Low Air Loss Support Surface Selection in the Neonatal and Pediatric Population

More than 50% of pressure injuries occurring in the pediatric and neonatal population are directly related to medical devices. Skin integrity alteration in the pediatric population causes physical pain for the child, mental anguish for the parents, and increased cost to health-care institutions.

Identified recurrent pediatric impaired skin integrity at a Magnet-designated children’s hospital became the focus for this guideline development initiative. In most health-care institutions, pediatric treatment and prevention guidelines are adapted from adult practices. Concerns arise for the safety, cost-effectiveness, and clinical efficacy due to anatomic and physiological differences between the two populations.

Guideline development included: assessing the at-risk patient, determining support surface availability, and choosing support surface functionality to provide moisture management with pressure redistribution. Algorithm development incorporated Braden Q, Neonatal Skin Condition Score, and/or Neonatal Abstinence Syndrome (NAS) Score. Additionally, the algorithm guided the provider based on spinal stability, patient mobility, paralytics/vasopressors, and respiratory support. Based on the assessment and patient weight, provider was guided to select the proper low air loss (LAL) support surface, fitted for the appropriate crib, pediatric frame, or cardiac surgical platform.

Based on study outcomes, the LAL guideline development provides early identification of the at-risk pediatric population. Early identification and surface initiation mitigates the causative factors and improves patient outcomes. Post IRB approval retrospective chart review included three patients using LAL. In each of the cases, patient healing was evident within the first 10 days of use. After LAL was initiated, additional skin breakdown did not occur during the patients’ hospitalization.