Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug;22(8):e70745.
doi: 10.1111/iwj.70745.

Measurement and Sequelae of Neonatal Skin Injuries: A Prospective Diagnostic/Feasibility Study

Deanne August  1   2   3   4 , Stephanie Hall  1   4 , Nicole Marsh  2   3   4 , Lynette Chapple  1 , Linda Cobbald  1 , Melissa M Lai  1   5 , David Hall  6   7 , Pieter Koorts  1 , Hui Grace Xu  3   8   9 , Jacqueline Cunninghame  1   2 , Jennifer Hall  1 , Ruth Royle  10 , Joshua Brynes  10 , Kathleen Finlayson  9 , Craig McBride  11 , Robert Ware  12 , Fiona Coyer  2   13 , Amanda Ullman  2   14
Affiliations

Measurement and Sequelae of Neonatal Skin Injuries: A Prospective Diagnostic/Feasibility Study

Deanne August et al. Int Wound J. 2025 Aug.

Abstract

Neonatal skin injuries are common, but location and metric size contribute to inconsistent severity reporting. To date, non-invasive technologies remain unexplored for neonatal injuries. The aim of this study was to assess the feasibility and accuracy of visual assessment against three technologies for injuries to the skin from pressure, stripping and tearing. The prospective diagnostic/feasibility study was conducted for neonates who acquired mechanical force injuries between February-July 2022. Injury measures taken within 72 h of identification were (i) skin injury severity or type pH (5.0-7.5), (ii) laser speckle (perfusion units/mm2), and (iii) imaging app (surface area, cm2). Technology feasibility, clinician-reported acceptability, accuracy, cost and injury sequelae at 6 months post-injury were also collected. A total of 24 neonates (mean (SD)) 34 (5) weeks old and (median (IQR) weight) 1244 (868 to 1740) grams were enrolled. Forty injuries (n = 120 assessments) were completed by visual assessment (100%), 34 (85%) by pH, 30 (75%) with laser speckle and 38 (95%) with the imaging app, respectively. Assessments between clinicians and researchers were inconsistent (n = 29, 72%) and technologies failed for at least 3% of assessments by each respective device. Median injured pH exceeded healthy (average -0.7 of unit), but differences between injured and healthy skin with laser speckle and the app were non-significant. Skin pH had the quickest acquisition (mean (SD) 3.1 (1.6) min) followed by the app (3.2 (2.5) min) and mean acceptability was highest for the imaging app (7.1/10), then pH (6.4/10). Cost per injury was most expensive for the app ($6.65 to $12.82) and lowest for pH ($0.17 to $0.41) per assessment. In conjunction with visual assessment, pH appears objective and cost-effective for intact and injured skin comparison.

Keywords: computer vision; digital application; injury; neonatal skin integrity; wound.

PubMed Disclaimer

Conflict of interest statement

D.A. has undertaken consultancy work for NAVI Technologies and 3M unrelated to this work. N.M. reports, Griffith University and the University of Queensland have received on their behalf speaker fees from 3M, investigator‐initiated research grants from Becton Dickinson, Eloquest, Biolife and Cardinal Health, unrelated to this study. F.C. has received speaker fees from Solventum (Formerly 3M). A.U. reports investigator‐initiated research grants paid to her employer from BD, 3M, Medline, Eloquest and Biolife, unrelated to this study. S.H., Ly.C., L.C., M.L., J.H., D.H., P.K., G.X., J.C., R.R., J.B., C.Mc., R.W., and F.C. have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Proportion of respondents per rating scale (Likert scale 1 to 5, higher rating equals greater agreement). Q1. Fits within care delivery space (incubator/cot space). Q2. Does not require change to neonatal care delivery (e.g., room lighting, mattress tilt). Q3. Technology has capacity to measure in anatomical location (nasal septum, toe, etc.). Q4. Technology is unaffected by neonatal movement.
FIGURE 2
FIGURE 2
Technology comparison for injured and healthy skin. (a) pH of healthy and injured skin, (b) perfusion of healthy and injured skin, (c) pH by type of injury and (d) perfusion by type of injury.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. August D. L., Kandasamy Y., Ray R., Lindsay D., and New K., “Fresh Perspectives on Hospital Acquired Neonatal Skin Injury Prevalence From a Multicentre Study: Length of Stay, Acuity and Incomplete Course of Antenatal Steroids,” Journal of Perinatal and Neonatal Nursing 35, no. 3 (2021): 275–283. - PubMed
    1. Jani P., Mishra U., Buchmayer J., et al., “Global Variation in Skin Injures and Skincare Practices in Extremely Preterm Infants,” World Journal of Pediatrics 19, no. 2 (2023): 139–157. - PMC - PubMed
    1. August D. L., Ray R. A., Kandasamy Y., and New K., “Neonatal Skin Assessments and Injuries: Nomenclature, Workplace Culture and Clinical Opinions‐Method Triangulation a Qualitative Study,” Journal of Clinical Nursing 29, no. 21–22 (2020): 3986–4006. - PubMed
    1. European Pressure Ulcer Advisory Panel NPIAPaPPPIA , Prevention and Treatment of Pressure Ulcers/Inuries Clinical Practice Guideline. The International Guideline, 2019.
    1. Edsberg L. E., Black J. M., Goldberg M., McNichol L., Moore L., and Sieggreen M., “Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System,” Journal of Wound, Ostomy, and Continence Nursing 43, no. 6 (2016): 585–597. - PMC - PubMed

LinkOut - more resources