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Beyond the Skin: Risk Factors of Pressure Injury Development in Premature Infants

Ann Marie Nie1

  • 1Wound and Ostomy Nurse Practitioner and Pressure Injury Preventionist at Dayton Children's Hospital, Dayton, OH.

Advances in Skin & Wound Care
|July 20, 2026
PubMed

Insights

Premature infants face unique pressure injury (PI) risks, with medical devices causing most cases. Generalized edema and low hemoglobin are key risk factors, necessitating tailored prevention strategies focusing on device management.

Area of Science:

  • Neonatal care
  • Pediatric dermatology
  • Wound prevention

Background:

  • Premature infants are a vulnerable population with limited research on pressure injury (PI) development.
  • Understanding PI risk factors is crucial for effective prevention strategies in neonates.
  • This study addresses the understudied area of PI development in premature infants aged 24 to 37 weeks' gestation.

Purpose of the Study:

  • To identify and analyze the specific risk factors associated with pressure injury (PI) development in premature infants.
  • To differentiate PI risk factors in premature infants from those observed in adult and pediatric populations.
  • To inform the development of targeted prevention strategies for PIs in this population.

Main Methods:

  • A retrospective, observational, correlational study design was employed.
  • Data were collected from 799 PIs in hospitalized pediatric patients (April 2017-February 2020), including 130 PIs in 108 premature infants.
  • Stepwise multivariate logistic regression was used to analyze PI risk factors, comparing full-thickness vs. partial-thickness and immobility-related vs. medical device-related PIs (MDRPIs).

Main Results:

  • The majority of PIs (93%) in premature infants were medical device-related (MDRPIs).
  • Generalized edema was a significant risk factor for both full-thickness PIs (P = .033) and MDRPIs (P < .001).
  • Low hemoglobin (P = .006) and longer length of stay (LOS) (P = .009) were also significant risk factors for MDRPIs.

Conclusions:

  • Pressure injury risk factors in premature infants differ significantly from those in adults.
  • Prevention strategies must be individualized, acknowledging that MDRPIs are the predominant type of PI in this population.
  • Focusing on medical device management is paramount for effective PI prevention in premature infants.
Abstract

Keywords:
neonatespremature infantspressure injurypressure injury risk factors

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