by Matthew Regulski, DPM
By Hy-Tape International, Inc.
Infants pose a major challenge for wound care professionals. Because neonatal skin is immature and thin compared with adult skin, it is more easily damaged and requires greater care.1 This makes it critical that health care professionals follow specialized best practices when caring for neonatal wounds to minimize skin damage and ensure optimal outcomes for patients.1,2
Challenges of Neonatal Skin and Wound Care
Neonatal skin presents several unique challenges that make wound care more difficult. Skin has only fully developed at the 34th week of gestation, meaning that the skin of newborn infants is immature and much weaker than the skin of older children or adults. The dermis of neonatal infants may have less collagen and elastin fibers than that of an adult or older child, thus increasing the risk for edema, pressure injuries, and other tissue injuries.1-3
This problem is exacerbated in premature infants, whose skin may not be fully developed. In full-term infants, the outermost layer of the skin (stratum corneum) is between 10 and 20 layers thick; however, in premature infants, it may be less than two layers thick. This means that the skin is much more easily damaged, and critical functions, such as control of transepidermal water loss and prevention of absorption of toxic substances, may be compromised.3
Best Practices for Preventing Skin Injury
Identify At-Risk Patients – A wound care patient is inherently at greater risk of skin injury than a patient without a wound. Many skin injuries are caused by the application or removal of wound dressings or medical equipment. Neonates who are acutely ill are at an even greater risk. Infants born at less than 32 weeks are at extremely high risk for developing pressure injuries and other tissue injuries. It is essential that health care professionals take extra precautions with these at-risk individuals and regularly screen them for skin damage.
Identify Early Signs of Skin Damage – It is critical that health care professionals recognize when neonatal patients have early erythema because skin damage can progress much more quickly to pressure injuries or other more serious injuries when compared with adults. Reddening, temperature differences, or pain can all be early signs that patients are at risk of skin damage. This can lead to partial- and full-thickness loss in the dermis and result in serious wounds. To prevent these issues, it is essential that health care professionals address skin damage early on.3
Regularly Cleanse and Reposition – Cleansing the wound area is important for preventing skin irritation and damage from wound effluent or incontinence. Dead tissue and foreign debris should be regularly debrided to prevent the growth of pathogenic organisms, and sterile saline solution should be used to cleanse the wound area. Wound areas that are subject to pressure or friction should also be positioned to prevent the formation of pressure ulcers.2
The Importance of Secure Wound Dressings and Gentle Adhesion – One of the most common causes of skin injury in neonates is medical adhesive. Weak neonatal skin can be irritated or damaged by harsh or excessively strong adhesives. This makes it critical that health care professionals use a gentle medical adhesive with infants. It is also important that the adhesive be secure and waterproof, to prevent incontinence or other foreign debris from reaching the wound area.2
Neonatal skin is immature and thin, is more easily damaged than adult skin, and requires special care to prevent skin injury. Injury prevention includes risk identification, monitoring for early signs of skin damage, regular cleansing and repositioning, and the use of an appropriate medical adhesive to secure dressings.
1. Fox MD. Wound care in the neonatal intensive care unit. Neonatal Netw. 2011;30(5):291–303.
2. Baharestani MM. An overview of neonatal and pediatric wound care knowledge and considerations. Ostomy Wound Manage. 2007;53(6):34–6, 38, 40, passim.
3. Amaya R. Challenges in the Neonatal/Pediatric Wound Care Arena. cine-med.com/apwca/agenda/presentations/gsf3_neonatal_pediatric_wound_care.pdf. Accessed on March 12, 2019.
About the Company
Hy-Tape International offers high-quality adhesive tape and has served the market for over 70 years. Tapes are available in strips, patches, and kit rolls giving health care providers a wide range of options for securing dressings and devices. Free product samples are available at www.hytape.com or by calling 1-800-248-0201.
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