Evidence‐based skin care in preterm infants

Abstract

Most guidelines on neonatal skin care emphasize issues pertaining to healthy, term infants. Few address the complex task of skin barrier maintenance in preterm, very preterm, and extremely preterm infants. Here, we provide an evidence‐based review of the literature on skin care of preterm neonates. Interestingly, the stratum corneum does not fully develop until late in the third trimester, and as such, the barrier function of preterm skin is significantly compromised. Numerous interventions are available to augment the weak skin barrier of neonates. Plastic wraps reduce the incidence of hypothermia while semipermeable and transparent adhesive dressings improve skin quality and decrease the incidence of electrolyte abnormalities. Tub bathing causes less body temperature variability than sponge bathing and can be performed as infrequently as once every four days without increasing bacterial colonization of the skin. Topical emollients, particularly sunflower seed oil, appear to reduce the incidence of skin infections in premature neonates—but only in developing countries. In developed countries, studies indicate that topical petrolatum ointment increases the risk of candidemia and coagulase‐negative Staphylococcus infection in the preterm population, perhaps by creating a milieu similar to occlusive dressings. For preterm infants with catheters, povidone‐iodine and chlorhexidine are comparably effective at preventing catheter colonization. Further studies are necessary to examine the safety and efficacy of various skin care interventions in premature infants with an emphasis placed on subclassifying the patient population. In the interim, it may be beneficial to develop guidelines based on the current body of evidence.

Abnormal Swelling in the Left Thigh of a Neonate

“…However, the preferred use of one solution over the other remains a dilemma. [5][6][7] Our unit routinely uses alcohol swab prior to all IM and IV injections. Would using chlorhexidine and povidoneiodine as antiseptic solution before IM or IV injection prevents skin and subcutaneous infections?…”

Assessment of the quality of a software application for the prevention of skin lesions in newborns*

“…The GA and weight variables, and the information on maternal HIV or Hepatitis B infection, filled-in in the patient’s registration screen, as well as the other items to be filled-in in the software during the evaluation process, are linked to various essential nursing interventions for the prevention of skin lesions in NBs. Weight and GA interfere in thermo-regulation care, in the choice of antiseptics, handling, bathing, ambience, and care with the umbilical stump, in view of the immature anatomical and physiological conditions of the skin of the newborns with GA less than 32 weeks and weight less than 1,500 grams ( 32 ) .…”

“…The GA and weight variables, and the information on maternal HIV or Hepatitis B infection, filled-in in the www.eerp.usp.br/rlae conditions of the skin of the newborns with GA less than 32 weeks and weight less than 1,500 grams (32) .…”

The effect of delaying first bathing on skin barrier function in late preterm infants: A study protocol for multi‐centre, single‐blind RCT

“…Preterm skin matures quickly after birth, although maturation can take more than 4 weeks. Transepidermal water loss is high and can lead to thermal instability, dehydration, and electrolyte imbalances in preterm infants (Kusari et al., 2019). Based on the literature, NICU staff can take steps to support the skin's weak barrier function and improve the well‐being of preterm infants.…”