From the Guidelines
The management of pediatric decubital ulcers should prioritize prevention through frequent repositioning, use of pressure-redistributing surfaces, and good skin hygiene, alongside a comprehensive approach to wound care and nutritional support. This approach is supported by evidence from studies such as 1 and 1, which highlight the importance of multifaceted care in managing pressure ulcers.
Prevention Strategies
Prevention is key and includes:
- Frequent repositioning every 2-4 hours to reduce prolonged pressure on any single area
- Use of pressure-redistributing surfaces like specialized mattresses or cushions
- Maintaining good skin hygiene to prevent infection
Wound Care
For established ulcers, treatment involves:
- Thorough wound assessment using a validated tool to determine severity
- Gentle cleansing with normal saline or mild soap and water
- Debridement of necrotic tissue when necessary, using enzymatic agents for children
- Appropriate dressing selection, with hydrocolloid dressings suitable for stage I-II ulcers and alginate or foam dressings better for more exudative wounds
Nutritional Support
Nutritional support is critical, with a focus on:
- Adequate protein (1.5-2 g/kg/day)
- Sufficient calories
- Micronutrients like vitamin C and zinc to promote healing, as supported by 1 which notes that nutritional supplementation with protein or amino acids improves the rate of wound healing.
Additional Considerations
- Pain management using age-appropriate scales and medications
- Topical antimicrobials like silver-containing dressings for infected wounds, with systemic antibiotics reserved for spreading infections
- Surgical consultation for stage III-IV ulcers, considering the evidence from 1 regarding the role of surgery in advanced-stage pressure ulcers.
By prioritizing these aspects of care, healthcare providers can effectively manage pediatric decubital ulcers, reducing morbidity, mortality, and improving quality of life for affected children.
From the Research
Management of Pediatric Decubital Ulcers
The management of pediatric decubital ulcers involves a comprehensive approach to prevent and treat these ulcers.
- Prevention is key, and this can be achieved by avoiding excessive pressure, encouraging movement, and minimizing risk factors such as malnutrition, poor circulation, and underlying diseases that impair mobility 2.
- A team-focused approach integrating all aspects of care, including pressure relief, infection control, nutrition, and surgery, may improve healing rates 3.
- Dressings and topical agents can be used to treat pressure ulcers, but the evidence is sparse and of low or very low certainty, making it unclear which dressings or topical agents are the most likely to heal pressure ulcers 4.
Risk Assessment and Prevention
- Risk factors for the development of decubitus ulcers should be assessed at the time of the physician's first contact with an immobile patient, or as soon as the patient's condition deteriorates 2.
- Therapeutic measures should be undertaken on the basis of the patient's individual risk profile, with an emphasis on active encouragement of movement and passive relief of pressure through frequent changes of position 2.
- Susceptibility to pressure ulcers comes from a combination of external factors (pressure, friction, shear force, and moisture), and internal factors (e.g. fever, malnutrition, anaemia, and endothelial dysfunction) 3.
Treatment Options
- There are many options for treating pressure ulcers, including alginate, hydrocolloid, and protease-modulating dressings, as well as topical agents such as collagenase ointment and polyvinylpyrrolidone plus zinc oxide 4.
- However, the evidence is limited, and more research is needed to determine which dressings or topical agents are the most effective in promoting healing 4.
- A clear and current overview of all the evidence is required to facilitate decision-making regarding the use of dressings or topical agents for the treatment of pressure ulcers 4.