King Edward Memorial Hospital study using cutting-edge tech to transform care of preterm babies’ skin

Doctors and nurses at King Edward Memorial Hospital are using cutting-edge technology in a global first to take a closer look at the fragile skin of preterm babies. An often-overlooked challenge of neonatal care is that preterm babies have delicate, paper-thin skin which tears easily. That means every procedure, adhesive and touch is a risk. As the first line of defence against infection for these tiny patients, healthy skin is essential for temperature regulation and fluid balance. And about half of the tiniest babies who stay in KEMH’s neonatal intensive care unit develop skin injuries in their first two weeks of life. KEMH consultant neonatologist Tobias Strunk plans to change that through a world-first study using the sophisticated imaging technology. “It’s a fantastic new development. It’s a machine that provides us with very detailed images of a newborn’s skin, just like we were looking under the microscope, but without having to take a skin sample,” Dr Strunk said. The DeepLive Optical Coherence Tomography scanner gives a detailed, three-dimensional view of the superficial layers of the skin, and can be used to identify early signs of skin stress or breakdown. It has predominantly been used for detecting and monitoring skin cancers and other dermatological imaging, but it was Dr Strunk’s idea to try it on vulnerable newborns given the ongoing challenges of neonatal skincare. “Skincare really has emerged as one of the challenges looking after our tiniest babies, because the skin is so immature and really not made to come in contact with the outside world just yet,” he said. “It (skin) provides the mechanical and chemical barrier that is essential to protect babies from infections. “We know that poor skin integrity is closely related to the risk of acquiring infections that can be life-threatening to babies.” The non-invasive technology can be used at the bedside, similar to an ultrasound, helping medical staff safely monitor neonates’ fragile skin — in real time — throughout their NICU stays. It is the first time this cutting-edge technology has been used in WA, and the first time it has been used specifically for neonatal skincare anywhere in the world. “We are really asking, how does the skin mature? What injures the skin and how can we prevent it? And which therapy works best?” Dr Strunk said. Baby Iris, pictured, is one of the neonates who currently has use of the DeepLive scanner. Born just shy of 25 weeks, she weighed little more than a standard loaf of bread at 823g. The tiny warrior is doing well 10 days into her stay at the NICU and, with the scanner at their fingertips, doctors and nurses can keep a close eye on some of the more vulnerable areas of her skin. Dr Strunk said he and his team had recruited about 20 neonates for the study so far. He hopes to get that number closer to 100. The research could help transform neonatal skincare, paving the way for a significant reduction in skin injuries in neonates like Iris and the more than 26,000 babies born preterm in Australia every year. Slashing those numbers could also result in fewer infections, less scarring, and shorter hospital stays for neonates and their families. “The machine provides such detailed imaging that we hope that in the future, we’ll be able to tell the injuries to the skin are occurring before our eyes can pick it up,” Dr Strunk said. “That’s been one of our limitations. “We could only look with our naked eye, so when the skin becomes red and it looks dry, it’s probably too late. We need to know earlier and this may be the tool that tells us when to act before our eyes can tell us.” Procuring the $400,000 machine for the two-year pilot study was made possible through support from Telethon and Mineral Resources. MinRes director people Andrea Chapman said the company was “proud to play a part” in funding some of the life-changing innovations being realised through Telethon. “The DeepLive OCT machine is an extraordinary example of how technology can give premature babies a stronger, healthier start to life, and we’re proud to play a part in making that possible,” Ms Chapman said.