Pressure injuries to the skin in a neonatal unit: Fact or fiction

Pressure related skin injuries (including ulceration, skin/epithelial stripping, and combination injuries) have historically been neglected within neonatal research. Although anecdotal evidence, wound reviews and isolated case studies have been published; there is limited research specific to neonatal pressure injuries despite this population being, arguably, the most vulnerable patient group. The objective of this study was to investigate specific rates of neonatal skin breakdown from pressure including locations, stages, and etiology associated with tissue damage. A descriptive cohort study was conducted in North Queensland's Tertiary perinatal center over a 2-year period. Prevalence audits for pressure injuries to the skin were conducted (including epithelial stripping) and incorporated categorization of with degree of tissue breakdown between Stage 1–4. A modified risk assessment and prevalence tool was utilized in this study. 247 neonatal patients were reviewed during the study period, of these infants, 77/247 were identified as having a skin injury (a prevalence rate of 31.2%). In total, 107 injuries were identified with the mean number of 1.4 injuries (range 1–4, SD 0.71). The mean gestational age was 28 weeks (range 22–41 weeks, SD 4.1 weeks) and the mean birth weight was 1155 g (range 445–2678 g, SD 620 g). Factors identified as contributing to pressure injuries included indwelling vascular catheters (22.4%), non-invasive continuous positive airway pressure delivery devices (14.0%), oxygen saturation and temperature probes (17.8.%). 31.8% of injuries could not be associated with a specific risk factor. Neonates are undeniably at risk for pressure injuries however; it is still unclear which proportions of injuries are entirely preventable. Further development of a risk assessment and prevalence tool will provide practitioners with insight into the specific risk factors applicable for neonatal pressure injuries. Additional studies with larger patient groups will more accurately update practice related to pressure injury prevention and management in neonatal units; as well as critically evaluate the adverse affects of routine care processes that unintentionally harm the skin of these fragile patients.