How do nurses provide moisture management to prevent pressure injuries in neonatal patient populations? Somethings old and somethings new…

Neonates and Pressure Injuries

Neonates are widely known as a vulnerable patient population—especially critically ill and premature infants.¹ This vulnerability has limited clinicians’ knowledge of moisture management products in the neonatal population that prevent pressure injuries. Recently, a survey of neonatal nurses from across the United States was conducted to find out what is being used for moisture management.² This study was designed as a cross-sectional survey with a convenience sample of neonatal intensive care unit (NICU) nurses.

A survey link was distributed electronically through websites, listservs, discussion boards, and newsletters to the National Association of Neonatal Nurses (NANN), the Academy of Neonatal Nurses (AAN), and WoundSource. There were 252 NICU nurses who completed the survey. Of the 252 responders, 251 had over 1 year of experience as an NICU nurse, 82% (n = 207/252) had greater than 5 years of experience, 41% (n = 103/252) worked in a level III NICU, and 56% (n = 141/252) worked in a level IV NICU.²

Neonatal Nurse Survey Results

Most participants, 69% (n = 173/252), reported that they used moisture management, 22% (n = 55/252) did not use moisture management, and 10% (n = 24/252) responded “maybe.” Moisture management was reported for the following sites: perineum, 17% (n = 43/252); buttocks area, 17% (n = 44/252); skin folds, 11% (n = 27/252); around medical devices, 10% (n = 25/252); and “other,” 22% (n = 55/252). The frequency of moisture management reported by participants was “always” in 54% (n = 135/252), “usually” in 17% (n = 44/252), “sometimes” in 16% (n = 39/252), and “never” in 12% (n = 31/252).²

The most frequently used moisture barrier products were petrolatum-based products (Vaseline, Unilever, London, UK) and stoma powders (Stomahesive powder, ConvaTec, Bridgewater, NJ), followed by Aquaphor Healing Ointment (Beiersdorf Inc, Hamburg, Germany) and Phytoplex Z-Guard Protectant Paste (Medline, Mundelein, IL). Various other barrier products such as wipes and creams were identified (some were identified only by the manufacturer’s name).

In addition, other powders, such as nystatin powder, were used in skin folds and creases. Future studies are needed to determine the use of moisture management strategies in response to the possibility of pressure injuries in the neonatal population. Neonatal skin is different, even within its own population, because of variation in skin development and prematurity. Interestingly, petroleum-based products and stoma powders have been used for a long time. Newer products may not have been reported because neonates absorb products through their skin, and there are limitations on evidence to support use in this vulnerable population.

References

1. Razmus I, Lewis L, Wilson D. Pressure ulcer development in infants: state of the science. J Healthc Qual. 2008;30(5):36-42.

2. Razmus I, Keep S. Neonatal intensive care nursing pressure injury prevention practices: a descriptive survey. J Wound Ostomy Continence Nurs. 2021;48(5):394-402.

About the Author

Ivy Razmus, RN, PhD, CWOCN is an Assistant Professor at the University of Detroit Mercy where she is currently teaching in the BSN Nursing program. Her research focus is on pressure injury prevention for pediatric patients including neonatal patients. She has experience as a Manager of Pediatric populations both neonatal and pediatric intensive care; as a quality analyst within a health system focusing on nursing sensitive quality indicators and root cause analysis; and as a CWOCN in the acute, critical and outpatient settings in the adult population.