Neonatal skin care: Developments in care to maintain neonatal barrier function and prevention of diaper dermatitis

Abstract

Background Understanding the importance of the barrier function of the skin of preterm and term neonates is crucial in effective neonatal skin and diaper care. This literature search aimed to review the development of different practices in neonatal care to maintain skin barrier function, in turn preventing diaper dermatitis. Methods We performed two quantitative literature searches of English language studies: an initial literature search of studies published in the last 5 years was conducted using Cinahl, Medline, Embase, British Nursing Index, and DelphiS, followed by a second search of publications from 1990 to 2017 using the National Institute of Clinical Excellence Health Databases Advanced Search using key words, synonyms, and Boolean phrasing. Titles and abstracts were reviewed for relevance. Results One hundred ten studies were analyzed for the purpose of this review; however, data are of variable quality. Guidance can be drawn from the existing literature relating to best practice options for diaper area cleansing methods, diaper type selection, and use of barrier creams. More research is required into the benefit or otherwise of diaper‐free time. Conclusions Super‐absorbent diapers reduce moisture at skin level and reduce diaper dermatitis. Barrier creams carry benefit both in prevention and cure but do not provide a substitute for frequent diaper changes. The literature does not demonstrate superiority of one cleansing method over another, but neither the use of wipes nor water increases diaper dermatitis prevalence. Further studies are required to explore the potential benefit of diaper‐free time, taking due consideration of the practicalities, particularly for vulnerable neonates within the Intensive Care setting.

Real-World Insights in Thailand on Usage Satisfaction and Perceived Efficacy of Dexpanthenol in Nappy Care

“…IND is primarily caused through repeated and prolonged exposure to irritants such as urine and feces. The urine/feces mixture causes disruption of the skin barrier through several mechanisms, including maceration (softening and weakening) of the skin, increased alkalinity, activation of fecal digestive enzymes and friction between nappy and skin [3][4][5][6][7]. Most clinically diagnosed cases involve mild reddening and scaling, but cases of more severe skin lesions or fungal or bacterial secondary infection can develop in a small percentage (around 5%) of cases [8,9].…”

A new therapeutic horizon in diaper dermatitis: Novel agents with novel action

“…Also, many studies have focused solely on the efficacy of interventions with no understanding of the link between symptom severity and contributing risk factors ( Esser and Johnson, 2020 ). Variable quality among the different clinical studies that evaluate the efficacy of these interventions is known to exist ( Burdall et al, 2019 ). Hence, more prospective studies evaluating the mechanism and clinical effects of therapeutic options for diaper dermatitis are needed.…”

“…The tested topical skin barrier and repair skincare products with the combination of zinc gluconate, taurine, panthenol, and zinc oxide are clinically proven to have good acceptability and efficacy in reducing skin erythema and irritation of the nappy area. In combination with other effective options for care, such as super-absorbent diapers and the potentially beneficial diaper-free time, the use of these agents may provide an effective treatment for nappy rash or diaper dermatitis ( Burdall et al, 2019 ). Commercially available products have been shown to relieve and prevent irritation in the diaper area by forming a protective film against external irritants and providing additional humectant and antioxidant protection for both children and adults with diaper dermatitis.…”

Fatores intervenientes na integridade cutânea de recém-nascidos em Unidade de Cuidado Intermediário Neonatal Convencional

“…Deste modo, a troca frequente de fraldas, associada ao uso de creme de barreira adequado, e, quando possível, de fraldas superabsorventes, são cuidados importantes para prevenção e tratamento desses eventos. (18,19) Em contrapartida, no âmbito de cuidados intensivos neonatais, observa-se maior incidência de escoriações decorrentes da fixação de dispositivos clínicos, lesão por pressão associada a tais artigos terapêuticos e queimaduras. Diferentemente das unidades de cuidados intermediários, tais achados decorrem da necessidade prolongada de uso de sondas orogástricas e cânulas orotraqueais, além da monitorização contínua por oximetria de pulso do RN em unidades intensivas.…”