A Study of Pathological and Iatrogenic Skin Conditions in Babies of the Neonatal Intensive Care Unit in a Tertiary Care Centre
A Study of Pathological and Iatrogenic Skin Conditions in Babies of the Neonatal Intensive Care Unit in a Tertiary Care Centre
Author(s):Dr Amrita S
Received: 2020-04-12
Accepted: 2020-05-09
Published: 2020-05-25
Abstract
Background: Neonatal skin is structurally and functionally immature, particularly in preterm infants, making babies in the neonatal intensive care unit (NICU) highly vulnerable to both intrinsic (pathological) skin disease and extrinsic (iatrogenic) skin injury arising from life-saving diagnostic and therapeutic procedures.
Objectives: To determine the pattern and frequency of pathological and iatrogenic skin conditions in neonates admitted to the NICU of a tertiary care centre, and to assess their association with gestational age and birth weight.
Methods: A prospective, observational study was carried out over 12 months in the NICU of a tertiary care hospital. Three hundred consecutively admitted neonates underwent complete cutaneous examination by a dermatologist at admission and at regular intervals during their stay. Lesions were classified as pathological (infective or non-infective disease) or iatrogenic (procedure-related). Relevant investigations were performed where indicated. Data were analysed using descriptive statistics and the chi-square/Fisher exact test.
Results: Of 300 neonates, a substantial proportion had at least one pathological and/or iatrogenic skin condition. Iatrogenic lesions were more frequent than pathological ones, with needle-prick/venepuncture marks being the commonest, followed by diaper dermatitis, medical adhesive-related skin injury, and extravasation injury. Among pathological conditions, cutaneous and oral candidiasis and bacterial pyoderma predominated. Iatrogenic injuries were significantly more common in preterm and very-low-birth-weight neonates (P < 0.001).
Conclusion: Pathological and, especially, iatrogenic skin conditions are common in NICU neonates, with prematurity and low birth weight being major risk factors. Many iatrogenic injuries are preventable through protocol-based neonatal skin care, underscoring the value of dermatologist–neonatologist collaboration.
Objectives: To determine the pattern and frequency of pathological and iatrogenic skin conditions in neonates admitted to the NICU of a tertiary care centre, and to assess their association with gestational age and birth weight.
Methods: A prospective, observational study was carried out over 12 months in the NICU of a tertiary care hospital. Three hundred consecutively admitted neonates underwent complete cutaneous examination by a dermatologist at admission and at regular intervals during their stay. Lesions were classified as pathological (infective or non-infective disease) or iatrogenic (procedure-related). Relevant investigations were performed where indicated. Data were analysed using descriptive statistics and the chi-square/Fisher exact test.
Results: Of 300 neonates, a substantial proportion had at least one pathological and/or iatrogenic skin condition. Iatrogenic lesions were more frequent than pathological ones, with needle-prick/venepuncture marks being the commonest, followed by diaper dermatitis, medical adhesive-related skin injury, and extravasation injury. Among pathological conditions, cutaneous and oral candidiasis and bacterial pyoderma predominated. Iatrogenic injuries were significantly more common in preterm and very-low-birth-weight neonates (P < 0.001).
Conclusion: Pathological and, especially, iatrogenic skin conditions are common in NICU neonates, with prematurity and low birth weight being major risk factors. Many iatrogenic injuries are preventable through protocol-based neonatal skin care, underscoring the value of dermatologist–neonatologist collaboration.
Keywords: neonate; neonatal intensive care unit; iatrogenic skin injury; neonatal dermatoses; prematurity; skin barrier
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