Csoma Zsanett Renáta, Meszes Angéla, Ábrahám Rita, Kemény Lajos, Tálosi Gyula, Doró Péter
Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.
MTA-SZTE Dermatological Research Group, Szeged, Hungary.
Pediatr Dermatol. 2016 Sep;33(5):543-8. doi: 10.1111/pde.12960.
BACKGROUND/OBJECTIVES: Recent technological advances and diagnostic and therapeutic innovations have resulted in an impressive improvement in the survival of newborn infants requiring intensive care. Consequently, with the use of modern invasive diagnostic and therapeutic procedures, the incidence of iatrogenic events has also increased. The aim of this study was to assess various iatrogenic complications in neonates requiring intensive care and determine possible contributing factors to the injuries.
Our prospective cross-sectional cohort survey was conducted in a central regional level III neonatal intensive care unit (NICU). Correlations between intensive therapeutic interventions, complications, factors influencing attendance and prognosis, and the prevalence of iatrogenic skin injuries (ISIs) were investigated over a 2-year study period.
Between January 31, 2012, and January 31, 2014, 460 neonates were admitted to the NICU, 83 of whom exhibited some kind of ISI. The major risk factors for ISIs were low birthweight, young gestational age, long NICU stay, use of the intubation-surfactant-extubation (INSURE) technique, surfactant use, mechanical ventilation, insertion of an umbilical arterial catheter, circulatory and cardiac support with dopamine or dobutamine, pulmonary hemorrhage, intracranial hemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia, and positive microbiology culture results.
To prevent ISIs, careful consideration of risk factors and the creation of protocols ensuring efficient treatment of injuries are needed.
背景/目的:近期的技术进步以及诊断和治疗方面的创新使得需要重症监护的新生儿存活率有了显著提高。因此,随着现代侵入性诊断和治疗程序的使用,医源性事件的发生率也有所增加。本研究的目的是评估需要重症监护的新生儿中的各种医源性并发症,并确定导致这些损伤的可能因素。
我们在一家中心区域三级新生儿重症监护病房(NICU)进行了前瞻性横断面队列研究。在为期2年的研究期间,调查了强化治疗干预、并发症、影响就诊和预后的因素以及医源性皮肤损伤(ISI)的发生率之间的相关性。
在2012年1月31日至2014年1月31日期间,460名新生儿入住NICU,其中83名出现了某种ISI。ISI的主要危险因素包括低出生体重、孕周小、在NICU住院时间长、使用插管-表面活性剂-拔管(INSURE)技术、使用表面活性剂、机械通气、插入脐动脉导管、使用多巴胺或多巴酚丁胺进行循环和心脏支持、肺出血、颅内出血、动脉导管未闭、支气管肺发育不良以及微生物培养结果呈阳性。
为预防ISI,需要仔细考虑危险因素并制定确保有效治疗损伤的方案。