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Guest Editorial: Neonatal and Pediatric Wound Care: Filling Voids in Knowledge and Practice
As survival rates among critically and chronically ill neonates and children improve through technological and surgical advances, so, too, does their risk for integumentary disruption.1 Yet, paradoxically, little neonatal and pediatric wound-healing research upon which to guide clinical practice exists in the literature.2 Few wound care products and pressure redistribution devices have been studied in this population.2-4 In fact, skin care regimens and wound care management are quite commonly based on individual or institutional preference and routine rather than clinical evidence.5 Antiquated, even painful wound care practices such as the use of full-strength hydrogen peroxide, wet-to-dry dressings applied to granulation beds, and/or full-thickness wounds left open to air remain almost the norm.3 Considering the integumentary immaturity and the anatomical, physiological, and immunological vulnerability of this population, especially during the neonatal period, it becomes obvious that research and clinical practice guidelines are desperately needed. This special issue of Ostomy Wound Management is dedicated to advancing knowledge in the field of neonatal and pediatric wound care. It examines key assessment, management, and documentation parameters involved in treating neonates and children with common wound types. Successful use of negative pressure wound therapy has been documented in adult populations for more than a decade – in this issue, the focus is placed on outcomes and special considerations in the young.
Two critical areas in pressure ulcer prevention and treatment are nutritional maximization and staff education. Both of these areas are described within the context of the chronically ill child in long-term care and the child in a burn facility. A review of the literature on regenerative healing of fetal skin discusses that which is known, that which is unknown, and possible future benefits to postnatal wound repair.
Developing and disseminating guidelines based on current knowledge/best practices and establishing a strong empirical base are essential to advancing wound care practice in the neonatal and pediatric population. Our neonatal and pediatric patients deserve better than dubious, antiquated and painful wound care practices. This article was not subject to the Ostomy Wound Management peer-review process.
1. Baharestani MM. Wounds in special populations: neonatal and pediatric populations. In: Baranoski S, Ayello EA, eds. Wound Care Essentials: Practice Principles, 2nd edition. Philadelphia, Pa: Lippincott Williams & Wilkins;2007.
2. Baharestani MM, Pope E. Chronic wounds in neonates and children. In: Krasner D, Rodeheaver GT, Sibbald GT, eds. Chronic Wound Care: A Clinical Source Book for Healthcare Professionals, 4th Edition. Malvern, Pa: HMP Communications;2007:679-693.
3. Pieper B, Templin T, Dobal M, Jacox A. Prevalence and types of wounds among children receiving care in the home. Ostomy Wound Manage. 2000;46(4):36-42.
4. Siegfried EC, Shah PY. Skin care practices in the neonatal nursery: a clinical survey. J Perinatology. 1999;19(1):31-39.
5. Malloy-McDonald MB. Skin care for high risk neonates. J WOCN. 1995;22(4):177-182.
