Infection
Stressors

The most common hospital-acquired NICU infections are bloodstream infections associated with the use of catheters.^2,([FOOTNOTE=Polin RA, Denson S, Brady MT. Strategies for prevention of health care-associated infections in the NICU. Pediatrics. 2012:129:e1085-1093.],[ANCHOR=],[LINK=]) Lower respiratory tract infections and ventilator-associated pneumonia are frequent and can potentially be severe.² These hospital-acquired infections can set back a neonate on the road to recovery.¹

The skin of premature neonates is not fully formed — it is approximately 40% to 60% thinner than adult skin — and not as capable of providing protection against environmental stressors.([FOOTNOTE=McNichol L, Lund C, Rosen T, Gray M. Medical adhesives and patient safety: state of the science: consensus statements for the assessment, prevention, and treatment of adhesive-related skin injuries. Orthop Nurs. 2013;32(5):267-281.],[ANCHOR=],[LINK=])^,([FOOTNOTE=Visscher M, Narendran V. The ontogeny of skin. Adv Wound Care. 2014;3:291-303.],[ANCHOR=],[LINK=]) Neonates commonly develop skin and soft-tissue infections.¹ In addition, poor skin integrity is also a major risk factor for neonatal sepsis.⁵

The premature epidermis is protected by few cornified layers, and the dermis lacks structural proteins found in full-term skin.⁵ As a result, premature skin is more permeable to infectious agents and irritants, has poor mechanical properties and is easily damaged.⁵ Consequently, a procedure as routine as adhesive removal can damage premature neonatal skin.⁵ Cellulitis, abscesses, and abrasions may occur where lancets are used or electrodes are applied. Skin damage or infections may also occur under diapers or bandages.²