Measurement and Sequelae of Neonatal Skin Injuries: A Prospective Diagnostic/Feasibility Study

Neonatal skin injuries are common, but location and metric size contribute to inconsistent severity reporting. To date, non-invasive technologies remain unexplored for neonatal injuries. The aim of this study was to assess the feasibility and accuracy of visual assessment against three technologies for injuries to the skin from pressure, stripping and tearing. The prospective diagnostic/feasibility study was conducted for neonates who acquired mechanical force injuries between February-July 2022. Injury measures taken within 72 h of identification were (i) skin injury severity or type pH (5.0-7.5), (ii) laser speckle (perfusion units/mm²), and (iii) imaging app (surface area, cm²). Technology feasibility, clinician-reported acceptability, accuracy, cost and injury sequelae at 6 months post-injury were also collected. A total of 24 neonates (mean (SD)) 34 (5) weeks old and (median (IQR) weight) 1244 (868 to 1740) grams were enrolled. Forty injuries (n = 120 assessments) were completed by visual assessment (100%), 34 (85%) by pH, 30 (75%) with laser speckle and 38 (95%) with the imaging app, respectively. Assessments between clinicians and researchers were inconsistent (n = 29, 72%) and technologies failed for at least 3% of assessments by each respective device. Median injured pH exceeded healthy (average -0.7 of unit), but differences between injured and healthy skin with laser speckle and the app were non-significant. Skin pH had the quickest acquisition (mean (SD) 3.1 (1.6) min) followed by the app (3.2 (2.5) min) and mean acceptability was highest for the imaging app (7.1/10), then pH (6.4/10). Cost per injury was most expensive for the app ($6.65 to $12.82) and lowest for pH ($0.17 to $0.41) per assessment. In conjunction with visual assessment, pH appears objective and cost-effective for intact and injured skin comparison.