Focus on Skin and Wounds in Neonates and Children
Notice bibliographique
Résumé
Managing wounds in neonates is different than in children or adults and deserves special considerations. Neonatal skin is physiologically and developmentally different, and some skin characteristics are dependent on gestational age.1 For example, skin barrier function increases with gestational age; the epidermis is mature by 34 weeks’ gestation, but preterm infants take 2 to 3 weeks longer to reach this maturity.2 The skin of preterm infants has less functionality and thus a higher risk of injury. Not only does skin development affect neonatal outcomes, but the wound causes are also unique. Pediatric specialists should consider several factors when called to assess a newborn with wounds. Evaluate if wounds are the result of skin fragility influenced by genetic disorders including epidermolysis bullosa or some types of ichthyosis. Consider facility-acquired pressure injury incidence and prevalence (as in this issue’s Open Access article on pressure injuries in the pediatric population by Delmore et al) and extrinsic factors such as medical devices.3,4 This evaluation may involve previous surgeries, immobility, sepsis, and other events. Finally, iatrogenic etiologies include chemical burns from antiseptics, access line extravasation injuries, or medical adhesive-related skin injury.5,6 Although institutional protocols for neonatal skin care vary, published guidelines address practices including bathing, moisturizing, umbilical cord handling, sterilization, and diapering7 and often include specific recommendations for preterm infants.8 However, there is limited guidance regarding the use of dressings. In this issue, Keswani et al provide a comprehensive review of wound care products for neonates. Both this CE/CME article and a recently published white paper3 provide important references for neonatal healthcare providers. Because many products exist with varying costs and availability, learn about product categories, know their properties, and anticipate possible scenarios in which a product category might be indicated. Formularies may guide practice, but choosing among products remains an important skill in need of development. Be familiar with atraumatic dressings and tapes, adhesive remover products, and the correct way to remove tape to help prevent injuries. Further, monitor neonates for possible complications including irritant or allergic contact dermatitis. Potential causes of irritant contact dermatitis include leakage of bodily fluids, as well as antiseptics, adhesives, occlusive topical ointments or creams, and some dressings. Another important consideration is the systemic absorption of topical medications.3 Adverse effects include silver-related leukopenia or argyria with silver sulfadiazine cream, aminoglycoside-related ototoxicity from gentamicin or neomycin, and iodine-induced thyroid disorders.9 Prilocaine-related methemoglobinemia from EMLA cream (Astra USA, Inc, Westborough, Massachusetts) can often be prevented; avoid formulation in infants less than 37 weeks’ gestational age and in children younger than 1 year who are on drugs that can induce methemoglobinemia.10 The need for topical medications should be considered carefully; adhere to the minimum required frequency and duration, in addition to limiting the area and amount of product being applied. If significant absorption is suspected, confirm the plasma concentration of the drug and promptly discontinue the offending agent. We hope you enjoy this focused issue supporting best practice care for your vulnerable neonatal and pediatric patients. Irene Lara-Corrales, MD, MSc Cathryn J. Sibbald, MD, MSc, FRCPC Elizabeth A. Ayello, PhD, MS, BSN, RN, CWON, ETN, MAPWCA, FAAN Gary R. Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JM
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».