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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

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Predictive Performance of Device-Neonatal Skin Risk Assessment Scale to Evaluating Pressure Injuries Risk in the

Biagio Nicolosi¹, Elisa Neri², Leonardo Fioravanti³

¹Wound and Burn Center, Health Profession Department, Meyer Children's Hospital IRCCS, Florence, Italy.

Journal of Clinical Nursing

|May 10, 2025

Summary

A new Neonatal Skin Risk Assessment scale (Dev-NSARS) accurately predicts neonatal pressure injuries (PIs) within 24 hours. This tool aids nurses in preventing PIs, reducing hospital stays and costs in neonatal intensive care units.

Keywords:

medical device related pressure injury neonatal intensive care pressure injury risk assessment

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Area of Science:

Neonatal intensive care
Clinical assessment tools
Pressure injury prevention

Background:

Medical devices are a primary cause of pressure injuries (PIs) in neonates, increasing morbidity and healthcare costs.
Neonatal pressure injuries significantly impact length of stay and resource utilization in neonatal intensive care units (NICUs).

Purpose of the Study:

To evaluate the validity of a modified Neonatal Skin Risk Assessment scale (Dev-NSARS) for predicting pressure injuries in neonates.
To compare the predictive performance of Dev-NSARS against the established Glamorgan scale.

Main Methods:

A national multicenter prospective study involving newborns in NICU and neonatal sub-intensive care units (NICU-Sub).
The Dev-NSRAS scale, incorporating medical device presence, was assessed for its discriminative power.
Sensitivity and specificity of Dev-NSARS were compared with the Glamorgan scale within the first 24 hours of admission.

Main Results:

Nine newborns (6.6%) developed 16 PIs, with 75% device-related.
Neonates with postconceptional age ≤ 30.8 weeks were at higher risk.
Dev-NSARS ≤ 11 demonstrated excellent predictive performance (AUC 0.921, 81.6% sensitivity, 93.6% specificity) within 24 hours, outperforming the Glamorgan scale.

Conclusions:

The Dev-NSARS scale, applied early by nursing staff, accurately predicts pressure injury risk in neonates.
This validated scale enhances early detection and personalized care planning in NICU and NICU-Sub settings.
Implementation of Dev-NSARS can reduce neonatal pressure injuries, shorten hospital stays, and decrease healthcare costs.