Dressings and Products in Pediatric Wound Care

Abstract

Significance: The increasing complexity of medical and surgical care provided to pediatric patients has resulted in a population at significant risk for complications such as pressure ulcers, nonhealing surgical wounds, and moisture-associated skin damage. Wound care practices for neonatal and pediatric patients, including the choice of specific dressings or other wound care products, are currently based on a combination of provider experience and preference and a small number of published clinical guidelines based on expert opinion; rigorous evidence-based clinical guidelines for wound management in these populations is lacking. Recent Advances: Advances in the understanding of the pathophysiology of wound healing have contributed to an ever-increasing number of specialized wound care products, most of which are predominantly marketed to adult patients and that have not been evaluated for safety and efficacy in the neonatal and pediatric populations. This review aims to discuss the available data on the use of both more traditional wound care products and newer wound care technologies in these populations, including medical-grade honey, nanocrystalline silver, and soft silicone-based adhesive technology. Critical Issues: Evidence-based wound care practices and demonstration of the safety, efficacy, and appropriate utilization of available wound care dressings and products in the neonatal and pediatric populations should be established to address specific concerns regarding wound management in these populations. Future Directions: The creation and implementation of evidence-based guidelines for the treatment of common wounds in the neonatal and pediatric populations is essential. In addition to an evaluation of currently marketed wound care dressings and products used in the adult population, newer wound care technologies should also be evaluated for use in neonates and children. In addition, further investigation of the specific pathophysiology of wound healing in neonates and children is indicated to promote the development of wound care dressings and products with specific applications in these populations.

Kara Noelle Shah, MD, PhD

Figure 1.

Optimal product choice for local wound care based on depth of injury and amount of exudate.

Figure 2.

Considerations in dressing and product choice based on the different phases of wound healing.

Figure 3.

Normal skin with intact epidermis, dermis, and subcutaneous tissue (A). Conditions leading to pressure ulcer development include increased pressure at the surface of the skin in conjunction with shear forces (B). Injury resulting from epidermal stripping (C), surgical wounding (D), moisture-associated skin damage (E), and intravenous extravasation injury (F). To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound