Vol. 3 No. 1 (2024): at home is better

Investigation of the prevalence of skin injuries in hospitalized newborns and main reports: an observational, cross-sectional, and monocentric pilot study.

Biagio Nicolosi
Eustachio Parente
RN, MSc, Departmental Management of Health Professions, Meyer Children's Hospital IRCCS, Florence, Italy
Irene Marilli
RN, University of Florence, Florence, Italy
Ranieri Prisco
RN, Pediatric Intensive Care Unit, Meyer Children's Hospital IRCCS, Florence, Italy
Mirco Gregorini
RN, MSc, Head of Departmental Management of Health Professions, Meyer Children's Hospital IRCCS, Florence, Italy
Daniele Ciofi
RN, MSN, PhD, Research Manager, Department Health Professions, Meyer Children's Hospital IRCCS, Florence, Italy

Published 2024-03-31


  • Pressure Ulcers,
  • Injuries Prevalence,
  • Newborn,
  • Moisture Associated Skin Damage,
  • Neonatal Intensive Care Unit


The literature still offers few results on the prevention and treatment of neonatal skin lesions. However, it is important to note that available data show a high prevalence of injuries in newborns, especially in Neonatal Intensive Care Units. This prevalence, cross-sectional and pilot monocentric study aims to obtain updated epidemiological indicators on lesions in the hospitalized neonatal population. We analyzed a pilot cohort, randomizing a time window (November 2022). A data collection form (CRF) was designed in which information relating to the variables analyzed was collected, i.e. the child's medical history and a detailed inspection of the skin. This data was recorded in a database. A quantitative and descriptive analysis of the frequency of sociodemographic variables of all aggregated prevalence cut-off data was performed. During data analysis, correlations were made with respect to the type of lesions based on statistical significance (Fisher's exact).
The results of the study demonstrate that the lesions are the result of a combination of several factors, including: setting, intrinsic and extrinsic factors, pathology and methods of use of skin management. For a better understanding of this problem it is necessary to deepen the research, expanding the number of observation windows.


  1. de Bengy AF, Lamartine J, Sigaudo-Roussel D, Fromy B. Newborn and elderly skin: two fragile skins at higher
  2. risk of pressure injury. Biol Rev Camb Philos Soc. 2022; 97(3):874-895.
  3. García-Molina P., Balaguer-López E., García-Fernández F.P., Ferrera-Fernández et al. Pressure ulcers'
  4. incidence, preventive measures, and risk factors in neonatal intensive care and intermediate care units.
  5. Wiley IWJ. 2018; 15(4):571-579.
  6. Gefen A, Alves P, Ciprandi G, Coyer F. et a. Device-related pressure ulcers: SECURE prevention, J Wound
  7. Care. 2020; 29(Sup2a):S1-S52.
  8. Gefen A, Alves P, Ciprandi G, Coyer F. et a. Device-related pressure ulcers: SECURE prevention. Second
  9. edition. J Wound Care. 2022; 31(Sup3a):S1-S72.
  10. Beeckman D, Van den Bussche K, Alves P, Arnold Long MC, et al. Towards an international language for
  11. Incontinence-Associated Dermatitis (IAD): design and evaluation of psychometric properties of the Ghent
  12. Global IAD Categorisation Tool (GLOBIAD) in 30 countries. British Journal of Dermatology. 2018; 178(6):1131-
  13. Payne R, Martin M. The Epidemiology and management of skin tears in older adults. Ostomy Wound Manage
  14. ; 26(1):26-37.
  15. Payne RL, Martin MC. Defining and classifying skin tears: need for a common language. Ostomy Wound
  16. Manage 1993; 39(5):16-26.
  17. Visscher M, Taylor T. Pressure Ulcers in the Hospitalized Neonate: Rates and Risk Factors. Sci Rep. 2014;
  18. :7429.
  19. Huffines B, Logsdon MC. The neonatal skin risk assessment scale for predicting skin break-down in
  20. neonates. Issues Compr Pediatr Nurs. 1997; 20:103–14.
  21. McLane KM, Bookout K, McCord S, McCain J, Jefferson LS. The 2003 national pediatric pressure ulcer and
  22. skin breakdown prevalence survey: a multisite study. J Wound Ostomy Continence Nurs. 2004; 31(4):168-78.
  23. Kottner J, Wilborn D, Dassen T. Frequency of pressure ulcers in the pediatric population: A literature review
  24. and new empirical data. Int. Journal Nurse studies. 2010; 47:1330-40.
  25. Triantafyllou C, Chorianopoulou E, Eleni Kourkouni E, et al. Prevalance, incidence, lenght of stay and cost
  26. of healthcare-acquired pressure ulcers in pediatric populations: A systematic review and meta-analysis. Int.
  27. J Nurs Stud. 2021; 115:103843.
  28. Bliss DZ, Savik K, Harms S, et al. Prevalence and correlates of perineal dermatitis in nursing home residents.
  29. Nurs Res. 2006; 55(4): 243-51.
  30. Campbell JL, Coyer FM, Osborne SR. Incontinence-associated dermatitis: a cross-sectional prevalence
  31. study in the australian acute care hospital setting. Int Wound J. 2014.
  32. Borchert K, Bliss DZ, Savik K, et al. The incontinence-associated dermatitis and its severity instrument:
  33. development and validation. J WOCN. 2010; 37(5): 527-35.
  34. Bliss DZ, Zehrer C, Savik K, et al. An economic evaluation of four skin damage prevention regimens in
  35. nursing home residents with incontinence. J WOCN. 2007; 34(2): 143-52.
  36. Long M, Reed L, Dunning K, Ying J. Incontience-associated dermatitis in a long-term acute care facility. J
  37. WOCN. 2012; 39(3): 318-27.
  38. Baharestani M.M., Ratliff C.R., Pressure ulcers in neonates and children: an NPUAP white paper, Adv Skin
  39. Wound Care, 2007, 20(4):208-220.
  40. Dixon M, Ratliff C. Pediatric pressure ulcer prevalence--one hospital's experience. Ostomy Wound Manage.
  41. ; 51(6):44-6, 48-50.
  42. Bernabe KQ, Pressure ulcers in the pediatric patient. Curr Opin Pediatr. 2012; 24(3):352-6.
  43. King A, Stellar JJ, Blevins A, Shah KN. Dressings and Products in Pediatric Wound Care. Adv Wound Care
  44. (New Rochelle). 2014; 3(4): 324–334.
  45. Fujii K, Sugama J, Okuwa M, Sanada H, Mizokami Y. Incidence and risk factors of pressure ulcers in seven
  46. neonatal intensive care units in Japan: a multisite prospective cohort study. Int Wound J. 2010; 7:323–328.
  47. Gardiner JC, Reed PL, Bonner JD et al. Incidence of hospital-acquired pressure ulcers: a population-based
  48. cohort study. Int Wound J. 2016; 13(5):809–20
  49. Coleman S, Gorecki C, Nelson EA, et al. Patient risk factors for pressure ulcer development: systematic
  50. review. Int J Nurs Stud. 2013; 50(7):974–1003.
  51. Gefen A, Brienza DM, Cuddigan J, et al. Our contemporary understanding of the aetiology of pressure ulcers/
  52. pressure injuries. Int Wound J. 2021 (online ahead of print).
  53. Gefen A. The aetiology of medical device-related pressure ulcers and how to prevent them. Br J Nurs. 2021;
  54. (15):S24–30.
  55. Linder-Ganz E, Gefen A. The effects of pressure and shear on capillary closure in the microstructure of
  56. skeletal muscles. Ann Biomed Eng. 2007; 35(12):2095–107.
  57. Pieper, B., Pressure ulcers: Impact, etiology, and classification. Wound Management 2010. https://tinyurl.
  58. com/wvwkjnh (accessed January 2022)
  59. Soetens JFJ, Worsley PR, Bader DL, et al. Investigating the influence of intermittent and continuous
  60. mechanical loading on skin through non- invasive sampling of IL-1alpha. J Tissue Viability. 2019; 28(1):1–6.
  61. Hemmes B, de Wert LA, Brink PRG, et al. Cytokine IL1alpha and lactate as markers for tissue damage in
  62. spineboard immobilisation. A prospective, randomised open-label crossover trial. J Mech Behav Biomed
  63. Mater. 2017; 75:82–8.
  64. Lustig A, Margi R, Orlov A, et al. The mechanobiology theory of the development of medical device-
  65. related pressure ulcers revealed through a cell-scale computational modeling framework. Biomech Model
  66. Mechanobiol. 2021; 20(3):851–60.
  67. Bhidayasiri R, Sringean J, Thanawattano C. Sensor-based evaluation and treatment of nocturnal hypokinesia
  68. in Parkinson’s disease: an evidence- based review. Parkinsonism Relat Disord. 2016; 22 Suppl 1:S127-133.
  69. Hilz MJ, Claus D, Druschky KF, et al. Air fluidization therapy of pressure sores due to Guillain-Barré and
  70. Cushing syndrome. Intensive Care Med. 1992; 18(1):62–3.
  71. Harms M. Inpatient management of guillain-barré syndrome. Neurohospitalist. 2011; 1(2):78–84.
  72. Leyva-Mendivil MF, Lengiewicz J, Limbert G. Skin friction under pressure: the role of micromechanics. Surf
  73. Topogr: Metrol Prop. 2018; 6(1):014001.
  74. Gerhardt L-C, Strässle V, Lenz A, et al. Influence of epidermal hydration on the friction of human skin
  75. against textiles. J R Soc Interface. 2008; 5(28):1317–28.
  76. Sprigle S, Caminiti R, Varenberg M. Friction characteristics of preventative wound dressings under clinically
  77. relevant conditions. Wound Repair Regen. 2021; 29(2):280–3.
  78. Dealey C, Brindle CT, Black J et al. Challenges in pressure ulcer prevention. Int Wound J. 2015; 12(3):309–12.
  79. https://doi.org/10.1111/iwj.12107
  80. Baharestani M, Black J, Carville K, et al. International review. Pressure ulcer prevention pressure shear
  81. friction and microclimate in context. Wounds International 2010. https://tinyurl.com/y8m65fap (accessed
  82. January 2022)
  83. Doughty d, Junkin J, Kurz P, et al. Incontinence-associated dermatitis. consensus statements, evidence-
  84. based guidelines for prevention and treatment, current challenges. J WOCN. 2012; 39(3): 303-15.
  85. Black JM, Gray M, Bliss DZ, et al. MASD Part 2: Incontinence-associated dermatitis and intertriginous
  86. dermatitis. J WOCN. 2011; 38(4): 359-70.
  87. Paediatric Incontinence Associated Dermatitis: Canadian Best Practice Recommendations. Nurses
  88. Specialized in Wound, Ostomy and Continence Canada. (1st ed.). 2023.
  89. Ichikawa-Shiegeta Y, Sugama J, Sanada H, et al. Physiological and appearance characteristics of skin
  90. maceration in elderly women with incontinence. J Wound Care. 2014; 23(1):18-30.
  91. Gray M, Beeckman D, Bliss DZ, et al. Incontinence-associated dermatitis: a comprehensive review and
  92. update. J WOCN. 2012; 39(1): 61-74.
  93. Gray M, Bliss DZ, Ermer-Sulten J, et al. Incontinence associated dermatitis: a consensus. J WOCN. 2007;
  94. (1): 45-54.
  95. Shigeta Y, Nakagami G, Sanada H, et al. Exploring the relationship between skin property and absorbent pad
  96. environment. J Clin Nurs. 2009; 18(11): 1607-16.
  97. Erssers J,Getliffe K,Voegeli D,Regan S. Acritical view of th einter-relationship between skin vulnerability and
  98. urinary incontinence and related nursing intervention. Int J Nurs Stud. 2005; 42: 823-35.
  99. Shiu SR, Hsu MY, Chang SC, et al. Prevalence and predicting factors of incontinence-associated dermatitis
  100. among intensive care patients. J Nurs Healthcare Res. 2013; 9(3): 210.
  101. Langemo D,Hanson D,Hunter S, et al. Incontinence and incontinence-associated dermatitis. Adv Skin
  102. Wound Care. 2011; 24(3): 126-40.
  103. Zehrer CL, Newman DK, Grove GL, Lutz JB. Assessment of diaper-clogging potential of petrolatum moisture
  104. barriers. Ostomy Wound Manage. 2005; 51(12): 54-58.
  105. Beeckman D, Schoonhoven L, Verhaeghe S, et al. Prevention and treatment of incontinence-associated
  106. dermatitis: literature review. J Adv Nurs. 2009; 65(6): 1141-54.
  107. Beeckman D, Verhaeghe S, Defloor T, et al. A 3-in-1 perineal care washcloth impregnated with dimethicone
  108. % versus water and pH neutral soap to prevent and treat incontinence-associated dermatitis. J WOCN.
  109. ; 38(6): 627-34.