Pressure ulcers’ incidence, preventive measures, and risk factors in neonatal intensive care and intermediate care units

International Wound Journal - Tập 15 Số 4 - Trang 571-579 - 2018
Pablo García‐Molina1,2,3, Evelin Balaguer‐López2,3, Francisco Pedro García‐Fernández4,5, María de los Ángeles Ferrera‐Fernández6,3, José-María Blasco7, José Verdú Soriano8,8
1Grupo Nacional de Estudio y Asesoramiento de Úlceras por Presión(GNEAUPP) Consultant Board Spain
2Nursing Department, University of Valencia, Valencia, Spain
3University Hospital of Valencia, Valencia, Spain
4Grupo Nacional de Estudio y Asesoramiento de Úlceras por Presión(GNEAUPP) Steering Committee Spain
5Nursing Department University of Jaen Jaén Spain
6Nursing Department, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
7Physiotherapy Department, University of Valencia, Valencia, Spain
8Community Nursing, Preventive Medicine and Public health and History of Science Department, University of Alicante, Alicante, Spain

Tóm tắt

Epidemiological studies on pressure ulcers (PUs) in hospitalised infants are scarce. Spain lacks comprehensive research studies providing data on the prevalence or incidence in this population. This work was developed to determine the incidence of PUs in hospitalised infants admitted to intensive and intermediate care units, along with relevant risk factors and preventive measures. A prospective study appraising the incidence of PUs in infants was performed. The risk factors and preventive measures were evaluated using a multivariate logistic regression model. A sample of 268 infants was included. The cumulative incidence of PUs was 12.70% (95% confidence interval, CI95% = [8.95%‐17.28%]). The cumulative incidence in the intermediate care units was 1.90% (CI95% = [0.39%‐5.45%]), while it was 28.18% (CI95% = [20.02%‐37.56%]) in the intensive care units. The PUs were categorised as stage I, 57.10%; stage II, 31.70%; and stage III, 11.10%. The multivariate analysis found the following to be risk factors: low scores in the Spanish version of the Neonatal Skin Risk Assessment Scale (e‐NSRAS) (Relative Risk (RR) 0.80; CI95% = [0.66‐0.97]), the use of non‐invasive mechanical ventilation (RR 12.24; CI95% = [4.02‐37.32]), and the length of stay (RR 1.08; CI95% = [1.02‐1.15]), suggesting a direct impact of these factors on PU development in infants. Kangaroo care influenced the prevention of PUs (RR 0.26; CI95% = [0.09‐0.71]). The infants admitted in intermediate care units suffered PUs. In the case of intensive care units, the incidence is even higher. The risk increases with the length of stay, while the presence of medical devices, particularly non‐invasive mechanical ventilation, is the main causal relationship. Kangaroo care has been shown to be an important preventive measure.

Từ khóa


Tài liệu tham khảo

Quesada C, 2006, Manual de Atención Enfermera de Úlceras por Presión en Pediatría [Manual Care of Pressure Ulcer in Pediatrics]

10.1136/adc.2004.069351

García‐Fernández F, 2014, Clasificación‐categorización de las lesiones relacionadas con la dependencia [Classification‐categorization of dependence‐related injuries]

Grupo de trabajo de la Guía de Práctica Clínica. Guía de Práctica Clínica para el Cuidado de Personas con Úlceras por Presión o Riesgo de Padecerlas [Clinical Practice Guidelines for the Care of Persons with pressure ulcers or risk of suffering]. In: Conselleria Sanitat Comunidad Valenciana ed. 2nd ed. Valencia 2012.

Haesler E, 2014, Prevention and treatment of pressure ulcers: quick reference guide

10.1111/jnu.12051

10.1111/srt.12369

10.1016/j.jnn.2013.08.006

Menezes Brito M, 2009, Análisis de los eventos adversos en una unidad de terapia intensiva neonatal como herramienta de gestión de calidad de la atención de enfermería, Enferm Global, 8, 1

10.1111/1552-6909.12403

Won‐Young C, 2012, Incidence and associated factors of pressure ulcers in newborns, J Korean Acad Child Health Nurs, 177

10.1111/j.1742-481X.2010.00688.x

10.1111/j.1365-2702.2009.02951.x

Torra i Bou JE, 2016, Incidencia de úlceras por presión en unidades de cuidados intensivos. Revisión sistemática con meta‐análisis [Incidence of pressure ulcers in intensive care units. Systematic review with meta‐analysis]

Bonell‐Pons L, 2014, Neonatal facial pressure ulcers related to noninvasive ventilation: incidence and risk factors, EWMA J, 14, 33

10.1016/B978-1-4160-3432-2.50005-4

10.12968/jowc.2015.24.3.81

10.1891/0730-0832.18.4.15

10.1097/01.ASW.0000266646.43159.99

10.1038/srep07429

Guideline Development Group, 2014, Pressure Ulcers: Prevention and Management of Pressure Ulcers. National Clinical Guideline Centre

10.12968/jowc.2009.18.1.32135

10.1097/01.PCC.0000075559.55920.36

García‐Molina P, 2015, Adaptación cultural y validación de la escala de valoración de riesgo de desarrollar úlceras por presión en neonatos hospitalizados (Neonatal Skin Risk Assessment Scale) [Cultural adaptation and validation of the risk assessment scale to develop pressure ulcers in hospitalized neonates (Neonatal Skin Risk Assessment Scale)]

10.1097/ANC.0000000000000337

10.1016/0378-3782(90)90105-R

McArtor RD, 1979, Iatrogenic second‐degree burn caused by a transilluminator, Pediatrics, 63, 422, 10.1542/peds.63.3.422

10.1136/adc.68.5_Spec_No.591

Baxter RJ, 1975, Cosmetic nasal deformities complicating prolonged nasotracheal intubation in critically ill newborn infants, Pediatrics, 55, 884, 10.1542/peds.55.6.884

10.3109/01460869709026881

10.1136/adc.2009.179416

10.1016/j.jtv.2016.03.001

10.1111/1552-6909.12233

10.4187/respcare.04036

10.1016/j.earlhumdev.2015.05.009

10.1159/000354923

10.1136/adc.2004.069351

10.1053/S1536-0903(03)00168-1

Dixon M, 2011, Hair braids as a risk factor for occipital pressure ulcer development: a case study, Ostomy Wound Manage, 57, 48

10.1136/bmj.g2592

National Clinical Guideline Center, 2014, The Prevention and Management of Pressure Ulcers in Primary and Secondary Care

10.1089/bfm.2014.0097

10.1111/birt.12135

Dolack M, 2013, Updated neonatal skin risk assessment scale (NSRAS), Ky Nurse, 61, 6

10.1016/j.pedn.2010.07.006

10.1111/iwj.12004

10.1111/iwj.12131

Thông tin
Thông tin xuất bản

International Wound Journal

Tập 15 Số 4

571-579

Thông tin tác giả