Carolyn H Lund

• Neonatal Clinical Nurse Specialist at UCSF Benioff Children's Hospital Oakland

Neonatal vascular access continues to pose challenges. Recent times have seen considerable innovations in practice and the design and manufacture of materials used to provide infusion-based therapies with the intent of reducing the incidence and severity of vascular access-related complications. However, despite these efforts, vascular access-relat...

Background: The impact of the newborn's first bath, whether given with water alone or water with skin cleansing products, on skin barrier function is unknown. Methods: We evaluated skin barrier function, measured by skin surface pH (primary outcome), transepidermal water loss (TEWL), and hydration of the stratum corneum (SCH) in 100 newborns bef...

Background: Bathing the newborn infant is controversial, ranging from how and when to give the newborn their first bath, whether to bathe newborns at all in the initial days of life, and how to approach bathing the hospitalized premature and full-term infant in the neonatal intensive care unit (NICU). Purpose: To review relevant literature about...

Skin injury from medical adhesives is a known problem for neonatal intensive care unit (NICU) patients. Medical adhesive-related skin injury (MARSI) for all patient populations includes mechanical problems such as skin stripping, skin tears, and tension blisters; dermatitis reactions such as irritant contact dermatitis and allergic dermatitis; and...

Skin injury related to medical adhesive usage is a prevalent but underrecognized complication that occurs across all care settings and among all age groups. If proper technique for application and/or removal of adhesive products is not used, tissue trauma can occur, impacting patient safety and quality of life and increasing healthcare costs. Littl...

Nursing for Women's Health convened a group of nurse researchers for a roundtable discussion about the relationship of research to the profession of nursing, how research drives evidence-based practice and how nurses can get involved in research and in its application to the care of women and newborns.

Skin injury related to medical adhesive usage is a prevalent but underrecognized complication that occurs across all care settings and among all age groups. If proper technique for application and/or removal of adhesive products is not used, tissue trauma can occur, impacting patient safety and quality of life and increasing healthcare costs. Littl...

Premature infants in the neonatal intensive care unit are at risk for necrotizing enterocolitis (NEC) and bowel perforation. Unfortunately the mortality and morbidity for intestinal perforation in neonates, especially extremely low-birth-weight infants (VLBW), is high. The criterion standard traditional management for bowel perforation has been exp...

This article presents a case study of a newborn with gastroschisis, followed by a retrospective analysis of gastroschisis cases admitted in a single tertiary neonatal intensive care unit over a 5-year period in terms of maternal age, prenatal diagnosis, type of repair, length of stay, and complications. Gastroschisis is an abdominal wall defect res...

To develop and evaluate an evidence-based clinical practice guideline for assessment and routine care of neonatal skin, educate nurses about the scientific basis for practices recommended in the guideline, and design procedures that facilitate implementation of the project guideline into clinical practice. Descriptive report of the collaborative ne...

Objective To test the effectiveness of an evidence-based clinical practice guideline for neonatal skin care on selected clinical outcomes for newborns in neonatal intensive-care units (NICU), special-care units (SCU), and well-baby nurseries. Design Prospective evaluation of the collaborative neonatal skin care research-based practice project of t...

To demonstrate the validity and reliability of the Neonatal Skin Condition Scale (NSCS) used in the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the National Association of Neonatal Nurses (NANN) neonatal skin care evidence-based practice project. NICU and well-baby units in 27 hospitals located throughout the United St...

Adhesives are applied and removed many times a day in the typical neonatal intensive care unit (NICU). Premature and full-term infants who require medical interventions and constant observation are regularly exposed to adhesive placement for a wide variety of indications. Adhesives are used to secure critical life support equipment such as endotrac...

To report our experience with thrombolytic agents in the management of two infants with silicone central venous catheters that had adhered to the vein wall as a result of infection with Malassezia furfur. Case review of two very low birth weight infants with adherent central venous catheters. Treatment with urokinase and tissue plasminogen activato...

Premature newborns are at risk for high insensible water loss and low body temperatures immediately after birth because of immature skin. Evaporative water and heat losses are the result of the larger surface area in relation to body weight; increased water content, permeability, and skin blood supply; and a thinner epidermis with fewer layers of s...

To develop and evaluate an evidence-based clinical practice guideline for assessment and routine care of neonatal skin, educate nurses about the scientific basis for practices recommended in the guideline, and design procedures that facilitate implementation of the project guideline into clinical practice. Descriptive report of the collaborative ne...

To test the effectiveness of an evidence-based clinical practice guideline for neonatal skin care on selected clinical outcomes for newborns in neonatal intensive-care units (NICU), special-care units (SCU), and well-baby nurseries. Prospective evaluation of the collaborative neonatal skin care research-based practice project of the Association of...

There are anatomic and physiologic differences in the skin of both premature and full-term infants that place them at increased risk for skin injury and breakdown. This article reviews these differences and discusses some of the infant skin care practices that can cause injury to infant skin with preventive strategies identified. Care of skin break...

To review the literature addressing the care of neonatal skin. Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included neonatal skin differences; neonatal skin and care practices for skin integrity; neonatal skin and toxicity; permeability; and contact irritant sensitizati...

Histologic analysis suggests that epidermal development is complete in utero at approximately 34 wk gestational age. Infants born more prematurely have elevated rates of both transepidermal water loss and transcutaneous heat loss, and have difficulty maintaining homeostasis. The underdeveloped integument is also a portal of entry for infection and...

Patients in the neonatal intensive care unit require life support and monitoring equipment that must be securely attached to the skin; removal or replacement often causes skin trauma. In this study, we compared the effects of application and removal of three different adhesives on the skin barrier function of premature neonates. The effects were me...

Preterm neonates have immature skin which can easily be injured, resulting in impaired barrier function. We compared the change in skin barrier function, as measured by transepidermal water loss (TEWL), in preterm neonates following the removal of three adhesives commonly used in the intensive care nursery: Transpore* tape, Hollihesive* pectin barr...

Skin-to-skin holding has been reported to be a useful technique for helping mothers feel close to their nonintubated infants hospitalized in the NICU. This article describes our experience with skin-to-skin holding of 25 intubated infants in the NICU. We found this technique was safe for the intubated infant and promoted parental attachment, even i...

The use of a pectin-based barrier between tape and skin as a method of minimizing epidermal stripping while keeping monitoring equipment and other devices securely attached to infants was evaluated. From 45 subjects, 199 application/removal procedures were recorded. The pectin-based barrier under tape held appliances securely for an average of 5.5...