Download PDF
Am J Perinatol 2018; 35(13): 1326-1330
DOI: 10.1055/s-0038-1654711
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Skin Punctures in Preterm Infants in the First 2 Weeks of Life

Daragh Finn
1   Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
2   Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
,
Daryl Butler
1   Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
,
Orla Sheehan
3   Department of Neonatal Nursing, University College Cork, Cork University Maternity Hospital, Cork, Ireland
,
Vicki Livingstone
2   Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
,
Eugene M. Dempsey
1   Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
2   Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
› Author Affiliations Funding This article was supported by a Science Foundation Ireland Research Centre Award (INFANT-12/RC/2272).
Further Information

Publication History

23 August 2017

16 April 2018

Publication Date:
23 May 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Objective The objective of this study was to investigate frequency and trends of skin punctures in preterm infants.

Study Design A prospective audit of preterm infants less than 35 weeks admitted over a 6-month period to a tertiary neonatal intensive care unit. Each skin puncture performed in the first 2 weeks of life was documented in a specifically designed audit sheet.

Results Ninety-nine preterm infants were enrolled. Infants born at < 32 weeks' gestation had significantly more skin punctures than infants > 32 weeks (median skin punctures 26.5 vs. 17, p-value < 0.05). The highest frequency of skin punctures occurred during the first week of life for infants > 28 weeks' gestation (medians 17.5 in 28–31 + 6 weeks' gestation, and 15 in > 32 weeks), and during the second week of life for those born at < 28 weeks (median 17.5). Infants with sepsis had more skin punctures (p-value < 0.001), but this was not significant on multivariate analysis. Median skin punctures in the second week of life were statistically higher in the sepsis group on multivariate analysis (odds ratio: 1.07, 95% confidence interval: 1.00–1.14, p = 0.041).

Conclusion Frequency of skin punctures is influenced by gestational age and postnatal age. Skin punctures were not an independent risk factor for sepsis.

Keywords

neonatal intensive care - newborn - infant - preterm - procedure - sepsis

Authors' Contributions

E.M.D. and D.F. conceived and designed the study. D.F., D.B., and O.S. acquired the data. V.L. analyzed the data. D.F., D.B., and E.M.D. interpreted the data. D.F. drafted the article. D.F., D.B., O.S., and E.M.D. critically revised the article for important intellectual content. All authors agreed on the final article and approved its submission for publication. D.F. will act as guarantor for the article.


Ethical Approval

Ethical approval was granted by both Cork University Maternity Hospital and University College Cork Research Ethics Committees' in November 2012.


 

  • References

  • 1 Barker DP, Rutter N. Exposure to invasive procedures in neonatal intensive care unit admissions. Arch Dis Child Fetal Neonatal Ed 1995; 72 (01) F47-F48
    CrossrefPubMedGoogle Scholar
  • 2 Carbajal R, Rousset A, Danan C. , et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA 2008; 300 (01) 60-70
    CrossrefPubMedGoogle Scholar
  • 3 Cignacco E, Hamers J, van Lingen RA. , et al. Neonatal procedural pain exposure and pain management in ventilated preterm infants during the first 14 days of life. Swiss Med Wkly 2009; 139 (15-16): 226-232
    PubMedGoogle Scholar
  • 4 Sharek PJ, Powers R, Koehn A, Anand KJ. Evaluation and development of potentially better practices to improve pain management of neonates. Pediatrics 2006; 118 (Suppl. 02) S78-S86
    CrossrefPubMedGoogle Scholar
  • 5 Barker DP, Willetts B, Cappendijk VC, Rutter N. Capillary blood sampling: should the heel be warmed?. Arch Dis Child Fetal Neonatal Ed 1996; 74 (02) F139-F140
    CrossrefPubMedGoogle Scholar
  • 6 Boyle EM, Freer Y, Wong CM, McIntosh N, Anand KJ. Assessment of persistent pain or distress and adequacy of analgesia in preterm ventilated infants. Pain 2006; 124 (1-2): 87-91
    CrossrefPubMedGoogle Scholar
  • 7 Franck LS, Allen A, Cox S, Winter I. Parents' views about infant pain in neonatal intensive care. Clin J Pain 2005; 21 (02) 133-139
    CrossrefPubMedGoogle Scholar
  • 8 Brummelte S, Grunau RE, Chau V. , et al. Procedural pain and brain development in premature newborns. Ann Neurol 2012; 71 (03) 385-396
    CrossrefPubMedGoogle Scholar
  • 9 Grunau RE, Whitfield MF, Petrie-Thomas J. , et al. Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants. Pain 2009; 143 (1-2): 138-146
    CrossrefPubMedGoogle Scholar
  • 10 Vinall J, Grunau RE. Impact of repeated procedural pain-related stress in infants born very preterm. Pediatr Res 2014; 75 (05) 584-587
    CrossrefPubMedGoogle Scholar
  • 11 Vinall J, Miller SP, Bjornson BH. , et al. Invasive procedures in preterm children: brain and cognitive development at school age. Pediatrics 2014; 133 (03) 412-421
    CrossrefPubMedGoogle Scholar
  • 12 Madan A, Kumar R, Adams MM, Benitz WE, Geaghan SM, Widness JA. Reduction in red blood cell transfusions using a bedside analyzer in extremely low birth weight infants. J Perinatol 2005; 25 (01) 21-25
    CrossrefPubMedGoogle Scholar
  • 13 Widness JA, Madan A, Grindeanu LA, Zimmerman MB, Wong DK, Stevenson DK. Reduction in red blood cell transfusions among preterm infants: results of a randomized trial with an in-line blood gas and chemistry monitor. Pediatrics 2005; 115 (05) 1299-1306
    CrossrefPubMedGoogle Scholar
  • 14 Wynn JL, Levy O. Role of innate host defenses in susceptibility to early-onset neonatal sepsis. Clin Perinatol 2010; 37 (02) 307-337
    CrossrefPubMedGoogle Scholar
  • 15 Fanaroff AA, Korones SB, Wright LL. , et al. The National Institute of Child Health and Human Development Neonatal Research Network. Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. Pediatr Infect Dis J 1998; 17 (07) 593-598
    CrossrefPubMedGoogle Scholar
  • 16 Wynn JL, Wong HR, Shanley TP, Bizzarro MJ, Saiman L, Polin RA. Time for a neonatal-specific consensus definition for sepsis. Pediatr Crit Care Med 2014; 15 (06) 523-528
    CrossrefPubMedGoogle Scholar
  • 17 Benitz WE, Han MY, Madan A, Ramachandra P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics 1998; 102 (04) E41
    CrossrefPubMedGoogle Scholar
  • 18 Simons SH, van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D. Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med 2003; 157 (11) 1058-1064
    CrossrefPubMedGoogle Scholar
  • 19 Johnston CC, Collinge JM, Henderson SJ, Anand KJ. A cross-sectional survey of pain and pharmacological analgesia in Canadian neonatal intensive care units. Clin J Pain 1997; 13 (04) 308-312
    CrossrefPubMedGoogle Scholar
  • 20 Stevens B, McGrath P, Gibbins S. , et al. Procedural pain in newborns at risk for neurologic impairment. Pain 2003; 105 (1-2): 27-35
    CrossrefPubMedGoogle Scholar
  • 21 Foster JP, Taylor C, Spence K. Topical anaesthesia for needle-related pain in newborn infants. Cochrane Database Syst Rev 2017; 2: CD010331
    Google Scholar
  • 22 Borenstein-Levin L, Synnes A, Grunau RE. , et al. Narcotics and sedative use in preterm neonates. J Pediatr 2017; 180: 92-98
    CrossrefPubMedGoogle Scholar
  • 23 Anand KJ. ; International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001; 155 (02) 173-180
    CrossrefPubMedGoogle Scholar
  • 24 Peters KL, Rosychuk RJ, Hendson L, Coté JJ, McPherson C, Tyebkhan JM. Improvement of short- and long-term outcomes for very low birth weight infants: Edmonton NIDCAP trial. Pediatrics 2009; 124 (04) 1009-1020
    CrossrefPubMedGoogle Scholar
  • 25 Roofthooft DW, Simons SH, Anand KJ, Tibboel D, van Dijk M. Eight years later, are we still hurting newborn infants?. Neonatology 2014; 105 (03) 218-226
    CrossrefPubMedGoogle Scholar
  • 26 Kalia YN, Nonato LB, Lund CH, Guy RH. Development of skin barrier function in premature infants. J Invest Dermatol 1998; 111 (02) 320-326
    CrossrefPubMedGoogle Scholar
  • 27 Marchini G, Nelson A, Edner J, Lonne-Rahm S, Stavréus-Evers A, Hultenby K. Erythema toxicum neonatorum is an innate immune response to commensal microbes penetrated into the skin of the newborn infant. Pediatr Res 2005; 58 (03) 613-616
    CrossrefPubMedGoogle Scholar