World Journal of Pediatrics

, Volume 13, Issue 2, pp 165–172 | Cite as

Lesions requiring wound management in a central tertiary neonatal intensive care unit

  • Angéla Meszes
  • Gyula Tálosi
  • Krisztina Máder
  • Hajnalka Orvos
  • Lajos Kemény
  • Zsanett Renáta Csoma
Original Article



Most of the skin disorders that occur in neonatal intensive care units are due in part to the immaturity and vulnerability of the neonatal skin. Various iatrogenic diagnostic and therapeutic procedures are also conducive to iatrogenic damage. This study was to review the neonates admitted to our neonatal intensive care unit who needed wound management, and to assess the most common skin injuries and wounds, and their aetiology.


Data were extracted from medical records of neonates who needed wound management in our Neonatal Intensive Care Unit between January 31, 2012 and January 31, 2013. Information about gestational age, sex, birth weight, area of involvement, wound aetiology, and therapy were collected.


Among the 211 neonates observed, wound management was required in 10 cases of diaper dermatitis, 7 epidermal stripping, 6 extravasation injuries, 5 pressure ulcers, 1 surgical wound and infection, 1 thermal burn, and 5 other lesions.


International guidelines in neonatal wound care practice are not available, and further research concerns are clearly needed. Dressings and antiseptic agents should be chosen with great care for application to neonates, with particular attention to the prevention of adverse events in this sensitive population. Team work among dermatologists, neonatologists and nurses is crucial for the successful treatment of neonates.

Key words

epidermal stripping extravasation injury neonatal intensive care unit surgical wound wound care in neonates 


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  1. 1.
    Rolfe KJ, Grobbelaar AO. A review of fetal scarless healing. ISRN Dermatol 2012;2012:698034.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Costa S, De Carolis MP, Fusco FP, Savarese I, Tesfagabir MG, Romagnoli C. Skin ulceration in a preterm infant: a warning sign of a percutaneous long line complication. Arch Dermatol 2011;147:512–514.CrossRefPubMedGoogle Scholar
  3. 3.
    Darmstadt GL, Dinulos JG. Neonatal skin care. Pediatr Clin North Am 2000;47:757–782.CrossRefPubMedGoogle Scholar
  4. 4.
    Lund C, Kuller J, Lane A, Lott JW, Raines DA. Neonatal skin care: the scientific basis for practice. J Obstet Gynecol Neonatal Nurs 1999;28:241–254.CrossRefPubMedGoogle Scholar
  5. 5.
    Irving V, Bethell E, Burton F, on behalf of a Neonatal Advisory Group. Neonatal wound care: minimising trauma and pain. Wound 2006;2:33–41.Google Scholar
  6. 6.
    Noonan C, Quigley S, Curley MA. Skin integrity in hospitalized infants and children: a prevalence survey. J Pediatr Nurs 2006;21:445–453.CrossRefPubMedGoogle Scholar
  7. 7.
    Lyon VB. Approach to procedures in neonates. Dermatol Ther 2005;18:117–123.CrossRefPubMedGoogle Scholar
  8. 8.
    Irving V. Skin problems in the pre-term infant: avoiding ritualistic practice. Prof Nurse 2001;17:63–66.PubMedGoogle Scholar
  9. 9.
    Afsar FS. Skin care for preterm and term neonates. Clin Exp Dermatol 2009;34:855–858.CrossRefPubMedGoogle Scholar
  10. 10.
    Tobin C. Managing an extravastion wound in a premature infant. Wounds International 2007;3:90–91.Google Scholar
  11. 11.
    Liverpool Womens NHS Foundation Trust, 2011. www. Account_20112012.pdf (accessed January 1, 2013).Google Scholar
  12. 12.
    Rutter N. The immature skin. Eur J Pediatr 1996;155 Suppl 2:S18–S20.CrossRefPubMedGoogle Scholar
  13. 13.
    Hardwicke J, Richards H, Jagadeesan J, Jones T, Lester R. Topical negative pressure for the treatment of neonatal poststernotomy wound dehiscence. Ann R Coll Surg Engl 2012;94:e33–e35.CrossRefPubMedGoogle Scholar
  14. 14.
    Rutter N. The dermis. Semin Neonatol 2000;5:297–302.CrossRefPubMedGoogle Scholar
  15. 15.
    LeFevre A, Shillcutt SD, Saha SK, Ahmed AS, Ahmed S, Chowdhury MA, et al. Cost-effectiveness of skin-barrierenhancing emollients among preterm infants in Bangladesh. Bull World Health Organ 2010;88:104–112.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Baharestani MM. An overview of neonatal and pediatric wound care knowledge and considerations. Ostomy Wound Manage 2007;53:34–6, 38, 40, passim.PubMedGoogle Scholar
  17. 17.
    Kugelman A, Inbar-Sanado E, Shinwell ES, Makhoul IR, Leshem M, Zangen S, et al. Iatrogenesis in neonatal intensive care units: observational and interventional, prospective, multicenter study. Pediatrics 2008;122:550–555.CrossRefPubMedGoogle Scholar
  18. 18.
    Metzker A, Brenner S, Merlob P. Iatrogenic cutaneous injuries in the neonate. Arch Dermatol 1999;135:697–703.CrossRefPubMedGoogle Scholar
  19. 19.
    Sekar KC. Iatrogenic complications in the neonatal intensive care unit. J Perinatol 2010;30 Suppl:S51–S56.CrossRefPubMedGoogle Scholar
  20. 20.
    Sardesai SR, Kornacka MK, Walas W, Ramanathan R. Iatrogenic skin injury in the neonatal intensive care unit. J Matern Fetal Neonatal Med 2011;24:197–203.CrossRefPubMedGoogle Scholar
  21. 21.
    Ligi I, Arnaud F, Jouve E, Tardieu S, Sambuc R, Simeoni U. Iatrogenic events in admitted neonates: a prospective cohort study. Lancet 2008;371:404–410.CrossRefPubMedGoogle Scholar
  22. 22.
    Hogeling M, Fardin SR, Frieden IJ, Wargon O. Forehead pressure necrosis in neonates following continuous positive airway pressure. Pediatr Dermatol 2012;29:45–48.CrossRefPubMedGoogle Scholar
  23. 23.
    Csoma Z, Meszes A, Mader K, Kemeny L, Talosi G. Overview of dermatologic disorders of neonates in a central regional intensive care unit in Hungary. Pediatr Dermatol 2015;32:201–207.CrossRefPubMedGoogle Scholar
  24. 24.
    Irving V. Wound care for preterm neonates. J Neonat Nursing 2006;2:102–106.Google Scholar
  25. 25.
    Lund CH, Osborne JW, Kuller J, Lane AT, Lott JW, Raines DA. Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Association of Women’s Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. J Obstet Gynecol Neonatal Nurs 2001;30:41–51.CrossRefPubMedGoogle Scholar
  26. 26.
    National Guideline Clearinghouse (NGC). Neonatal skin care, second edition. Evidence-based clinical practice guideline. Association of Women’s Health, Obstetric and Neonatal Nurses AWHONN, 2007. Rockville MD: Agency for Healthcare Research and Quality (AHRQ). 2007.Google Scholar
  27. 27.
    Kumar RJ, Pegg SP, Kimble RM. Management of extravasation injuries. ANZ J Surg 2001;71:285–289.CrossRefPubMedGoogle Scholar
  28. 28.
    Wilkins CE, Emmerson AJ. Extravasation injuries on regional neonatal units. Arch Dis Child Fetal Neonatal Ed 2004;89:F274–F275.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Tiraboschi IC, Niveyro C, Mandarano AM, Messer SA, Bogdanowicz E, Kurlat I, et al. Congenital candidiasis: confirmation of mother-neonate transmission using molecular analysis techniques. Med Mycol 2010;48:177–181.CrossRefPubMedGoogle Scholar
  30. 30.
    Reynolds BC. Neonatal extravasation injury: case report. Infant 2007;3:230–232.Google Scholar
  31. 31.
    Cho KY, Lee SJ, Burm JS, Park EA. Successful combined treatment with total parenteral nutrition fluid extravasation injuries in preterm infants. J Korean Med Sci 2007;22:588–594.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Hirsch B, Grunbaum M, Wagner F, Bi Y, Lucka L, Du MQ, et al. A novel A20 (TNFAIP3) antibody (Ber-A20) can be used to detect unmutated A20 by immunohistology. Histopathology 2012;60:e19-E27.CrossRefGoogle Scholar
  33. 33.
    Fujii K, Sugama J, Okuwa M, Sanada H, Mizokami Y. Incidence and risk factors of pressure ulcers in seven neonatal intensive care units in Japan: a multisite prospective cohort study. Int Wound J 2010;7:323–328.CrossRefPubMedGoogle Scholar
  34. 34.
    Fischer C, Bertelle V, Hohlfeld J, Forcada-Guex M, Stadelmann-Diaw C, Tolsa JF. Nasal trauma due to continuous positive airway pressure in neonates. Arch Dis Child Fetal Neonatal Ed 2010;95:F447–F451.CrossRefPubMedGoogle Scholar
  35. 35.
    Rimdeika R, Bagdonas R. Major full thickness skin burn injuries in premature neonate twins. Burns 2005;31:76–84.CrossRefPubMedGoogle Scholar
  36. 36.
    Cartlidge PH, Fox PE, Rutter N. The scars of newborn intensive care. Early Hum Dev 1990;21:1–10.CrossRefPubMedGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Angéla Meszes
    • 1
    • 5
  • Gyula Tálosi
    • 2
  • Krisztina Máder
    • 2
  • Hajnalka Orvos
    • 3
  • Lajos Kemény
    • 1
    • 4
  • Zsanett Renáta Csoma
    • 1
  1. 1.Department of Dermatology and AllergologyUniversity of SzegedSzegedHungary
  2. 2.Department of PediatricsUniversity of SzegedSzegedHungary
  3. 3.Department of Obstetrics and GynecologyUniversity of SzegedSzegedHungary
  4. 4.MTA-SZTE Dermatological Research GroupSzegedHungary
  5. 5.SzegedHungary

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