Recorded NICU pressure injuries fell abruptly; the reason remains unresolved

In one Italian NICU, 121 pressure-injury events were recorded in 83 neonates across 49,134 patient-days. Event density fell abruptly in January 2020 (IRR 0.378, 95% CI 0.148-0.963), while 113/121 events were device-related. The study cannot separate safer care from changes in case mix, device exposure, or reporting.

The hot take

The clearest safety signal is that devices accounted for 113 of 121 recorded events. The abrupt 2020 fall remains unexplained.

Dussi and colleagues analyzed every pressure-injury event recorded from January 2018 through December 2024 in one 30-bed tertiary NICU in northern Italy. The surveillance file contained 121 events among 83 neonates and 49,134 patient-days. It did not contain total admissions, device-days, or a tested prevention intervention.

The chart shows a break, not a smooth improvement: 4.80 and 4.73 events per 1,000 patient-days in 2018 and 2019, then 1.70 in 2020 and values between 1.08 and 1.85 thereafter. A segmented quasi-Poisson model with a prespecified January 2020 breakpoint estimated an immediate level change of IRR 0.378 (95% CI 0.148-0.963; p=0.044). Neither the pre-break monthly slope (IRR 1.010; p=0.786) nor the post-break slope (IRR 0.985; p=0.677) was statistically significant.