Prevention Decalogue for Dependency-Related Skin Lesions in Neonates: A Consensus-Based Delphi Study

Introduction. The extreme fragility of neonatal skin, particularly in extremely preterm infants, underscores the need for effective preventive measures. This study aims to validate and design a decalogue for the prevention of dependency-related skin lesions (DRSL) in the neonatal population, based on existing consensus documents. Methods. The Delphi method was employed to validate the content of the decalogue through expert consultation across Spain. Key criteria—including relevance, clarity, ambiguity, simplicity, satisfaction, and applicability—were assessed using a 4-point Likert scale and a 10-point scale, with a 75% agreement threshold for validation. Descriptive statistics were used to analyze responses. Items not meeting the threshold were revised based on qualitative feedback and re-evaluated. The final list of interventions was established through consensus in the second round. Results. A total of 23 experts participated in the first round, and 20 in the second. Across both rounds, all items were validated with a high level of agreement. In the second round, all items exceeded 85% agreement for relevance, clarity, ambiguity, and simplicity. The average satisfaction (9.36–9.47) and applicability (9.09–9.42) revealed a high level of agreement concerning the clinical applicability of the Decalogue. The decalogue outlines essential measures for preventing DRSL in neonates, including risk assessment, postural changes, the use of specialized pressure-relieving surfaces, and monitoring of device-related pressure points. It also highlights the importance of tailored skin care based on neonatal maturity and the need for thorough documentation of preventive interventions. Discussion. Consensus achieved via the Delphi process substantiates the Decalogue’s capacity to effectively articulate key preventive strategies with clarity and brevity. Moreover, its implementation will foster evidence-based care practices, ultimately enhancing the quality of care in neonatal units. However, ongoing efforts are required to further improve DRSL prevention and continuously update strategies in light of emerging evidence.