Prevalence and risk factors of dependence-related skin lesions in neonatal units: A multicentre study across Spanish hospitals

Abstract

Aim This study aimed to obtain updated epidemiological indicators of dependence-related skin lesions (DRSLs) in neonatal units of Spanish hospitals and to analyze preventive interventions and risk factors associated with DRSL development. Materials and methods A multicentre, observational, cross-sectional prevalence study was conducted across three data collection phases in 12 Spanish hospitals with neonatal units, and included 398 hospitalised neonates. Data collection was based on direct observation, clinical record review, and caregiver interviews. The Neonatal Skin Risk Assessment Scale (e-NSRAS) was used to assess DRSL risk. Demographic variables, risk factors, and preventive measures were also analyzed. Results DRSL prevalence was 29.4 %. Moisture-related lesions (18.6 %) were the most common, especially in intermediate care, followed by pressure injuries (13.07 %), more prevalent in intensive care, and friction-related lesions (3.02 %). Non-invasive mechanical ventilation and urinary catheterisation were significantly associated with DRSL occurrence. Additionally, 34 % of neonates were classified as at risk of pressure injuries. Discussion A high DRSL prevalence was observed among hospitalised neonates, exceeding rates reported in other national and international studies. The e-NSRAS appears unsuitable for assessing all DRSL types. The use of multiple medical devices was associated with higher DRSL rates, and preventive measures were often applied late or inadequately. Study limitations include those typical of cross-sectional studies, such as representativeness, confounding factors, and sample size. Conclusion DRSLs are a prevalent issue in Spanish neonatal units. The development and implementation of targeted preventive measures, along with the adaptation of assessment tools, are critical for enhancing the quality of neonatal care.