Neonatal Skin Care: The Scientific Basis for Practice

Abstract

<jats:p><jats:bold>Objective:</jats:bold>To review the literature addressing the care of neonatal skin.</jats:p><jats:p><jats:bold>Data Sources:</jats:bold>Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included neonatal skin differences; neonatal skin and care practices for skin integrity; neonatal skin and toxicity; permeability; and contact irritant sensitization.</jats:p><jats:p><jats:bold>Study Selection:</jats:bold>Articles and comprehensive works relevant to key concepts and published after 1963, with an emphasis on new findings from 1993 to 1999. One hundred two citations were identified as useful to this review.</jats:p><jats:p><jats:bold>Data Extraction:</jats:bold>Data were extracted and organized under the following headings: anatomy and physiology of the skin; physiologic and anatomic differences in neonatal skin; nutritional deficiencies; skin care practices; and care of skin breakdown.</jats:p><jats:p><jats:bold>Data Synthesis:</jats:bold>Newborns’ skin is at risk for disruption of normal barrier function because of trauma. In light of available evidence about differences in neonatal skin development, clinical practice guidelines are suggested for baths, lubrication, antimicrobial skin disinfection, and adhesive removal. In addition, basic care practices are suggested for maintaining skin integrity, reducing exposure to potentially toxic substances, and promoting skin health beyond the neonatal period. Preventive care recommendations are made for reducing trauma, protecting the skin’s immature barrier function, and promoting skin integrity.</jats:p><jats:p><jats:bold>Conclusions:</jats:bold>This review generated evidence with which to create a new and comprehensive practice guideline for clinicians. Evaluation of the guideline is under way at 58 U.S. sites.</jats:p>

Beginning at the Bottom

“…A Cochrane Review did not fi nd defi nitive evidence to support or refute the use and type of disposable diapers for prevention of DD (Baer, Davies, & Easterbrook, 2006). However, multiple descriptive and expert opinion articles recommend using super absorbent diapers containing gelling materials, which keep moisture away from skin (Davis, Leyden, Grove, & Raynor, 1989;Lund et al, 1999;Nield & Kamat, 2007;Scheinfeld, 2005). Caregivers should change diapers frequently, as often as every 2 hours or sooner if the diaper is wet and/or soiled (AWHONN, 2007;Atherton, 2004;Borkowski, 2004;Nield & Kamat;Visscher, 2009).…”

“…Appropriate application of prevention and treatment products is also an important factor to consider. Several experts (Lund et al, 1999(Lund et al, , 2001Taquino, 2000) advise caregivers to apply barrier products thickly and refrain from rubbing off completely during diaper changes to prevent further skin damage. Covering barrier products with a thin layer of petrolatum may help prevent the diaper from sticking to the product (Borkowski, 2004).…”

Unraveling the mystery of vernix caseosa

“…As thermoregulation and resuscitation are the priorities of care, wiping of skin was considered the preferred method for accomplishing drying and stimulation of respiratory effort. As the movement toward evidence-based practice has become a major practice effort, the practice and procedure for this nursing activity have fallen under scrutiny 326768. A multiple-site national study was conducted by the National Association of Neonatal Nursing (NANN) and the Association of Women's Health Obstetrical and Neonatal Nursing (AWHONN) in 1998 69.…”

Burns caused by fan heater used for managing post-operative hypothermia in a premature neonate

“…The skin of a neonate, especially a preterm neonate, is more susceptible to damage. 6 The epidermis is thinner in a premature neonate. 7 Premature neonate also lacks the body fat necessary to maintain their core body temperature even when swaddled with blankets.…”