Analysis Of Risk Factors And Establishment And Evaluation Of Medical Adhesive-related Skin Injury In Preterm Infants

ObjectiveTo investigate the current situation of Medical adhesive related skin injury(MARSI)in premature infants,including the incidence of MARSI in premature infants,the location and time of MARSI,the common types and other clinical characteristics.To analyze the risk factors which affect the occurrence of MARSI in premature infants.Nomogram was established to predict the probability of MARSI in premature infants,and the prediction model was verified internally and evaluated clinically.This study could provide a screening tool for NICU nurses to identify high risk factors of MARSI in premature infants at early stage and provide intervention measures to reduce the occurrence of MARSI.Methods1 In the first part,we selected 268 premature infants in a Grade 3A Hospital in Shandong Province from July 2018 to September 2018 according to the inclusive and exclusion criteria by means of convenient sampling.Self-designed questionnaire was used to collect information on demographic data,maternal status,nutrition,skin condition,treatment,medical viscose products.Self-designed MARSI questionnaire was used to collect information on occurrence situation of MARSI in premature infants.The risk factors of MARSI in premature infants were analyzed by single factor and logistic regression analysis.2 The second part was based on R software.The independent variables and regression coefficients from logistic regression analysis were used to establish Nomogram to predict the occurrence of MARSI in premature infants.C-index,calibration curve and decision-making curve were used to test and verify differentiation,consistency and clinical usefulness.We selected 115 premature infants from October to November 2018.The inclusion criteria,exclusion criteria,data collection methods were the same as that in the first part.Sensitivity,specificity and accuracy were used to evaluate prediction effect of Nomogram.Recults1 The incidence of MARSI in NICU preterm infants was 23.9%.Epidermis was the most common clinical type.The peak period of MARSI occured within one week after birth.Facial and limbs were the predisposing locations.2 Logistic regression analysis showed that gestational age(28-32weeks)(P=0.021,OR=2.736,95%CI:1.163-6.435),skin edema(P<0.001,OR=33.782,95%CI:10.510-108.5835),maternal diabetes mellitus(P=0.039,OR=16.011,95%CI:1.146-223.692)and pr essure-sensitive tear tape(P=0.027,OR=13.567,95%CI:1.340-137.311)were inde pendent risk factors for MARSI in premature infants.3 The Nomogram showed that the probability of MARSI in premature infants was 50% when the total score was 201,and the higher the score,the greater the ri sk of MARSI.The C-index was 87.29% and the differentiation was moderate.The calibration curve showed that the predicted probability was consistent with the actua l occurrence probability.Meanwhile,DCA showed that the net benefit of patients w ith the Nomogram was higher than that of patients with any single index.4 The Nomogram was used to predict the occurrence of 115 premature infants.The accuracy of clinical prediction was 93%,the sensitivity was 83.3%,and the specificity was 94.8%,which indicated that the clinical prediction ability of Nomogram was good.Conclusion1 The incidence of MARSI in premature infants was high.The risk factors of MARSI in premature infants were gestational age,skin edema,diabetic mothers and pressure-sensitive tear tape.2 The risk factors of MARSI in Nomogram were gestational age,skin condition,maternal diseases,viscose products.Through internal and external validation,the Nomogram could predict the risk of MARSI in premature infants and help nurses to accurately screen the high-risk population of MARSI in premature infants.