Characterization of Pressure Ulcers in Pediatric and Neonatal Patients

Purpose:  Pediatric patients may be at risk for pressure ulcers due to compromised blood perfusion, decreased mobility, poor nutrition, limited and/or heightened neurological responsiveness, fluid retention, moisture, and the presence of medical devices.  Incidence rates of 5% – 42% for critical patients have been reported.  The purpose was to determine the occurrence, severity, and characteristics associated with the development of pressure ulcers in the high risk units in a pediatric academic center.    

Methodology:  The research design was a descriptive retrospective chart review.  All patients in four high risk units (NICU, PICU, TCC (Trach/vent unit), and rehabilitation unit) were examined biweekly from September, 2007 through October, 2009.  A trained staff RN identified that a pressure ulcer may be present and the hospital CWOCN, validated that the wound was a pressure ulcer, staged the ulcer and determined the cause. 

Statistics:  Frequency data within the population of patients with pressure ulcers was compared using z-tests (p < 0.05).

Results:  A total of 3779 patient evaluations identified 276 pressure ulcers for an occurrence rate of 7.3%.  The mean age was 34.4 weeks in the NICU and 6.4 years for the other three units. The pressure ulcers occurred in 147 patients with a mean of 1.9 ulcers per patient.  The percent occurrence by stage was 26% stage I, 53% stage II, 11%, stage III, 0 stage IV, 7.6% unstageable, and 1.4% deep tissue injury.  Known causes were 36% from traditional pressure sites and 62% from devices.  The top 5 device related causes were 22.5% from a bipap/cpap mask, 13.3% from trach device, 8.7% from casts, 8.7% from pulse ox and 10.4% unknown. Patients with device related pressure ulcers were significantly younger than those with traditional pressure ulcer sites.  

Conclusion: Findings indicate a need for interventions to minimize device related pressure ulcers in the pediatric population.