Predicting Neonatal Skin Injury: The First Step to Reducing Skin Injuries in Neonates

BACKGROUND: Skin injuries remain common in neonates admitted to neonatal intensive care units. While predicting neonates at risk of skin-injury may assist in reducing the incidence of injury, currently there is limited evidence on which tool may be superior.METHODS: A prospective study was completed during November-December 2016 to evaluate the predictive value of the Skin Risk Assessment and Management Tool (SRAMT). Comparisons were made between SRAMT and Neonatal/Infant Braden-Q Scale (BQS) as well as staff's capacity to predict a neonate's risk of skin injury. Data collected included gestation, weight, day of assessment, injury types, causation, medical devices in situ and risk scores.RESULTS: In total, 248 assessments were completed with 38% (93) recorded skin injuries. Median (interquartile range) gestation and weight at assessment were 36.7 (26.86-56.86) weeks and 2.44 (0.99-4.06) kg, respectively. Receiver operating characteristic curve analysis showed the SRAMT had AUC (SE) of 0.94 (0.02) compared with 0.82 (0.03) for BQS (0.011, P<.001). The SRAMT and BQS had sensitivity of [(90.0 (80.5-95.9), 72.86 (60.9-82.8)] and specificity [(88.46 (81.7-93.4), 79.23 (71.2-85.8)], respectively.CONCLUSION: In this study, the SRAMT's capacity to predict neonates at risk of injury was higher than the Neonatal BQS and staff. Predicting injuries remains complex and often multifactorial.