Beyond the Skin: Risk Factors of Pressure Injury Development in Premature Infants.

Abstract

OBJECTIVE: Premature infants are understudied in relation to pressure injury (PI) development. Prevention of PIs relies on understanding PI risk factors. Research was conducted to determine PI risk factors for premature infants aged 24 to 37 weeks' gestation. METHODS: A retrospective, observational, correlational study was conducted that included 799 PIs that developed in hospitalized pediatric patients between April 2017 and February 2020. This study included 108 premature infants who developed 130 PIs. Adult and pediatric PI risk factors were utilized for a stepwise multivariate logistic regression model. RESULTS: Analysis revealed that 30 (23%) full-thickness and 100 (77%) partial-thickness PIs were present. Nine (7%) immobility-related PIs and 121 (93%) medical device-related PIs (MDRPI) were noted. Two logistic regression models were performed: full-thickness versus partial-thickness and immobility-related PI versus MDRPIs. The results of the full-thickness versus partial-thickness PIs analysis noted that generalized edema was statistically significant (P = .033; 95% CI, 1.793 to 10.097). The analysis for immobility-related PI versus MDRPI noted significance for low hemoglobin (P = .006; 95% CI, 2.346 to 167.585) and generalized edema (P < .001; 95% CI, 3.542 to 68.320). Length of stay (LOS) was significant for the development of MDRPI: LOS [F = 3.183; t = -.2.669 (df = 128); P = .009; mean difference, -.390; SE, .146; 95% CI, -0.679 to 0.101]. CONCLUSIONS: Pressure injury risk factors for premature infants differ from adult risk factors. Prevention measures should be tailored to risk factors while understanding that 93% of PIs in premature infants are medical device-related. Pressure injury prevention measures should focus on medical devices. GENERAL PURPOSE: To understand risk factors of pressure injury (PI) development in premature infants. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will: Evaluate limitations and evidence gaps in the current literature on PI risk factors and prevention strategies in premature infants.Analyze the research methods and study findings used to identify risk factors associated with the development of PIs in premature infants.Apply study findings related to PI incidence and associated risk factors to inform PI prevention strategies in premature infants.