Yeni Doğanlarda Deri Bakımı: Bez Dermatiti ve Yönetimi

Yıl 2023, , 302 - 314, 01.06.2023

Tuba Gıynaş , Figen Yardımcı

https://doi.org/10.52880/sagakaderg.1195064

Öz

İnsan vücudunun yüzey alanı en geniş ve ağırlığı en fazla organı olan deri, dış çevreden gelebilecek fiziksel, kimyasal, biyolojik etkenlere karşı insan vücudu için koruyucu bir bariyer görevi görür. Ayrıca vücut sıcaklığının düzenlemesi, vücuttan çıkan aşırı kaybının önlemesi ve duyusal algıya katkı sağlama gibi önemli fonksiyonları vardır. Bu fonksiyonları yerine getirmek için deri epidermis, dermis ve derialtı dokusu olmak üzere üç temel katmandan oluşur. Cildin gelişimi ve olgunlaşma süreci yaş dönemlerine göre farklılık göstermektedir. Yenidoğan cilt yapısı; morfolojik ve fonksiyonel yönden yetişkin cilt yapısından farklıdır. Bunun nedeni yenidoğanların yaşamının ilk günlerinde, intrauterin ortamdaki sıcak ve sıvı ile dolu bir ortamdan, soğuk ve kuru olan dış ortama geçmesi, yenidoğan döneminden itibaren ciltte değişimlerin olması, yapı ve fonksiyonlarında gelişmelerin sürekli devam etmesidir. Bebek bezi dermatitinde temel unsur önlemektir. Geliştikten sonra genel amaç ise, enfeksiyonu azaltmak, ciltteki hasarı onarmak ve tekrar hasar oluşumunu önlemektir. Pişik cilt maserasyonu ve tahriş edici maddelerle uzun süreli temasta dahil olmak üzere birçok faktörün etkileşimi sonucu, cilt bariyerinin bozulmasına yol açan en yaygın cilt sorunlarından birisidir. Karmaşık ve multifaktöriyel bir etiyolojiye sahiptir. Pişiği önlemek ve yönetmek etiyolojisinin iyi bilinmesi ve nedensel faktörlerin ortadan kaldırılması ile mümkündür. Hem önleme hem de tedavi için farmakolojik olmayan pişik önleyici yaklaşımlar hava, bariyer, temizlik, bebek bezi ve eğitimi olmak üzere 5 maddede toplanmış ve “ABCDE” harfleri verilmiştir. Yenidoğanın deri bütünlüğünü korumak için önlemler, ebeveynler ve diğer bakım verenler tarafından güvenli bir şekilde sağlanmalıdır.

Anahtar Kelimeler

Yenidoğan, cilt bakımı, risk değerlendirmesi, bez dermatiti, bebek bezi

Destekleyen Kurum

YOK

Proje Numarası

YOK

Teşekkür

YOK

SKIN CARE IN NEWBORNS: DIAPER DERMATITIS AND ITS MANAGEMENT

Öz

Skin, which has the largest surface area and the most weight in the human body, acts as a protective barrier for the human body against physical, chemical and biological factors that may come from the external environment. In addition, it has important functions such as regulating body temperature, preventing excessive loss from the body and contributing to sensory perception. The skin consists of three basic layers that are morphologically different from the outside to the inside, including epidermis, dermis and subcutaneous tissue (subcutis) in order to fulfill these functions. The development and maturation process of the skin differ according to age periods. Newborn skin structure is different from adult skin structure in terms of morphological and functional aspects. The reason for this is that newborns pass from a warm and liquid filled environment in the intrauterine environment to a cold and dry external environment in the first days of life, that there are changes in the skin starting from the newborn period, and that development of its structure and functions continue. The primary element for the diaper dermatitis is prevention. The general aim is to reduce infection, repair damage in the skin and prevent re-damage after development. Rash is one of the most common skin problems in newborns and babies. It leads to disruption of the skin barrier as a result of the interaction of many factors including rash skin maceration and prolonged contact with irritants. It has a complex and multifactorial etiology. Preventing and managing diaper rash is possible with good knowledge of its etiology and elimination of causal factors. Non-pharmacological rash prevention approaches for both prevention and treatment collected in 5 items including air, barrier, cleaning, diaper and education, and the letters “ABCDE” were given. The precautions to protect the skin integrity of the newborn should be safely provided by parents and other caregivers.

Anahtar Kelimeler

Newborn, skin care, risk assessment, diaper dermatitis, diaper

Proje Numarası

YOK

Kaynakça

• Amer, M., Diab, N., Soliman, M., Amer, A. (2017). Neonatal skin care: what should we do? A four-week follow-up randomized controlled trial at Zagazig University Hospitals. International Journal of Dermatology, 56, 1198-1203.
• Proksch, E. (2018). pH in nature, humans and skin. Journal of Dermatology, 45, 1044-1052.
• McGrath, J.; Eady, R.; Pope, F. (2004). Anatomy and organization of human skin. In Rook’s Textbook of Dermatology; John Wiley and Sons: Hoboken, NJ, USA. Volume 1, pp. 3.2–3.80.
• Menon, G. K. (2015). Skin basics; structure and function. In Lipids and skin health (pp. 9-23). Springer, Cham.
• Rahma, A., & Lane, M. E. (2022). Skin Barrier Function in Infants: Update and Outlook. Pharmaceutics, 14(2), 433.
• Irvine, D.A., Hoeger, H.P. ve Yan, C.A. (2011). Harper’s Textbook of Pediatric Dermatology. 3. Baskı. Wiley-Blackwell. 300-312
• Dyer, J. A. (2013, February). Newborn skin care. In Seminars in Perinatology (Vol. 37, No. 1, pp. 3-7). WB Saunders.
• Visscher, M. O. (2009). Update on the use of topical agents in neonates. Newborn and Infant Nursing Reviews, 9, 31-47.
• Kulukian, A. ve Fuchs, E. (2013). Spindle Orientation and Epidermal Morphogenesis. Philosophical Transactions of the Royal Society Biological Sciences. 368(1629).
• Iarkowski, L. E., Tierney, N. K., & Horowitz, P. (2013). Tolerance of skin care regimen in healthy, full-term neonates. Clinical, cosmetic and investigational dermatology, 6, 137.
• Stamatas, G. N., Nikolovski, J., Mack, M. C., & Kollias, N. (2011). Infant skin physiology and development during the first years of life: a review of recent findings based on in vivo studies. International journal of cosmetic science, 33(1), 17-24.
• Elias, P.M. (1983). Epidermal lipids, barrier function, and desquamation. J. Investig. Dermatol, 80, 44–49.
• Ananthapadmanabhan, K.; Mukherjee, S.; Chandar, P. (2013). Stratum korneum fatty acids: Their critical role in preserving barrier integrity during cleansing. Int. J. Cosmet. Stratum Korneumi, 35, 337–345.
• Kabashima, K., Honda, T., Ginhoux, F., & Egawa, G. (2019). The immunological anatomy of the skin. Nature Reviews Immunology, 19(1), 19-30.
• Candi, E., Schmidt, R., & Melino, G. (2005). The cornified envelope: a model of cell death in the skin. Nature reviews Molecular cell biology, 6(4), 328-340.
• Visscher, M., Narendran, V. (2014). Neonatal infant skin: Development, structure and function. Newborn and Infant Nursing Reviews, 14 (4), 135–141.
• Dhar, S. (2007). Newborn skin care revisited. Indian Journal of Dermatology, 52(1), 1.
• Paige DG, Gennery AR, Cant AJ. (2010). The neonate. Rook’s textbook of dermatology. Ed. Burns T, Breathnach S, Cox N, Griffiths C. 8’inci baskı. Oxford, WileyBlackwell, 17.1-17.85.
• Paller, S.A. ve Mancini, J.A. (2016). Hurwitz Clinical Pediatric Dermatology. 5. Baskı. Elsevier. 211-218.
• Oranges, T., Dini, V., & Romanelli, M. (2015). Skin physiology of the neonate and infant: clinical implications. Advances in wound care, 4(10), 587-595.
• Evans NJ, Rutter N. (1986). Development of the epidermis in the newborn. Biol Neonate, 49:74–80 Fluhr, J. W., Darlenski, R., Taieb, A., Hachem, J. P., Baudouin, C., Msika, P., ... & Berardesca, E. (2010). Functional skin adaptation in infancy–almost complete but not fully competent. Experimental dermatology, 19(6), 483-492.
• Haubrich, K. A. (2003). Role of Vernix caseosa in the neonate: potential application in the adult population. AACN Advanced Critical Care, 14(4), 457-464.
• Adam, R. (2008). Skin Care of the Diaper Area, Pediatric Dermatology Vol. 25, Wiley. Bautista, M. I. B., Wickett, R. R., Visscher, M. O., Pickens, W. L., & Hoath, S. B. (2000). Characterization of vernix caseosa as a natural biofilm: comparison to standard oil‐based ointments. Pediatric dermatology, 17(4), 253-260.
• Walker, L., Downe, S., & Gomez, L. (2005). Skin care in the well term newborn: two systematic reviews. Birth, 32(3), 224-228.
• World Health Organization. Department of Reproductive Health. (2003). Pregnancy, childbirth, postpartum, and newborn care: a guide for essential practice. Oygür N, Önal E, Zenciroğlu A. (2016). Türk Neonatoloji Derneği, Doğum Salonu Yönetimi Rehberi. Brandon D, Hill CM, Heimall., L, Lund CH, Kuller J, McEwan T, ve ark. (2018). Neonatal Skin Care: Evidence-Based Clinical Practice Guideline. (4th ed.). Washington DC: Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN).
• Visscher, M., & Geiss, S. (2014). Emollient Therapy for Newborn Infants—A Global Perspective. Newborn and Infant Nursing Reviews, 14(4), 153-159.
• Cohen BA, Siegfried EC: Newborn skin: Development and basic science. ED. Taeusch W, Ballard RA, Gleason CA. Avery’s diseases of the newborn. 8th ed. Philadelphia, Elsevier, 2005;1471-82.
• Jackson, A. (2008). Time to review newborn skincare. Infant, 4(5), 168-71.
• Utaş, S. (2011). Yeni Doğanlarda Deri Bakımı. Archives of the Turkish Dermatology & Venerology/Turkderm, 45(3).
• Sarkar, R., Basu, S., Agrawal, R. K., & Gupta, P. (2010). Skin care for the newborn. Indian pediatrics, 47(7), 593-598.
• Fernandes, J. D., Machado, M. C. R., & Oliveira, Z. N. P. D. (2011). Children and newborn skin care and prevention. Anais brasileiros de dermatologia, 86, 102-110.
• Stamatas, G. N., Nikolovski, J., Luedtke, M. A., Kollias, N., & Wiegand, B. C. (2010).
• Infant skin microstructure assessed in vivo differs from adult skin in organization and at the cellular level. Pediatric dermatology, 27(2), 125-131.
• Bender, J. K., Faergemann, J., & Sköld, M. (2017). Skin health connected to the use of absorbent hygiene products: a review. Dermatology and therapy, 7(3), 319-330.
• Rawlings, A. V., & Matts, P. J. (2005). Stratum corneum moisturization at the molecular level: an update in relation to the dry skin cycle. Journal of Investigative Dermatology, 124(6), 1099-1110.
• Cohen, J. C., Hartman, D. G., Garofalo, M. J., Basehoar, A., Raynor, B., Ashbrenner, E., & Akin, F. J. (2009). Comparison of closed chamber and open chamber evaporimetry. Skin research and technology, 15(1), 51-54.
• Chiou, Y. B., & Blume-Peytavi, U. (2004). Stratum corneum maturation. Skin pharmacology and physiology, 17(2), 57-66.
• Hoeger, P. H., & Enzmann, C. C. (2002). Skin physiology of the neonate and young infant: a prospective study of functional skin parameters during early infancy. Pediatric dermatology, 19(3), 256-262.
• Yosipovitch, G., Maayan-Metzger, A., Merlob, P., & Sirota, L. (2000). Skin barrier properties in different body areas in neonates. Pediatrics, 106(1), 105-108.
• Çiğdem, Z. (2015). Yenidoğan cildinin özellikleri ve değerlendirilmesi. Türkiye Klinikleri Pediatric Nursing-Special Topics, 1 (2), 1-5.
• Odio, M., & Thaman, L. (2014). Diapering, diaper technology, and diaper area skin health. Pediatric Dermatology, 31, 9-14.
• Owa, A., Oladokun, R., & Osinusi, K. (2017). Skin pH and transepidermal water loss values in children with diaper dermatitis in Ibadan, Nigeria. Pediatric Dermatology, 34(3), 303-307.
• Atherton, D. J. (2016). Understanding Irritant Napkin Dermatitis. International Journal of Dermatology, 55(S1): 7-9.
• Blume‐Peytavi, U., Hauser, M., Lünnemann, L., Stamatas, G. N., Kottner, J., & Garcia Bartels, N. (2014). Prevention of diaper dermatitis in infants—a literature review. Pediatric dermatology, 31(4), 413-429.
• Merrill, L. (2015). Prevention, treatment and parent education for diaper dermatitis. Nursing for women's health, 19(4), 324-337.
• Stamatas, G. N. ve Tierney, N. K. (2014). Diaper dermatitis: etiology, manifestations, prevention, and management. Pediatric Dermatology, 31(1), 1–7.
• Klunk, C., Domingues, E., & Wiss, K. (2014). An update on diaper dermatitis. Clinics in dermatology, 32(4), 477-487.
• Atherton, D.J. (2001). The aetiology and management of irritant diaper dermatitis. European Academy of Dermatology and Venereology, 15(1), 1-4.
• Van Gysel, D., Kenneall., y, D., & Hatzopolous, I. (2012). Skin care and environmental sustainability improvements with baby diaper developments. Eur J Obstet Gynecol, 7(suppl 1), 31-34.
• Jesca, M., & Junior, M. (2015). Practices regarding disposal of soiled diapers among women of child bearing age in poor resource urban setting. J. Nurs. Health Sci, 4(4), 63-67.
• Shin, H. T. (2005). Diaper dermatitis that does not quit. Dermatologic therapy, 18(2), 124-135.
• Odio, M., Streicher-Scott, J., & Hansen, R. C. (2001). Disposable baby wipes: efficacy and skin mildness. Dermatology Nursing, 13(2), 107.
• Blume-Peytavi, U. ve Kanti, V. (2018). Prevention and treatment of diaper dermatitis. Pediatric Dermatology, 35, 19–23.
• Campbell, R. L., Seymour, J. L., Stone, L. C., & Milligan, M. C. (1987). Clinical studies with disposable diapers containing absorbent gelling materials: evaluation of effects on infant skin condition. Journal of the American Academy of Dermatology, 17(6), 978-987.
• Baer, E. L., Davies, M. W., & Easterbrook, K. (2006). Disposable nappies for preventing napkin dermatitis in infants. Cochrane Database of Systematic Reviews, (3).
• Akşit, S. (2001). Diaper dermatit. Sürekli Tıp Eğitimi Dergisi, 10(9), 328-329.
• Leverich, L., (2010). Diaper, in: Cloth Diapers. pp. 1-11.
• Khoo, S. C., Phang, X. Y., Ng, C. M., Lim, K. L., Lam, S. S., & Ma, N. L. (2019). Recent technologies for treatment and recycling of used disposable baby diapers. Process Safety and Environmental Protection, 123, 116-129.
• Hoath SB, Pikens WL. (2003). The biology of vernix. In: Hoath SB, MaibachHI, eds.Neonatal Skin Structure and Function. 2nd ed. New York: Marcel Dekker Inc; p. 193-210.
• Barker, N., Hadgraft, J., & Rutter, N. (1987). Skin permeability in the newborn. Journal of investigative dermatology, 88(4), 409-411. Wolf, R., Wolf, D., Tüzün, B., & Tüzün, Y. (2000). Diaper Dermatitis. Clinics in Dermatology, 18, 657–660.
• Gupta, A. K., & Skinner, A. R. (2004). Management of diaper dermatitis. International Journal of Dermatology, 43(11), 830-834.
• Humphrey, S., Bergman, J. N. ve Au, S. (2006). Practical management strategies for diaper dermatitis. SkinTherapy Letter, 11(7):1-6.
• Alonso, C., Larburu, I., Bon, E., González, M. M., Iglesias, M. T., Urreta, I. ve Emparanza, J. I. (2013). Efficacy of Petrolatum Jelly for the Prevention of Diaper Rash: A Randomized Clinical Trial. Journal for Specialists in Pediatric Nursing; 18(2): 123-132.
• Vongsa, R., Rodriguez, K., Koenig, D., & Cunningham, C. (2019). Benefits of using an appropriately formulated wipe to clean diapered skin of preterm infants. Global Pediatric Health, 6, 2333794X19829186.
• Capone, K. A., Dowd, S. E., Stamatas, G. N., & Nikolovski, J. (2011). Diversity of the human skin microbiome early in life. Journal of Investigative Dermatology, 131(10), 2026-2032.
• Vila, T., Sultan, A. S., Montelongo-Jauregui, D., & Jabra-Rizk, M. A. (2020). Oral candidiasis: a disease of opportunity. Journal of Fungi, 6(1), 15.
• Mack, K. H. (2010). The best practice guideline for the treatment of pediatric diaper dermatitis (Doctoral dissertation, University of South Carolina).
• Sağlık Bakanlığı (2017). Temel Yenidoğan Bakımı. Erişim Tarihi: 03.08.2022, https://kirklareliism.saglik.gov.tr/Eklenti/115479/0/temel-yenidogan-bakimi-kitabipdf.pdf. Boiko, S. (1999). Treatment of Diaper Dermatitis. Dermatologic Clinics, 17(1), 235–240. Coughlin, C. C., Eichenfield, L. F., & Frieden, I. J. (2014). Diaper dermatitis: clinical characteristics and differential diagnosis. Pediatric dermatology, 31, 19-24.
• Lavender, T., Furber, C., Campbell, M., Victor, S., Roberts, I., Bedwell, C., & Cork, M. J. (2012). Effect on skin hydration of using baby wipes to clean the napkin area of newborn babies: assessor-blinded randomised controlled equivalence trial. BMC pediatrics, 12(1), 1-9.
• Arıkan, D., & Alemdar, D. K. (2013). Çocuklarda Bez Dermatiti Görülme Sıklığının ve Yapılan Uygulamaların İncelenmesi. TAF Preventive Medicine Bulletin, 12(4), 409–416.
• Gözen, D., Çağlar, S., & Doğan, Z. (2011). 0-24 Ay arası bebeği olan annelerin pişiği önleme ve bakımına yönelik uygulamaları. Florence Nightingale Journal of Nursing, 19(1), 17-22.
• Yılmaz, G. & Yıldız, S. (2019). Bez Dermatiti ve Hemşirelik Bakımı. Hemşirelik Bilimi Dergisi, 2 (2), 31-37.
• Wondergem, F. (2010). Napkin dermatitis and its treatment. Journal of Community Nursing, 24(4)