Ly C
Université Pierre-et-Marie-Curie, site Saint-Antoine, 27, rue de Chaligny, 75012 Paris, France.
Arch Pediatr. 2017 Sep;24(9):884-893. doi: 10.1016/j.arcped.2017.06.011. Epub 2017 Aug 16.
Infiltration and extravasation account for 23-78 % of the complications stemming from peripheral venous perfusions in neonatal intensive care units. Their consequences, sometimes dramatic, can be pain, infections, or even loss of skin, which can lead to nerve and/or muscle damage, particularly severe for preterm neonates. Today there are no recommendations on the care of these lesions, which can lead to an erroneous choice or to a delay in the possible treatments.
This review of the literature aims to explore and propose elements of therapeutic care collected in the scientific literature. It focuses on skin lesions due to extravasation of peripheral venous perfusions in neonatal intensive care units.
The PubMed database and the publishers' platform ScienceDirect were used. The bibliographies of the selected articles were also run. All types of studies examining one or several treatments for the care of postextravasation skin lesions in neonatal intensive care units were included in the search, without any limit on the date, except for case reports. To estimate the quality of the studies, the tool proposed by the French National Authority for Health, which classifies the various types of studies according to their proof level, was used.
RESULTS/DISCUSSION: Thirteen publications were analyzed, including four case series, five retrospective studies, and four interventional studies. The vast majority of these studies have been published since 2005. No comparative, controlled, and randomized trials appear in the literature. Chronologically, we observed a growing interest in the premature infant population, in parallel with the increasing number of publications. Among the significant number of treatments proposed, five main categories were identified: topical treatment, surgery, the Gault method, no specific treatment, and others. All the skin lesions of the babies studied healed, without important aftereffects. These publications also show that most of the time a combination of different types of treatment is used depending on the lesions' progress and doctor's assessment. Few differences are made between term neonates and premature neonates in the choice of treatment. All these types of care can be applied to both populations. In spite of the lack of consensus on the care to be adopted, all the authors emphasize the important role of prevention according to the official regulations.
The total absence of studies with a sufficient level of proof does not allow, at this time, the elaboration of guidelines for the care of these lesions. However, the proposals made in the literature seem promising. Therefore, it would be wise to conduct randomized trials on relatively large samples to compare these various types of treatment.
在新生儿重症监护病房中，外周静脉灌注引发的并发症里，渗漏和外渗占23%-78%。其后果有时很严重，可能会导致疼痛、感染，甚至皮肤坏死，进而可能造成神经和/或肌肉损伤，这对早产儿尤为严重。目前对于这些损伤的护理尚无相关建议，这可能导致错误的选择或延误可能的治疗。
本文献综述旨在探索并提出科学文献中收集到的治疗护理要点。重点关注新生儿重症监护病房中外周静脉灌注外渗导致的皮肤损伤。
使用了PubMed数据库和出版商平台ScienceDirect。还查阅了所选文章的参考文献。搜索纳入了所有研究新生儿重症监护病房中外渗后皮肤损伤一种或多种治疗方法的各类研究，除病例报告外，对日期无任何限制。为评估研究质量，使用了法国国家卫生管理局提出的工具，该工具根据证据水平对各类研究进行分类。
结果/讨论：分析了13篇出版物，包括4个病例系列、5项回顾性研究和4项干预性研究。这些研究绝大多数自2005年以来发表。文献中未出现比较、对照和随机试验。按时间顺序，我们观察到随着出版物数量的增加，对早产儿群体的兴趣也在增加。在提出的大量治疗方法中，确定了五个主要类别：局部治疗、手术、高尔特方法、无特殊治疗及其他。所研究婴儿的所有皮肤损伤均愈合，无严重后遗症。这些出版物还表明，大多数情况下，会根据损伤进展和医生评估采用不同类型治疗方法的组合。足月儿和早产儿在治疗选择上差异不大。所有这些护理类型均可应用于这两类人群。尽管在应采用的护理方面缺乏共识，但所有作者都强调了按照官方规定进行预防的重要作用。
目前尚无足够证据水平的研究，因此此时无法制定这些损伤的护理指南。然而，文献中提出的建议似乎很有前景。因此，对相对大的样本进行随机试验以比较这些不同类型的治疗方法是明智的。
