Incidence of incontinence-associated dermatitis in hospitalised neonates. Adaptation and validation of a severity scale

• Published in: Anales de Pediatría Vol. 100; no. 6; pp. 420 - 427
• Main Authors: Balaguer-López, Evelin, Estañ-Capell, Javier, Rodrígez Dolz, María Carmen, Barberá Ventura, María Carmen, Ruescas López, Manuel, García-Molina, Pablo
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España, S.L.U 01.06.2024
• Subjects: Clinical score; Dermatitis del pañal; Diaper dermatitis; Diaper Rash - diagnosis; Diaper Rash - epidemiology; Escala clínica; Fecal Incontinence - complications; Fecal Incontinence - diagnosis; Fecal Incontinence - epidemiology; Female; Hospitalization; Humans; Incidence; Incidencia; Infant, Newborn; Male; Neonatal hospitalization; Neonatos hospitalizados; Piel; Prospective Studies; Severity of Illness Index; Skin; Spain - epidemiology; Urinary Incontinence - diagnosis; Urinary Incontinence - epidemiology; Spain; Piel; Neonatos hospitalizados; Skin; Diaper dermatitis; Incidencia; Dermatitis del pañal; Clinical score; Escala clínica; Incidence; Neonatal hospitalization
• ISSN: 2341-2879; 2341-2879
• DOI: 10.1016/j.anpede.2024.04.015

[Display omitted] Up to 60% of hospitalised neonates may develop incontinence-associated dermatitis (IAD). Our aim was to adapt the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis to the Spanish population and to find out the nationwide frequency of IAD in hospitalized neonates. Cross-cultural adaptation and assessment of content validity of the scale. We carried out a prospective, multicentre observational study of the incidence of nappy rash in postnatal wards and neonatal intensive care units in 6 Spanish hospitals. We obtained a content validity index of 0.869 for the total scale (95% CI, 0.742−0.939). The sample included 196 neonates. The cumulative incidence of IAD was 32.1% (9.1% mild-moderate, 8% moderate and 1.6% severe). The incidence rate was 2.2 IAD cases per 100 patient days. A stool pH of less than 5.5, a greater number of bowel movements a day, a greater daily urine output and the use of oral drugs were among the factors associated with the development of IAD. The Spanish version of the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis had an adequate content validity for the assessment of DAI in the hospitalised neonatal population. Mixed feeding, treatment with oral drugs and the use of medical devices in the perianal area were associated with an increased risk of nappy dermatitis in infants. Hasta el 60% de los neonatos hospitalizados pueden desarrollar una dermatitis asociada a la incontinencia (DAI). El objetivo fue adaptar al contexto español la escala Clinical evaluation scale for characterization of the severity of Diaper Dermatitis y averiguar la magnitud nacional de la DAI en neonatos hospitalizados. Adaptación transcultural y validez de contenido. Estudio observacional, prospectivo y multicéntrico de incidencia de dermatitis del pañal en unidades de hospitalización y cuidados intensivos neonatales de 6 hospitales españoles. Se obtuvo un índice de validez de contenido de 0.869 para el total de la escala (IC95% 0.742 – 0.939). Se incluyen un total de 196 neonatos. Se obtuvo una incidencia acumulada de DAI del 32.1% (9.1% leves-moderadas, 8% moderadas y 1.6% grave). La tasa de incidencia fue de 2.2 DAI por cada 100 neonatos/día de ingreso. El pH de las heces <5.5, el nº deposiciones/día, los ml de orina/día y los fármacos orales fueron algunos de los factores favorecedores de DAI. La versión española de la Clinical evaluation scale for characterization of the severity of Diaper Dermatitis tiene un contenido válido para valorar DAI en población neonatal ingresada. Los neonatos portadores de lactancia mixta, fármacos orales y dispositivos locales en la zona perianal tienen más riesgo de presentar dermatitis del pañal.