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Improved outcome of extremely low birth weight infants with Tegaderm application to skin
Vineet Bhandari1, Nancy Brodsky, Rachel Porat
1Division of Neonatology, Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, PA, USA.
Insights
Applying semipermeable polyurethane membrane (Tegaderm) to extremely low birth weight (ELBW) infants shortly after birth reduces fluid and electrolyte disturbances. This intervention significantly improves clinical outcomes, including reduced lung disease and mortality.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Perinatal Medicine
Background:
- Extremely low birth weight (ELBW) infants experience significant fluid and electrolyte imbalances in early life.
- These disturbances can negatively impact clinical outcomes.
Purpose of the Study:
- To investigate the effect of semipermeable polyurethane membrane (Tegaderm) application on fluid and electrolyte status in ELBW infants.
- To assess the impact of Tegaderm on clinical outcomes, including mortality and respiratory disease.
Main Methods:
- Retrospective chart review of ELBW infants (BW < 1.0 kg) before and after Tegaderm implementation.
- Daily data collection on fluid intake, weight, serum electrolytes, and BUN/creatinine during the first week of life.
- Comparison of clinical morbidities (IVH, NEC, PDA, sepsis, BPD) and survival rates between groups.
Main Results:
- Tegaderm application was associated with significantly lower serum Na levels, daily fluid intake, and daily weight loss in the first week.
- Fewer infants in the Tegaderm group developed hypernatremia (17% vs 51%) and required high fluid intake (13% vs 54%).
- The Tegaderm group showed improved respiratory outcomes (less BPD, reduced need for supplemental oxygen) and higher survival rates (90% vs 64%).
Conclusions:
- Semipermeable polyurethane membrane application is effective in mitigating fluid and electrolyte disturbances in ELBW infants.
- Tegaderm significantly improves clinical outcomes, including reduced bronchopulmonary dysplasia and decreased mortality.
- Early skin barrier management with Tegaderm is a beneficial intervention for ELBW infants.
Objective:
Significant fluid and electrolyte disturbances occur in extremely low birth weight (ELBW) infants in the first few days of life. We investigated the effect of semipermeable polyurethane membrane (Tegaderm) applied to the skin shortly after birth on fluid and electrolyte status and the clinical outcome in these infants.
Study Design:
We reviewed charts of ELBW infants (BW<1.0 kg) born during 24 months prior to Tegaderm application and 19 months after starting Tegaderm. Data were collected daily from the first week of life and additional clinical morbidities were compared.
Results:
A total of 39 infants from pre-Tegaderm period (NOTEG) (mean+/-SD, BW 756+/-158 g, GA 26.1+/-1.9 weeks) were compared to 30 infants with extensive Tegaderm application to chest, abdomen and extremities (TEG) (BW 802+/-160 g, GA 26.3+/-1.8 weeks). The groups were similar in maternal demographics as well as postnatal surfactant use. Throughout the first week of life, serum Na levels, daily fluid intake and daily weight loss were significantly higher in the NOTEG infants (all P< or =0.04) while BUN/Serum creatinine levels were similar. Hypernatremia (Na>150 mEq/l) developed in 51% of NOTEG infants compared to 17% of TEG (P=0.0005) and daily fluid intake > or =170 ml/kg/day was required in 54 vs 13% (P=0.0008), respectively. The mean time to regain BW was significantly longer in NOTEG vs TEG infants, 20.7+/-7.4 vs 15.8+/-6.3 days, respectively (P<0.02). There were no statistical significant differences among the groups in incidence of IVH, NEC, PDA or nosocomial sepsis; however, respiratory outcome was better in TEG infants. They had significantly less BPD (58% in NOTEG vs 22% TEG (P=0.01)) and fewer infants in the TEG group required supplemental oxygen at discharge (58% vs 22% (P=0.01)). Survival was significantly higher in TEG 90% vs 64% in NOTEG infants (P=0.02).
Conclusions:
Semipermeable polyurethane membrane application to skin of ELBW infants shortly after birth decreased postnatal fluid and electrolyte disturbances and significantly improved their outcome by reducing severity of lung disease and decreasing mortality.
