Presence and pattern of scarring in children born very preterm

From lab to life: how wearable devices can improve health equity

Wearable devices can provide personalised medicine at the point of need, potentially increasing access to health services and therefore improving health equity. Here the authors discuss their experiences developing wearable devices for vulnerable patient populations, including neonates and pregnant individuals.

What the skin of 341 premature newborns says - a transversal study

OBJECTIVES

Determine the frequency of dermatological diagnoses in preterm newborns up to 28 days of life and associated perinatal factors.

METHOD

a cross-sectional analytical study with a convenience sample and prospective data collection, was conducted between November 2017 and August 2019. Overall, 341 preterm newborns who had been admitted to a University hospital - including those admitted to the Neonatal Intensive Care Unit - were evaluated.

RESULTS

61 (17.9%) had less than 32 weeks gestational age (GA), with a mean GA and birth weight of 33.9 ± 2.8 weeks and 2107.8 ± 679.8g (465 to 4230g), respectively. The median age at the time of evaluation was 2.9 days (4 h to 27 days). The frequency of dermatological diagnoses was 100% and 98.5% of the sample had two or more, with an average of 4.67+1.53 dermatoses for each newborn. The 10 most frequent diagnoses were lanugo (85.9%), salmon patch (72.4%), sebaceous hyperplasia (68.6%), physiological desquamation (54.8%), dermal melanocytosis (38.7%), Epstein pearls (37.2%), milia (32.2%), traumatic skin lesions (24%), toxic erythema (16.7%), and contact dermatitis (5%). Those with GA< 28 weeks showed more traumatic injuries and abrasions, whereas those with ≥ 28 weeks had physiological changes more frequently, and those with GA between 34-366/7 weeks, had transient changes.

CONCLUSION

Dermatological diagnoses were frequent in our sample and those with higher GA showed a higher frequency of physiological (lanugo and salmon patch) and transient changes (toxic erythema and miliaria). Traumatic lesions and contact dermatitis were among the 10 most frequent injuries, reinforcing the need to effectively implement neonatal skin care protocols, especially in preterm.

Securing peripheral intravenous catheters in babies without applying adhesive dressings to the skin: a proof-of-concept study

BACKGROUND

Most babies admitted to a Neonatal Intensive Care Unit (NICU) require a peripheral intravenous catheter (PIVC). PIVCs are secured using splints and adhesive dressings applied to the skin. Removing the dressings causes skin injury, pain, and risks infection. We designed the Pēpi Splint, which supports PIVCs without the application of adhesive dressings to the skin. We sought to determine the effectiveness and acceptability of the Pēpi Splint using a proof-of-concept design.

METHODS

Eligible babies were > 1000 g and > 30 weeks' corrected gestation admitted to Wellington Regional NICU and who required a PIVC. All babies received the same care as those not in the study, with the addition of the Pēpi Splint. Primary outcomes were the proportion of babies in which the Pēpi Splint secured the PIVC for the required time and proportion of babies who experience an adverse event. Secondary outcomes were the acceptability of the Pēpi Splint as reported by the parents.

RESULTS

Thirty-eight babies, median (range) birth weight 2625 g (396-4970) and gestation 37wk (22-41). When the Pēpi was applied the postnatal weight was 2969 g (1145 - 4970) and gestation 37wk (29 - 41). The Pēpi Splint held the PIVC secure for 34/38 babies (89%), for a duration of 37 h (6 to 97). There were no adverse events. Of the four babies reported to have unsecure PIVCs, two were due to the securement two were displaced during feeding. Fifty-eight parents responded to a questionnaire (32 mothers, 26 fathers). Of these parents 52 (90%) would participate again and 52 (90%) would recommend participating to others. Overall, clinicians reported the Pēpi Splint was easy to use 33/38 (87%).

CONCLUSION

The Pēpi Splint safely secures PIVCs without adhesive dressings being applied to the skin and is acceptable to both parents and clinicians. Our findings provide support for a larger multicentred randomised controlled trial.

TRIAL REGISTRATION

Registered with the Australian and New Zealand Clinical Trials Registry Reference ACTRN12620001335987 .

Printing Flexible and Hybrid Electronics for Human Skin and Eye-Interfaced Health Monitoring Systems

Advances in printing materials and techniques for flexible and hybrid electronics in the domain of connected healthcare have enabled rapid development of innovative body-interfaced health monitoring systems at a tremendous pace. Thin, flexible, and stretchable biosensors that are printed on a biocompatible soft substrate provide the ability to noninvasively and unobtrusively integrate with the human body for continuous monitoring and early detection of diseases and other conditions affecting health and well being. Hybrid integration of such biosensors with extremely well-established silicon-based microcircuit chips offers a viable route for in-sensor data processing and wireless transmission in many medical and clinical settings. Here, a set of advanced and hybrid printing techniques is summarized, covering diverse aspects ranging from active electronic materials to process capability, for their use in human skin and eye-interfaced health monitoring systems with different levels of complexity. Essential components of the devices, including constituent biomaterials, structural layouts, assembly methods, and power and data processing configurations, are outlined and discussed in a categorized manner tailored to specific clinical needs. Perspectives on the benefits and challenges of these systems in basic and applied biomedical research are presented and discussed.

Binodal, wireless epidermal electronic systems with in-sensor analytics for neonatal intensive care

Existing vital signmonitoring systems in the neonatal intensive care unit (NICU) requiremultiple wires connected to rigid sensors with strongly adherent interfaces to the skin.We introduce a pair of ultrathin, soft, skin-like electronic devices whose coordinated, wireless operation reproduces the functionality of these traditional technologies but bypasses their intrinsic limitations.The enabling advances in engineering science include designs that support wireless, battery-free operation; real-time, in-sensor data analytics; time-synchronized, continuous data streaming; soft mechanics and gentle adhesive interfaces to the skin; and compatibility with visual inspection and with medical imaging techniques used in the NICU. Preliminary studies on neonates admitted to operating NICUs demonstrate performance comparable to the most advanced clinical-standard monitoring systems.

Aletheia-20 unconcealed observations from quality improvement and evidence-based medicine

Quality improvement (QI) and evidence-based medicine (EBM) activities ideally generate value (benefit/cost). Physicians and hospitals vary in ability to demonstrate efficiency despite common methodology available to all. Based upon our 60-some years of combined QI and EBM experience, we suggest reasoned consideration of meta-cognition-thinking about thinking. How do we observe, analyze, intuit, then share observations and learning with collaborative networks? The Greek word aletheia denotes disclosure of the essence of an object or event as its genuine nature, "unhidden, revealed, unconcealed". Aletheia is authenticity, not a claim or opinion, not an argument or hypothesis, nor an intervention-based assertion. QI and EBM have crucial features obscured by the lure and distraction of technology, economic conflicts, and inherent self-interests. We offer 20 QI and EBM observations in the spirit of aletheia. Enhancing the well-being of children is the foundation of a civilized society, a journey needful of shared QI understanding.