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Pressure ulcers' incidence, preventive measures, and risk factors in neonatal intensive care and intermediate care
Pablo García-Molina1,2,3, Evelin Balaguer-López1,2, Francisco Pedro García-Fernández4,5
1Nursing Department, University of Valencia, Valencia, Spain.
Insights
Infant pressure ulcer incidence was 12.70%, higher in intensive care. Non-invasive ventilation and longer stays are key risks, while kangaroo care aids prevention.
Area of Science:
- Neonatal care
- Clinical epidemiology
- Patient safety
Background:
- Epidemiological data on pressure ulcers (PUs) in hospitalized infants is limited, particularly in Spain.
- There is a need for comprehensive research on PU incidence, risk factors, and preventive strategies in this vulnerable population.
Purpose of the Study:
- To determine the incidence of pressure ulcers in hospitalized infants in intensive and intermediate care units.
- To identify significant risk factors associated with PU development in infants.
- To evaluate the effectiveness of preventive measures, such as kangaroo care.
Main Methods:
- A prospective study was conducted involving 268 hospitalized infants.
- Data on PU incidence, risk factors, and preventive measures were collected.
- Multivariate logistic regression analysis was used to identify independent risk factors and protective measures.
Main Results:
- The cumulative incidence of PUs was 12.70% overall, significantly higher in intensive care units (28.18%) compared to intermediate care units (1.90%).
- Identified risk factors included low Neonatal Skin Risk Assessment Scale (e-NSRAS) scores, use of non-invasive mechanical ventilation, and longer hospital length of stay.
- Kangaroo care demonstrated a significant preventive effect (RR 0.26).
Conclusions:
- Hospitalized infants, especially those in intensive care, are at significant risk of developing pressure ulcers.
- Non-invasive ventilation and prolonged hospitalization are major contributors to PU development.
- Kangaroo care is an effective preventive strategy for pressure ulcers in infants.
Abstract:
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.
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