Why are neonatal and premature
infants at risk of skin tears?
Neonatal and premature infants pose a major challenge for wound care professionals. Their skin is more immature and thinner compared to adult skin, making it more susceptible to skin injuries such as skin tears.[1]
Skin tears are traumatic wounds that occur in people with fragile skin. They result in the partial or full separation of the skin’s layers.
Skin tears typically happen when areas of the body with more fragile skin experience shearing, blunt force, or some form of mechanical trauma (e.g. mishandling of equipment).
While they are more prevalent in the elderly population, neonates and premature infants are also at high risk of skin tears.
Skin tears can cause neonates considerable pain and discomfort. If treated improperly, neonatal skin tears can cause permanent skin damage or disfigurement in the affected area.
What are the differences between neonatal and adult skin?
The skin is the largest organ in the body. It is the body’s first line of defence against harmful toxins, microorganisms, UV light and also helps the body with thermal regulation.
The skin is made up of three layers:
• The epidermis (or outer layer)
• The dermis (or middle layer)
• The hypodermis (or bottom layer)
Neonatal skin is fragile due to the immaturity of the outermost layer of the epidermis (the stratum corneum). Neonatal skin is around 40-60% thinner than adult skin and lacks the same cohesion between all three layers. This means neonates are up to 43% more vulnerable than adults to injuries such as skin tears.[2]
Why are premature infants more at risk of skin tears?
Premature infants, especially those with less than 24 weeks of gestation, are often born with underdeveloped organ systems. This means the skin of premature infants is unable to perform as well physiologically as that of their full-term counterparts.[3]
Common skin issues in premature infants include ‘paper thin’ skin, a weaker epidermis, transepidermal water loss, and poor electrolyte management. This not only increases the skin’s intrinsic susceptibility to skin injuries, but also impairs its wound healing abilities.
As skin tears are normally caused by friction, blunt force and shearing, the medical demands of premature infants can threaten the skin’s integrity as they require more extensive medical attention than full-term neonates.
This includes invasive procedures using medical equipment such as endotracheal intubation (ETT), monitoring probes, and ventilation tubes. Medical adhesives are usually required for the fixation of critical devices.[4]
How to prevent skin tears in neonates?
Measures such as skin tear risk assessments and safeguarding protocols must be taken to prevent and limit the incidence of neonatal skin tears.
Identify at-risk infants
Identifying an infant at risk of a skin tear is a fundamental part of prevention. Although the skin of neonatal infants is thinner and more fragile than adult skin, there are some factors that indicate that they may be more vulnerable to skin tears:
• Premature infants born at less than 32 weeks are at greater risk than infants born at full-term
• Premature infants in intensive care are at an even greater risk of skin tears because of the removal of dressings with strong adhesives and the poor handling of medical devices
• Infants that have a history of being treated for skin injuries and wounds and those currently being treated for similar issues will be more at risk of skin tears
Creating a safe environment for at-risk infants
Another important component of skin tear prevention in neonatal or premature infants is to minimise external risk factors:
• Provide better training for the correct handling of lifesaving equipment (e.g. ventilators)
• Avoid holding or touching an at-risk infant with jewellery or sharp nails to prevent snagging or pinching the skin
• Avoid using dressings and tapes with strong adhesives to prevent the skin from tearing.
In the event of a neonatal or premature infant skin tear occurring in the home, it is crucial to seek professional medical advice and treatment.
References:
- Broom, Margaret, et al. Predicting Neonatal Skin Injury: The First Step to Reducing Skin Injuries in Neonates. Health Serv Insights 2019; 12: 1
- Fumarola, Sian, et al. Overlooked and Underestimated: Medical Adhesive-Related Skin Injuries. Journal of Wound Care 2020; 29 (Suppl 3c): 9
- Eichenfield LF, Hardaway CA. Neonatal Dermatology. Curr Opin Pediatr. 1999:11:471-474
- Broom, Margaret, et al. Predicting Neonatal Skin Injury: The First Step to Reducing Skin Injuries in Neonates. Health Serv Insights 2019; 12: 2
Useful videos:
How to apply and remove dressings for skin tears
What are the most common locations for skin tears?
ISTAP skin classification
Useful articles:
What are skin tears? – Download this article
A guide to skin tear management best practice
Understanding the aetiology of skin tears in older people
Disclaimer:
Please note that while every effort is made to ensure the accuracy of the content presented, it is purely for educational purposes only and is not a substitute for professional medical advice.