Skin injuries in newborns hospitalized in neonatal intensive care: a cross-sectional study

Tenfen, Carolina; Barreto, Grasiely Masotti Scalabrin; Moreira, Neide Martins; Ferreira, Helder; Zilly, Adriana; Silva, Rosane Meire Munhak da

doi:10.1590/1980-220X-REEUSP-2024-0058en

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Original Article • Rev. esc. enferm. USP 58 • 2024 • https://doi.org/10.1590/1980-220X-REEUSP-2024-0058en linkcopy

Skin injuries in newborns hospitalized in neonatal intensive care: a cross-sectional study^*

Lesiones cutáneas en recién nacidos hospitalizados en cuidados intensivos neonatales: estudio transversal

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To analyze the skin injuries of hospitalized newborns and identify factors related to the number of lesions.

Method: This was a cross-sectional epidemiological study carried out over a period of one year in a Neonatal Intensive Care Unit in the west of Paraná. The study included 74 newborns with a score ≥5 on the Newborn Skin Condition Scale. Data analysis by chi-square and Pearson's test (p < 0.05).

Results: The frequency was 25.4%, 59.4% had more than one lesion, mainly dermatitis and pressure injury. Birth characteristics were not related to the number of lesions. Not using antibiotics and parenteral nutrition, hemoglobin >11g/dl, phototherapy, pain score <4 and hospitalization >30 days were related to the number of lesions. The presence of two injuries led to longer healing time and three to longer hospitalization. A higher score on the Skin Condition Scale was related to healing time and late start of the diet.

Conclusion: Skin injuries were found to be infrequent among newborns, but there is still a need to improve practices to prevent and maintain skin integrity.

DESCRIPTORS
Wounds and Injuries; Skin; Infant, Newborn; Intensive Care Units, Neonatal; Neonatal Nursing

Characteristics	n	%	P-value
Sex
Female	32	43.2	0.2955
Male	42	56.8
Birth weight (grams)
<1,000	10	13.5	0.0471
1,000 e <1,500	16	21.6
1,500 e <2,500	22	29.7
≥2,500	26	35.1
Gestational age (weeks)
<28	13	17.6	0.1462
28 e <32	9	12.2
32 e <35	21	28.4
35 e <37	12	16.2
≥37	19	25.7
Apgar score 1 ^st minute
0-3	25	33.8	0.1797
4-6	18	24.3
7-10	31	41.9
Apgar score 5 ^th minute
0-3	4	5.4	0.0001
4-6	13	17.6
7-10	57	77.0

Characteristics	1 lesion		2 lesions		3 lesions		P-value
Characteristics	n	%	n	%	n	%	P-value
Sex
Female	23	45.1	5	41.7	4	36.4	0.8668
Male	28	54.9	7	58.3	7	63.6
Birth weight (grams)
<1,000	5	9.8	3	25.0	2	18.2	0.0909
1,000 e <1,500	12	23.5	0	0.0	4	36.4
1,500 e <2,500	15	29.4	3	25.0	4	36.4
≥2,500	19	37.3	6	50.0	1	9.1
Gestational age (weeks)
<28	7	13.7	2	16.7	4	36.4	0.0802
28 e <32	8	15.7	1	8.3	0	0.0
32 e <35	15	29.4	2	16.7	4	36.4
35 e <37	8	15.7	1	8.3	3	27.3
≥37	13	25.5	6	50.0	0	0.0
Apgar score 1 ^st minute
0-3	16	31.4	3	25.0	6	54.5	0.4929
4-6	14	27.5	2	16.7	2	18.2
7-10	21	41.2	7	58.3	3	27.3
Apgar score 5 ^st minute
0-3	2	3.9	1	8.3	1	9.1	0.8540
4-6	8	15.7	2	16.7	3	27.3
7-10	41	80.4	9	75.0	7	63.6

Characteristics	1 lesion		2 lesions		3 lesions		P-value
Characteristics	n	%	n	%	n	%	P-value
Antibiotics
No	4	7.8	1	8.3	11	100.0	0.0001
Yes	47	92.2	11	91.7	0	0.0
Hemoglobin
< 11g/dl	6	11.8	3	25.0	3	27.3	0.2989
≥ 11g/dl	45	88.2	9	75.0	8	72.7
Total parenteral nutrition
No	32	62.7	10	83.3	3	27.3	0.0215
Yes	19	37.3	2	16.7	8	72.7
Phototherapy
No	20	39.2	5	41.7	5	45.5	0.9298
Yes	31	60.8	7	58.3	6	54.5
Length of stay
Up to 7 days	5	9.8	0	0.0	0	0.0	0.6450
8 -14 days	9	17.6	2	16.7	1	9.1
15 - 30 days	12	23.5	4	33.3	2	18.2
More than 30 days	25	49.0	6	50.0	8	72.7
NIPS *
<4	42	82.4	10	83.3	8	72.7	0.7736
≥4	9	17.6	2	16.7	3	27.3

Characteristics	1 lesion	2 lesions	3 lesions	P-value
Characteristics	Mean (SD)	Mean (SD)	Mean (SD)	P-value
Birth weight	2091,51 (892,87)	1701,82 (705,26)	2311,25 (1147,25)	0.2716
Gestational age	33,27 (3,87)	31,27 (4,05)	34,42 (4,85)	0.1738
Apgar score 1^st minute	5,02 (2,87)	3,73 (2,80)	5,75 (3,19)	0.2440
Apgar score 5^th minute	7,33 (2,08)	6,64 (1,75)	7,58 (2,10)	0.5122
NSCS*	5,45 (0,64)	5,64 (0,81)	5,58 (0,67)	0.6426
NIPS**	1,65 (2,0)	1,55 (2,30)	1,42 (1,73)	0.9339
Healing (days)	33,33 (25,14)	50,73 (35,30)	10,22 (8,39)	0.5549
Hospitalization (days)	10,33 (11,63)	15,63 (19,94)	38,33 (23,23)	0.1450

Variables	N	R*	CI (95%)	Valor p
Birth weight	114	–0.030	(–0.15; 0.21)	0.7305
Weight at onset of lesion	114	–0.023	(0.21; 0.16)	0.8058
Gestational age	114	–0.011	(–0.19; 0.17)	0.9036
Apgar 1^st minute	114	–0.243	(–0.41; 0.06)	0.0089
Apgar score 5^th minute	114	–0.309	(–0.47; –0.13)	0.0008
Healing (days)	87	0.106	(–0.11; 0.31)	0.3274
Hospitalization (days)	114	–0.223	(–0.39; –0.04)	0.0168
NIPS**	114	–0.239	(–0.41; –0.06)	0.0104
Hemoglobin	113	0.198	(0.01; 0.37)	0.0357
Hematocrit	113	0.195	(0.01; 0.37)	0.0388
Amount of ATB***	114	–0.218	(–0.39; –0.04)	0.0193
Start of diet (days)	109	0.196	(0.01; 0.37)	0.0403

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E-mail: reeusp@usp.br

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[TFN1] ^*
Neonatal Infant Pain Scale.

Skin injuries in newborns hospitalized in neonatal intensive care: a cross-sectional study*

Lesiones cutáneas en recién nacidos hospitalizados en cuidados intensivos neonatales: estudio transversal

Skin injuries in newborns hospitalized in neonatal intensive care: a cross-sectional study^*