Keywords
Advanced Wound Care
Burn Injuries
First 24 Hours
Dressing
How to Cite
Abstract
Introduction. Early management of paediatric burn wounds is a critical determinant of wound progression, healing time, and long-term outcomes. The first 24 hours after injury represent a dynamic phase in which clinical decisions regarding cleansing, antisepsis, dressing selection, and follow-up may influence burn wound conversion and complications. Despite available guidelines, early paediatric burn care remains heterogeneous, and real-world data describing institutional practices are limited.
Methods. A cross-sectional observational survey was conducted to describe early paediatric burn wound management practices in Italian burn centres. A structured, evidence-informed questionnaire was distributed electronically to designated clinical referents from 17 centres managing paediatric burns. Respondents were asked to report protocol-driven, centre-level practices regarding first aid, wound cleansing and antisepsis, initial dressing selection according to burn depth, timing of first reassessment, and caregiver education. Data were collected between May and June 2025 and analysed using descriptive statistics.
Results. Eleven professionals participated, predominantly nurses (90.9%), most of whom worked in major burn centres. Cooling with running water for 20 minutes was the most frequently reported first-aid measure across burn aetiologies (90.9%). Wound cleansing was performed in all centres, most commonly using normal saline (63.6%). Antisepsis was frequently adopted, particularly for flame burns (100%), with 0.05% sodium hypochlorite being the most commonly reported agent. Paraffin-impregnated gauze was the preferred dressing for first-degree (81.8%) and superficial partial-thickness burns (72.7%). For deep partial-thickness and small full-thickness burns (<5 cm), collagenase, silver alginate, and hydrogel were more frequently selected. First wound reassessment occurred within 24 hours in 63.6% of centres. Most respondents (81.8%) reported providing structured caregiver education focused on home dressing management and pain control.
Discussion and Conclusions. Early paediatric burn wound management practices in Italian burn centres appear broadly aligned with current first-aid and early reassessment recommendations. However, variability in antiseptic use and dressing selection persists, particularly for deeper burns, highlighting the need for shared, depth- and objective-driven frameworks to support early clinical decision-making and future multicentre consensus initiatives.
References
1. Subrata SA. A concept analysis of burn care in nursing. Scand J Caring Sci. 2021;35(1):75-85. https://doi.org/10.1111/scs.12847
2. World Health Organization. Burns. Geneva: WHO; 2024 [cited 2026 Jan 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/burns
3. Moi AL, Haugsmyr E, Heisterkamp H. Long-term study of health and quality of life after burn injury. Ann Burns Fire Disasters. 2016;29(4):295–299.
4. Giusti F, Martella A, Bertoni L, Seidenari S. Skin barrier, hydration, and pH of the skin of infants under 2 years of age. Pediatr Dermatol. 2001;18(2):93–96. 10.1046/j.1525-1470.2001.018002093.x
5. Nicolosi B, Parente E, Fontani I, Idrizaj S, Stringi D, Bamonte C, et al. Risk factors for skin injuries in hospitalized children: a retrospective study. Infermieristica J. 2024;3(4):277–285. https://doi.org/10.36253/if-3159
6. Patel KF, Rodríguez-Mercedes SL, Grant GG, Rencken CA, Kinney EM, Austen A, et al. Physical, psychological, and social outcomes in pediatric burn survivors aged 5 to 18 years: a systematic review. J Burn Care Res. 2022;43(2):343–352. https://doi.org/10.1093/jbcr/irab225
7. De Sousa A. Psychological aspects of paediatric burns: a clinical review. Ann Burns Fire Disasters. 2010;23(3):155–159.
8. Alharbi Z, Piatkowski A, Dembinski R, Reckort S, Grieb G, Kauczok J, et al. Treatment of burns in the first 24 hours: a simple and practical guide by answering 10 questions in a step-by-step form. World J Emerg Surg. 2012;7:13. https://doi.org/10.1186/1749-7922-7-13
9. Palackic A, Jay JW, Duggan RP, Branski LK, Wolf SE, Ansari N, et al. Therapeutic strategies to reduce burn wound conversion. Medicina (Kaunas). 2022;58(7):922. https://doi.org/10.3390/medicina58070922
10. Rowan MP, Cancio LC, Elster EA, Burmeister DM, Rose LF, Natesan S, et al. Burn wound healing and treatment: review and advancements. Crit Care. 2015;19:243. https://doi.org/10.1186/s13054-015-0961-2
11. Nicolosi B, García-Molina P, Veggi S, Pinzauti E, Pancani S. Oxygen-enriched oleic matrix medical dressings for the treatment of extensive burns and related acute and post-burn complications in children: a case series. Wounds UK. 2024;20(4):46–51
12. Resch A, Staud C, Radtke C. Nanocellulose-based wound dressing for conservative wound management in children with second-degree burns. Int Wound J. 2021;18(4):478–486. https://doi.org/10.1111/iwj.13548
13. Nischwitz SP, Luze H, Popp D, Winter R, Draschl A, Schellnegger M, et al. Global burn care and the ideal burn dressing reloaded: a survey of global experts. Burns. 2021;47(7):1665–1674. https://doi.org/10.1016/j.burns.2021.02.008
14. Selig HF, Lumenta DB, Giretzlehner M, Jeschke MG, Upton D, Kamolz LP. The properties of an “ideal” burn wound dressing: what do we need in daily clinical practice? Results of a worldwide online survey among burn care specialists. Burns. 2012;38(7):960–966. https://doi.org/10.1016/j.burns.2012.04.007
15. Kong MH, Baldwin AJ, Kerstein R. The impact of socioeconomic deprivation on the adequacy of burn first aid: a retrospective cohort study. Burns. 2026;52(2):107864. https://doi.org/10.1016/j.burns.2026.107864
16. Neriamparambil AJ, Sawhney R, Wong WL. Evidence-based management of burns: a narrative review of evolving practices. Eur Burn J. 2025;6(4):59. https://doi.org/10.3390/ebj6040059
17. Brychta P. European practice guidelines for burn care: minimum level of burn care provision in Europe. In: Jeschke MG, Kamolz LP, Sjöberg F, Wolf SE, editors. Handbook of Burns. Vienna: Springer; 2012. p. 97–102. https://doi.org/10.1007/978-3-7091-0348-7_6
18. van de Warenburg MS, Teeuwen B, Hummelink S, Ulrich DJ, Vehmeijer-Heeman ML. Does the dressing matter in pediatric partial-thickness burns: a systematic review and meta-analysis. Burns. 2025;51(4):107428. https://doi.org/10.1016/j.burns.2025.107428
19. Anderson DI, Fordyce EM, Vrouwe SQ. The quality of survey research in burn care: a systematic review. Burns. 2022;48(8):1825–1835. https://doi.org/10.1016/j.burns.2022.01.009
20. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–349. https://doi.org/10.1016/S0140-6736(07)61602-X
21. Bettencourt AP, McHugh MD, Sloane DM, Aiken LH. Nurse staffing, the clinical work environment, and burn patient mortality. J Burn Care Res. 2020;41(4):796–802. https://doi.org/10.1093/jbcr/iraa061
22. Stiles K, Goodwin N. British Burn Association first aid clinical practice guidelines. London: British Burn Association; 2020.
23. Griffin B, Cabilan CJ, Ayoub B, Xu HG, Palmieri T, Kimble R, et al. The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: a systematic review and meta-analysis. Australas Emerg Care. 2022;25(4):367–376. https://doi.org/10.1016/j.auec.2022.05.004
24. Griffin BR, Frear CC, Babl F, Oakley E, Kimble RM. Cool running water first aid decreases skin grafting requirements in pediatric burns: a cohort study of 2495 children. Ann Emerg Med. 2020;75(1):75–85. https://doi.org/10.1016/j.annemergmed.2019.06.028
25. Holbert MD, Singer Y, Palmieri T, Rose J, Mackey K, Singh S, et al. Cool running water as a first aid treatment for burn injuries. Ann Emerg Med. 2026;87(1):90–102. https://doi.org/10.1016/j.annemergmed.2025.08.003
26. Hayek S, El Khatib A, Atiyeh B. Burn wound cleansing: a myth or a scientific practice. Ann Burns Fire Disasters. 2010;23(1):19–24.
27. Carter JE, Amani H, Carter D, Foster KN, Griswold JA, Hickerson WL, et al. Evaluating real-world national and regional trends in definitive closure in U.S. burn care: a survey of U.S. burn centers. J Burn Care Res. 2021;43(1):141–148. https://doi.org/10.1093/jbcr/irab151
28. Chai H, Chaudhari N, Kornhaber R, Cuttle L, Fear M, Wood F, et al. Chemical burn to the skin: a systematic review of first aid impacts on clinical outcomes. Burns. 2022;48(7):1527–1543. https://doi.org/10.1016/j.burns.2022.05.006
29. Scalise A. The new formulation of the 0.05% sodium hypochlorite electrolytic solution for cutaneous use: reasons and advantages. AboutOpen. 2021;8(1):14–22. https://doi.org/10.33393/ao.2021.2221
30. Slaviero L, Avruscio G, Vindigni V, Tocco-Tussardi I. Antiseptics for burns: a review of the evidence. Ann Burns Fire Disasters. 2018;31(3):198–203.
31. Pham CH, Collier ZJ, Fang M, Howell A, Gillenwater TJ. The role of collagenase ointment in acute burns: a systematic review and meta-analysis. J Wound Care. 2019;28(Suppl 2):S9–S15. https://doi.org/10.12968/jowc.2019.28.Sup2.S9
32. Jeyaraman M, Jeyaraman N, Ramasubramanian S, Nallakumarasamy A, Murugan S, Jayakumar T, et al. Efficacy of dialkylcarbamoylchloride (DACC)-impregnated dressings in surgical wound management: a review. Eur Burn J. 2025;6(1):1. https://doi.org/10.3390/ebj6010001
33. Nicolosi B, Parente E. Use of antimicrobial dialkyl carbamoyl chloride (DACC) surface dressings for the treatment of infected post-surgical complications in neonates with low risk of adverse reactions: a case series in the AOU Meyer NICU. Infermieristica J. 2023;2(1):39–45. https://doi.org/10.36253/if-2105
34. Khundkar R, Malic C, Burge T. Use of Acticoat dressings in burns: what is the evidence? Burns. 2010;36(6):751–758. https://doi.org/10.1016/j.burns.2009.04.008
35. Wasiak J, Cleland H, Campbell F. Dressings for superficial and partial thickness burns. Cochrane Database Syst Rev. 2008;(4):CD002106. https://doi.org/10.1002/14651858.CD002106.pub4
36. Douglas HE, Wood F. Burns dressings. Aust Fam Physician. 2017;46(3):94–97. https://www.racgp.org.au/afp/2017/march/burns-dressings/
37. Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nat Rev Dis Primers. 2020;6(1):11. https://doi.org/10.1038/s41572-020-0145-5
38. Ciornei B, David VL, Popescu D, Boia ES. Pain management in pediatric burns: a review of the science behind it. Glob Health Epidemiol Genom. 2023;2023:9950870. https://doi.org/10.1155/2023/9950870
39. Haruta A, Mandell SP. Assessment and management of acute burn injuries. Phys Med Rehabil Clin N Am. 2023;34(4):701–716. https://doi.org/10.1016/j.pmr.2023.06.019
40. Chen Y, Cai T, Le P, Zhang L, Chen Y, Wu L, et al. Family caregivers’ perceptions and challenges in the care of pressure injuries in daily life: a qualitative study. BMC Geriatr. 2025;25:490. https://doi.org/10.1186/s12877-025-06114-1
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Biagio Nicolosi, Ariela Rogai, Benedetta Di Falco, Eleonora Bastarelli, Carlotta Bini, Davide Griffa, Maria Minoia, Stefania Allegri, Luisa Lorenzo, Manuela Stangoni, Flavio Facchini, Guido Ciprandi, Antonio Di Lonardo