The Pressure Is On!: Neonatal Skin and Nasal Continuous Positive Airway Pressure.

BACKGROUND: Premature infants have an increased risk for developing skin breakdown. Perceivably noninvasive interventions may have detrimental effects on the infant's skin. PURPOSE: This case presentation describes an extreme case of nasal breakdown associated with nasal continuous positive airway pressure (nCPAP). METHODS: Highlighted is the vital importance of proper placement, along with appropriate apparatus size, in the efforts to prevent skin breakdown. Ensuring that pressure points are avoided is imperative to prevent nCPAP-related injuries, along with treating the area in the event of skin denudation. A literature search was conducted to determine best practice options to prevent these injuries. FINDINGS: There is little information in the literature to guide treatment and prevention of this type of breakdown. IMPLICATIONS FOR PRACTICE: Avoidance of pressure in a localized area is the most commonly found recommendation. IMPLICATIONS FOR RESEARCH: There are extensive opportunities for adding to our current knowledge in terms of prevention and treatment of skin breakdown associated with device utilization in the neonatal intensive care unit, especially with the increasing use of nCPAP.

Neonatal skin and chlorhexidine: a burning experience.

PURPOSE: Despite the lack of safety data, chlorhexidine gluconate (CHG) is an antiseptic with broadspectrum coverage often used in neonatal intensive care units (NICUs). Adverse skin reactions, most commonly burns, have been reported after the use of CHG. Preserving skin integrity in preterm infants is vital in the prevention of sepsis, excessive water loss, hypothermia, and renal failure. DESIGN: This is a case report of two incidents of significant skin burning in extremely low birth weight (ELBW) infants who were treated with CHG for the purposes of umbilical cord sterilization prior to umbilical line placement. SAMPLE: This case report of burns associated with CHG in one infant weighing 610 g at birth and a second infant weighing 600 g at birth. RESULTS: CHG does have a strong association with causing skin burns in the ELBW population; however, wiping the solution off of the skin seems to reduce injury.

Bronze baby syndrome.

An in-depth review of jaundice in the newborn was covered in this column in the September/October 2007 issue. This article will include a brief review of bilirubin formation and discuss what is currently known about bronze baby syndrome (BBS). This column will include a short review of bilirubin formation and conclude with an unusual case study of a patient who developed BBS in the absence of direct hyperbilirubinemia.

Troponin.

Troponin T and I can be found within the myocardial filaments. Measuring these cardiac troponin levels in full-term newborns and premature infants has not become a common practice in the neonatal intensive care unit and newborn nurseries. Research studies are discovering that an elevation in troponin T and I levels can be directly correlated with the severity of the infant's illness, and it can be potentially prognostic of morbidity. This literature analysis discusses what can be considered normal cardiac troponin levels along with what elevated levels are and possible conditions associated with those elevations.

Diagnosing intestinal perforation: a new approach.

Spontaneous intestinal perforation has been shown to be a significant morbidity in the extremely low birthweight neonate. Occult spontaneous intestinal perforation (SIP), without pneumoperitoneum on abdominal radiograph, typically occurs in neonates > 2 weeks of age and is usually diagnosed by visualization of particulate matter seen on an abdominal ultrasound. We present a case of a 25-week growth-restricted neonate at 12 days of life who was diagnosed with occult SIP by a novel mechanism.