Lesões de pele em recém-nascido: revisão integrativa Skin lesions in newborns: integrative review

The objective is to describe and analyze the scientific evidence about skin lesions in newborns. It was searched for scientific productions having as criteria of inclusion publications period from 2012 to 2017, that correlated the descriptors "skin", "injuries and lesions" and "newborn". The searched databases were PUBMED, WEB OF SCIENCE, LILACS, CINAHL and SCIELO. When analyzing the 10 selected studies, it was agreed among the authors that the production of scientific knowledge regarding the theme of skin lesions in NB, represents a guiding axis for the care. The integrity of the skin is of great importance for the survival of the newborn. Due to its action between the internal organs and the external environment, the skin acts as a barrier against infection. Risk factors for skin lesions in newborns are associated with procedures performed in hospital care. It is concluded that in the researched literature, studies that address the skin care of the newborn with lesions are still scarce, therefore, it is necessary to develop new studies in this sense.


INTRODUCTION
The skin is considered the largest organ of the human body and isolates the organic immunovigilance and tactile sensation (1) .
In the neonate the skin is characterized as delicate, thin and fragile, where the physiological and pathological reactions are often complex, therefore, its alterations are common in this period. These characteristics, combined with the immaturity of the systems and the use of medical devices, essential for their survival, increase the risk of skin damage (2) .
Any unusual finding on the surface of the skin is considered as a skin lesion. The lesions may be primary, when they represent an initial sign of pathological process, or secondary, when they correspond to the result of a late formation or trauma of a primary lesion (3) .  (4) . A review study also identified two other causes for the development of skin lesions in newborns, which were injuries related to inadequate manipulation of the newborn and skin dryness (5) .
Skin lesions in newborns are important for public health, especially in the hospital context. It is estimated that the incidence of skin lesions in newborns is 16%, with a high prevalence of 58%. It is known that skin lesions are one of the main causes of prolongation of hospitalizations of neonates, with an average of 37.2 days in hospitalizations (6) .
In this context, the qualification of the assistance provided by the multiprofessional team and the reduction of neonatal morbidity and mortality demand specific actions in the provision of care peculiar to the newborn (NB), which must be fully developed. This is a basic element for greater rationality and effectiveness in the process of perinatal care organization (7) .
With regard to specific nursing care, the goal of care is to lead the neonate to recovery, adaptation and well-being, so they must be based on scientific knowledge and the autonomy of the nursing professional (8)

RESULTS
When the ten selected studies were analyzed, four of them used the quantitative approach and three, the qualitative one. The others are literature reviews. Of the four quantitative variables, three were used for retrospective analysis in an inpatient setting.
Other research environments included a pediatric medical outpatient clinic and followup of patients with spina bifida. The descriptor "infant newborn" was the one that was most repeated, starring in three of the studies, followed by "skin" and "wounds and injuries", which appeared in two studies each.
Of the data collection instruments used,  Source: research data.
Regarding the objectives presented by the researchers, four were based on the concern to respond, with scientific evidence, problems of higher incidence and prevalence in skin care inherent to the health service in irritation, which can progress to papule and vesicle lesions (14) .
In the occurrence of cutaneous lesions, it is necessary to evaluate the degree of complexity of these, to distinguish cases of benign course and pathological cases. Thus, the causative agent, the period of injury, the depth, the body zone in which it is located, the extent and the characteristics present must be observed, so that it can establish orientations and conduct of professionals and parents for optimal treatment of the lesion (20) .  (20) .
It is worth mentioning that the majority of the procedures performed in the RN with EB can traumatize the skin and must be adapted in a way that reduces this risk. It is also considered that many newborns are premature, which increases even more the the maturation of the skin barrier after preterm birth, which requires on average 2 to 4 weeks, and are factors that determine the practice of care (24) . respecting the optimal amount of pressure for each age group. If negative pressure therapy was placed on the hollow viscera, a nonadherent oil-coated gauze was placed before applying the sponge in adhesive bonding (19) .
Fluid repositions were performed in cases of significant loss of wound fluid.
Characteristics such as gender, age, associated comorbidities and nutrition were analyzed.
Wounds were classified according to etiology (ie trauma, surgically created, congenital, burns, pressure ulcers and grafts), age (acute versus chronic), and anatomical location. Any single characteristics of the treated site, such as the presence of bone, bowel, tendon or nerve, were also observed. We also analyzed treatment details regarding the duration and frequency of changes (16) .  (19) .
Initial studies have indicated a better response to prevention of erythema with the use of silicone adhesive tapes than with other types of tape. In addition, it was observed that the discomfort, removal of keratin and hairs was significantly lower when compared to the silicone tape compared to other tapes (28).
Epidermal skin scaling of the neonatal skin can be minimized with the use of dressings with soft silicone based adhesives (29) .
Although the general principles of wound healing are similar in children and adults, there are limited clinical guidelines to guide the choice of specific wound care products for wound treatment in children (30). It is pertinent that care that preserves the integrity of newborns should be a priority during NICU admission. A care that prevents skin lesions and infections from these lesions, keeping the skin intact and providing comfort.
The information generated in this study can be used by professionals as subsidies for professional practice, consolidating their strategies to care for the skin of the newborn.