surgical suction and washout for treatment of cytotoxic drug extravasations[J]. Acta Chir Belg, 2000, 100(1):37-38. PMID:10776527.
[87]
Massand S, Carr L, Schneider E, et al. Management of intravenous infiltration injuries[J]. Ann Plast Surg, 2019, 83(6):e55-e58. DOI:10.1097/SAP.0000000000001984. PMID:31688099.
[88]
Lawson SL, Brady W, Mahmoud A. Identification of highly concentrated dextrose solution (50% dextrose) extravasation and treatment-a clinical report[J]. Am J Emerg Med, 2013, 31(5):886.e3-886.e5. DOI:10.1016/j.ajem.2012.12.010. PMID:23602753.
[89]
Yan YM, Fan QL, Li AQ, et al. Treatment of cutaneous injuries of neonates induced by drug extravasation with hyaluronidase and hirudoid[J]. Iran J Pediatr, 2014, 24(4):352-358. PMID:25755854. PMCID:PMC4339556.
[90]
Sushko K, Litalien C, Ferruccio L, et al. Topical nitroglycerin ointment as salvage therapy for peripheral tissue ischemia in newborns:a systematic review[J]. CMAJ Open, 2021, 9(1):E252-E260. DOI:10.9778/cmajo.20200129. PMID:33731426. PMCID:PMC8096410.
[91]
Wong AF, McCulloch LM, Sola A. Treatment of peripheral tissue ischemia with topical nitroglycerin ointment in neonates. Treatment of peripheral tissue ischemia with topical nitroglycerin ointment in neonates[J]. J Pediatr, 1992, 121(6):980-983. DOI:10.1016/s0022-3476(05)80356-7. PMID:1447671.
[92]
Reynolds PM, Maclaren R, Mueller SW, et al. Management of extravasation injuries:a focused evaluation of noncytotoxic medications[J]. Pharmacotherapy, 2014, 34(6):617-632. DOI:10.1002/phar.1396. PMID:24420913.
[93]
Gopalakrishnan PN, Goel N, Banerjee S. Saline irrigation for the management of skin extravasation injury in neonates[J]. Cochrane Database Syst Rev, 2017, 7(7):CD008404. DOI:10.1002/14651858.CD008404.pub3. PMID:28724193. PMCID:PMC6483149.
Wiegand R, Brown J. Hyaluronidase for the management of dextrose extravasation[J]. Am J Emerg Med, 2010, 28(2):257.e1-257.e2. DOI:10.1016/j.ajem.2009.06.010. PMID:20159411.
[96]
Kostogloudis N, Demiri E, Tsimponis A, et al. Severe extravasation injuries in neonates:a report of 34 cases[J]. Pediatr Dermatol, 2015, 32(6):830-835. DOI:10.1111/pde.12664. PMID:26337780.
[97]
Ghanem AM, Mansour A, Exton R, et al. Childhood extravasation injuries:improved outcome following the introduction of hospital-wide guidelines[J]. J Plast Reconstr Aesthet Surg, 2015, 68(4):505-518. DOI:10.1016/j.bjps.2014.12.029. PMID:25618570.
[98]
Andrés AM, Burgos L, López Gutiérrez JC, et al. Treatment protocol for extravasation lesions[J]. Cir Pediatr, 2006, 19(3):136-139. PMID:17240942.
[99]
Casanova D, Bardot J, Magalon G. Emergency treatment of accidental infusion leakage in the newborn:report of 14 cases[J]. Br J Plast Surg, 2001, 54(5):396-399. DOI:10.1054/bjps.2001.3593. PMID:11428769.
[100]
Ching DL, Wong KY, Milroy C. Paediatric extravasation injuries:a review of 69 consecutive patients[J]. Int J Surg, 2014, 12(10):1036-1037. DOI:10.1016/j.ijsu.2014.08.355. PMID:25150804.
[101]
Cochran ST, Bomyea K, Kahn M. Treatment of iodinated contrast material extravasation with hyaluronidase[J]. Acad Radiol, 2002, 9(Suppl 2):S544-S546. DOI:10.1016/s1076-6332(03)80288-x. PMID:12188333.
[102]
Crowther DM, Buck ML, McCarthy MW, et al. Improving pediatric adverse drug event reporting through clinical pharmacy services[J]. J Pediatr Pharmacol Ther, 2011, 16(4):285-290. DOI:10.5863/1551-6776-16.4.285. PMID:22768013. PMCID:PMC3385043.
[103]
Humphreys J, Johnston JH, Richardson JC. Skin necrosis following intravenous noradrenaline[J]. Br Med J, 1955, 2(4950):1250-1252. DOI:10.1136/bmj.2.4950.1250. PMID:13269844. PMCID:PMC1981272.
[104]
Coffman JD, Cohen RA. Intra-arterial vasodilator agents to reverse human finger vasoconstriction[J]. Clin Pharmacol Ther, 1987, 41(5):574-579. DOI:10.1038/clpt.1987.74. PMID:3105944.
Siwy BK, Sadove AM. Acute management of dopamine infiltration injury with Regitine[J]. Plast Reconstr Surg, 1987, 80(4):610-612. DOI:10.1097/00006534-198710000-00024. PMID:3659173.
[107]
Subhani M, Sridhar S, Decristofaro JD. Phentolamine use in a neonate for the prevention of dermal necrosis caused by dopamine:a case report[J]. J Perinatol, 2001, 21(5):324-326. DOI:10.1038/sj.jp.7200493. PMID:11536027.