Evaluation of Skin Injuries in Newborn Infants Undergoing Nasal Non-Invasive Mechanical Ventilation

Öz

Background: In nasal noninvasive mechanical ventilation (nNIMV) application, mild, moderate and severe skin injuries occur due to the use of prongs/mask. Objective: The aim of this study is to determine the skin condition and rate of skin damage in hospitalized infants in the neonatal intensive care unit and receiving nNIMV support. Methods: In this research, which employed a descriptive retrospective design with an archival review, the records of 95 infants who received nNIMV support for more than 24 hours were examined by the researchers. Data were collected using the Newborn Skin Condition Score included in the nurse observation form. Results: Skin condition scores of newborns in the study were 3.61±0.68 on the 1st day, 3.82±0.66 on the 2nd day, 3.92±0.70 on the 3rd day and 4.08±0.57 on the 4th day. A statistically significant difference was found between the skin condition scores of the babies according to birth weight and delivery type (respectively, p=.002, p=.010). According to the skin condition scores of infants, there was 50.5% skin damage on the 1st day, 67.7% on the 2nd day, 74.1% on the 3rd day and 90% on the 4th day; accordingly, it was determined that skin damage increased as the length of stay increased. Conclusion: In this study, it was determined that as the duration of noninvasive mechanical ventilation applied to newborns increased, both skin condition scores and skin damage increased. It is recommended to develop a guideline for the prevention of skin injuries in newborn infants who underwent nasal NIMV.

Anahtar Kelimeler

• Newborn
• Nasal Noninvasive Mechanical Ventilation
• Skin Condition Score
• Skin Injury

Nazal Non-İnvaziv Mekanik Ventilasyon Uygulanan Yenidoğan Bebeklerde Cilt Hasarlanmalarının Değerlendirilmesi

Öz

Giriş: Nazal noninvazif mekanik ventilasyon (nNİMV) uygulamasında kanül/maske kullanımına bağlı hafif, orta ve şiddetli cilt hasarlanmaları oluşmaktadır.. Amaç: Bu araştırmanın amacı, yenidoğan yoğun bakım ünitesinde yatan ve nNİMV desteği alan bebeklerde cilt durumunu değerlendirmek ve cilt hasarı gelişme oranını belirlemektir. Yöntem: Tanımlayıcı retrospektif desende bir arşiv taraması olan bu araştırmada yenidoğan yoğun bakım ünitesinde yatan ve 24 saatten daha uzun süre nNİMV desteği alan 95 bebeğin dosyası araştırmacılar tara-fından incelendi. Hemşire gözlem formunda yer alan Yenidoğan Cilt Durum Değerlendirmesi kullanılarak veriler toplandı. Bulgular: Araştırmaya alınan yenidoğan bebeklerin cilt durum puanları 1. gün 3.61±0.68, 2. gün 3.82±0.66, 3. gün 3.92±0.70 ve 4. gün 4.08±0.57 idi. Bebeklerin doğum ağırlığına ve doğum şekline göre cilt durum puanları arasında istatistiksel olarak anlamlı fark bulundu (sırasıyla; p=.002, p=.010). Bebeklerin cilt durum puanları incelendiğinde; 1. gün %50.5, 2. gün %67.7, 3. gün %74.1 ve 4. gün %90 oranında ciltte hasarlanma olduğu ve buna göre nNİMV desteği alma süresi arttıkça cilt hasarlanmasının arttığı saptandı. Sonuç: Bu araştırmada nNİMV uygulanan yenidoğan bebeklerin yatış süresi arttıkça cilt durum puanlarının ve cilt hasarlanmasının arttığı saptandı. Nazal NİMV uygulanan yenidoğan bebeklerde cilt yaralanmalarının önlenmesi ile ilgili rehber geliştirilmesi önerilir.

Anahtar Kelimeler

• Yenidoğan
• Nazal Noninvazif Mekanik Ventilasyon
• Cilt Durum Değerlendirmesi
• Cilt Hasarı

Kaynakça

1. Alessi, S. (2018). Evidence regarding the use of bubble continuous positive airway pressure in the extremely low birth-weight infant: benefits, challenges, and implications for nursing practice. Advances in Neonatal Care, 18(3), 199-207.
2. Arslan, S. ve Okulu, E. (2018). Noninvazif Solunum Desteğine Genel Bakış ve Fizyolojik İlkeler. Türkiye Klinikleri Pediatrik Bilimler-Özel Konular. Edt: Kaynak Türkmen, M. Turkiye Klinikleri J Pediatr Sci, 14(2): 223-8.
3. Bashir, T., Murki, S., Kiran, S., Reddy, V. K. ve Oleti, T. P. (2019). ‘Nasal mask’in comparison with ‘nasal prongs’ or ‘rotation of nasal mask with nasal prongs’ reduce the incidence of nasal injury in preterm neonates supported on nasal continuous positive airway pressure (nCPAP): A randomized controlled trial. PLoS One, 14(1), e0211476.
4. Bayraktar, S., Balci, S. ve Ince, Z. (2021). The effect of 2 humidifier temperature settings on inspired gas temperatures and the physiological parameters of preterm infants receiving mechanical ventilation therapy. Advances in Neonatal Care, 21(4), 308-313.
5. Behnke, J., Lemyre, B., Czernik, C., Zimmer, K. P., Ehrhardt, H. ve Waitz, M. (2019). Non-invasive ventilation in neonatology. Deutsches Ärzteblatt International, 116(11), 177.
6. Boel, L., Broad, K. ve Chakraborty, M. (2018). Non-invasive respiratory support in newborn infants. Paediatrics and Child Health, 28(1), 6-12.
7. Bonfim, S. F., Vasconcelos, M. G., Sousa, N. F., Silva, D. V. ve Leal, L. P. (2014). Nasal septum injury in preterm infants using nasal prongs. Revista Latino- Americana de Enfermagem, 22(5), 826-833.
8. Chandrasekaran, A., Thukral, A., Jeeva Sankar, M., Agarwal, R., Paul, V. K. ve Deorari, A. K. (2017). Nasal masks or binasal prongs for delivering continuous positive airway pressure in preterm neonates—a randomised trial. European Journal of Pediatrics, 176(3), 379-386.

9. Chen, C. Y., Chou, A. K., Chen, Y. L., Chou, H. C., Tsao, P. N. ve Hsieh, W. S. (2017). Quality improvement of nasal continuous positive airway pressure therapy in neonatal intensive care unit. Pediatrics & Neonatology, 58(3), 229-235.
10. Çalışır, H., Karabudak, S. S., Güler, F., Aydın, N. ve Türkmen, M. K. (2016). Yenidoğan cilt durum skoru Türkçe formunun geçerlik ve güvenirliği. Cumhuriyet Hemşirelik Dergisi, 5(1), 9-15.
11. Guimarães, A. R., Rocha, G., Rodrigues, M. ve Guimarães, H. (2020). Nasal CPAP complications in very low birth weight preterm infants. Journal of Neonatal-Perinatal Medicine, 13(2), 197-206.
12. Haymes, E. (2020). The effects of continuous positive airway pressure (CPAP) on nasal skin breakdown. Journal of Neonatal Nursing, 26(1), 37-42.
13. Imbulana, D. I., Owen, L. S., Dawson, J. A., Bailey, J. L., Davis, P. G. ve Manley, B. J. (2018). A randomized controlled trial of a barrier dressing to reduce nasal injury in preterm infants receiving binasal noninvasive respiratory support. The Journal of Pediatrics, 201, 34-39.e3.
14. Khan, J., Sundaram, V., Murki, S., Bhatti, A., Saini, S. S. ve Kumar, P. (2017). Nasal injury and comfort with jet versus bubble continuous positive airway pressure delivery systems in preterm infants with respiratory distress. European Journal of Pediatrics, 176(12), 1629-1635.
15. Kumar, G., Copra, M. ve Copra, M. (2017). To study effectiveness of nasal prong and nasal mask in nasal continuous positive airway pressure in preterm neonates with respiratory distress. Journal of Medical Science and Clinical Research, 5(5), 21409-15.
16. Magalhães, P. A. F., D’Amorim, A. C. G., Oliveira, E. F. A. L., Ramos, M. E. A., Mendes, A. P. D. A., Barbosa, J. F. S. ve Reinaux, C. M. A. (2022). Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation. Revista Brasileira de Terapia Intensiva, 34(2), 247- 254.
17. Newnam, K. M., McGrath, J. M., Salyer, J., Estes, T., Jallo, N. ve Bass, W. T. (2015). A comparative effectiveness study of continuous positive airway pressure-related skin breakdown when using different nasal interfaces in the extremely low birth weight neonate. Applied Nursing Research, 28(1), 36-41.
18. Owen, L.S. ve Manley, B.J. (2016). Nasal intermittent positive pressure ventilation in preterm infants: Equipment, evidence, and synchronization. Seminars in Fetal & Neonatal Medicine, 21(3), 146-153.
19. Raurell-Torredà, M., Romero-Collado, A., Rodríguez- Palma, M., Farrés-Tarafa, M., Martí, J. D., Hurtado- Pardos, B., ... ve Esquinas, A. M. (2017). Prevention and treatment of skin lesions associated with non-invasive mechanical ventilation. Recommendations of experts. Enfermería Intensiva (English ed.), 28(1), 31-41.
20. Reed, R. C., Johnson, D. E. ve Nie, A. M. (2021). Preterm infant skin structure is qualitatively and quantitatively different from that of term newborns. Pediatric and Developmental Pathology, 24(2), 96- 102.
21. Ribeiro, D. F. C., Barros, F. S., Fernandes, B. L., Nakato, A. M. ve Nohama, P. (2020). Nasal prongs: risks, injuries incidence and preventive approaches associated with their use in newborns. Journal of Multidisciplinary Healthcare, 13, 527-537.
22. Satar, M. ve Mert, K. (2018). Yenidoğanda solunumun fizyolojik prensipleri. Turkiye Klinikleri J Pediatr Sci,14(2),184-91.
23. Sharma, D., Kaur, A., Farahbakhsh, N. ve Agarwal, S. (2021). To compare nasal mask with binasal prongs in delivering continuous positive airway pressure for reducing need of invasive ventilation: randomized controlled trial. The Journal of Maternal-Fetal & Neonatal Medicine, 34(12), 1890-96.
24. Thukral, A., Sankar, M. J., Chandrasekaran, A., Agarwal, R. ve Paul, V. K. (2016). Efficacy and safety of CPAP in low-and middle-income countries. Journal of Perinatology, 36(1), S21-S28.
25. Visscher, M. ve Taylor, T. (2014). Pressure ulcers in the hospitalized neonate: rates and risk factors. Scientific Reports, 4(1), 7429.
26. Xie, L. H. (2014). Hydrocolloid dressing in preventing nasal trauma secondary to nasal continuous positive airway pressure in preterm infants. World Journal of Emergency Medicine, 5(3), 218-22.