Abstract: Background：Iatrogenic skin injury is a common problem in neonates admitted to NICU. Objective：To investigate the incidence of neonatal iatrogenic skin injury in NICUs in China. Design：Cross-sectional survey. Methods：Children's Hospital of Fudan University took the lead in establishing the NICU clinical data database of neonatal iatrogenic skin injury, which included 22 tertiary hospitals in 15 provinces, autonomous regions and municipalities directly under the central government. The causes of iatrogenic skin injury were related to diapers, viscose, pressure (including medical devices), surgery, vascular access, and physical or chemical factors. The continuous cases reported by NICUs of the cooperative hospitals were sent to the database, and the data were from the electronic medical record system or paper medical document records. The reported data included demographic data, medical devices use, iatrogenic skin injury events, the age, weight and length of hospital stay of the infant at the time of each iatrogenic skin injury, the location, size, type, color, treatment measures and prognosis of skin injury. The leading hospital trained the cooperating hospitals according to the indicators in the database and started data collection after passing the examination. The leading hospital was responsible for reviewing the data. Main outcome measures：Incidence of iatrogenic skin injury in NICU hospitalized neonates. Results：From December 1, 2019 to January 31, 2020, the data of NICU consecutive cases (n=8,126) collected by 22 cooperative hospitals were all qualified and included in this analysis. There were 521 cases of iatrogenic skin injury (6.4%), and the incidence of iatrogenic skin injury in NICU in children's specialized hospitals, general hospitals and maternal and child health hospitals were 7.4%(280/3,783), 6.4% (153/2,387) and 4.5%(88/1,956), respectively. There were 566 times of iatrogenic skin injury in 521 neonates, and 45 cases (8.6%) had two times of iatrogenic skin injury. The median age of neonates with iatrogenic skin injury was 6 (3, 17) days, those within 1 week after birth accounting for 57.4%(n=299). The median corrected gestational age of neonates with iatrogenic skin injury was 37.2% (32.7, 40.0) weeks, those with the corrected gestational age≥40 weeks accounting for 57.4%(n=294). The median weight of neonates with iatrogenic skin injury was 2,800 (1,9123,450) g, those with the weight≥2,500 g accounting for 59.1%(n=308). There were 250 cases of diaperrelated skin injury (48.0%), 81 cases of pressurerelated (including medical devicerelated) (15.5%), 69 cases of viscoserelated (13.2%), 70 cases of various physical and chemical factorsrelated (13.4%), 22 cases of vascular accessrelated (4.2%), 14 cases of surgeryrelated (2.7%), and 15 cases of other types (2.9%). The proportion of all kinds of iatrogenic skin injury in neonates aged 17 days was the highest. Except that pressurerelated skin injury was easy to occur in very low birth weight infants and iatrogenic viscoserelated skin injury was easy to occur in all body recombination, other types of skin injury mostly occurred in neonates weighing≥2,500 g. Pressure-related and viscose-related skin injuries mostly occurred in neonates with the corrected gestational age of 28-32 weeks. Vascular access-related skin injuries accounted for a relatively even proportion in each corrected gestational age group, and other skin injuries were more likely to occur in neonates with the corrected gestational age >32 weeks. Most iatrogenic skin injuries(78.9%) occurred within one-week hospitalization stay of <1 week. The incidence rate decreased week by week. Conclusion：The incidence of iatrogenic skin injury in NICU neonates in China was 6.4%. Diaper-related dermatitis, the application of medical devices, and the use of medical tape were the three main factors of iatrogenic skin injury in neonates. Iatrogenic skin injury was affected by many factors, such as gestational age, birth weight, and the use of various catheters.

Key words: Newborn, Iatrogenic skin injury, Intensive care unit, Multi-center, Incidence