7/17/2019 Neonatal and Infant Care

http://slidepdf.com/reader/full/neonatal-and-infant-care 1/10

Neonatal & Infant Skin Care

• Introduction

Preserving the skin integrity of the neonate is important to maintain the function of the skin, protect

against potential wounds and avoid skin disorders in the future.

 Aim

• Provide evidence based skincare to neonates

• Identify those who may be at risk for alterations in skin integrity

• Protect against potential skin breakdown caused by epidermal stripping, extravasation,

wound breakdown and excoriation

• Implement interventions to promote and protect optimal skin function

• Care for premature neonates in an environment that minimises Trans pidermal !ater

"oss and promotes #tratum Corneum barrier maturation

• $inimi%e the potential for future skin sensiti%ation

&efinition of Terms

Preterm baby "ess than '( weeks gestational age

Term baby '() *+ weeks gestational age

Neonate "ess than * weeks age post term-

Infant oung children, / month to /0 months age

TEWL Trans pidermal !ater "oss

Atopy Predisposition toward developing certain allergic hypersensitivity reactions

Emollient A substance that softens 1 moisturi%es the skin

Erythema 2edness of the skin

Stratum Corneum (SC) The outermost layer of the epidermis acting as a mechanical barrier 

Xeroi #kin dryness

7/17/2019 Neonatal and Infant Care

http://slidepdf.com/reader/full/neonatal-and-infant-care 2/10

!erni" !axy white substance on newborn skin

#e$i%ipe Absorbent disposable towels available from 3uipment &istribution Centre-

 

 Assessment

 Assess skin condition on admission and commencement of each shift and at each nappy change as

needed-. 4e proactive. 5bserve and clean areas such as the neck, behind the ears, axillae and groin.

&ry, red or itchy skin is an indication that skin integrity may be impaired. If a pustular, vesicular or purulent

skin lesion is noted, communicate with the appropriate medical team for management.

Consider the following factors that may increase the risk of skin trauma and breakdown6

• Prematurity

• 7acuum or forcep extraction

• #kin oedema, infection, thermal in8ury

• #edation or inability to mobilise

• 9se of endotracheal tubes, continuous positive airway pressure, nasogastric:orogastric

tubes xtracorporeal membrane oxygenation C$5-

• $onitors, electrodes, probes

• #urgical wounds, ostomies

•  Adhesive removal

• nvironmental humidification

• ;appy rash

• ;utritional status

• <amily history of atopy

 

ana'ement 

To maintain skin integrity and minimise heat loss consider the following )

7/17/2019 Neonatal and Infant Care

http://slidepdf.com/reader/full/neonatal-and-infant-care 3/10

4athing

• nsure vital signs and temperature are stable before first bath

• Consider universal precautions, wear gloves

• Immersion bathing should be considered based on assessment of individual condition

• ;ewborns may be bathed after / hour of age when appropriate care is taken to support

thermal stability. To minimise heat loss after first bath, immediately put a nappy and hat on and

wrap in warm blankets. !hen infant temperature is within normal limits after approximately /+

minutes- dress and re wrap in dry warm blankets

• 4ath or sponge daily or more often as needed

• 9se warm water 

• 9se a water depth deep enough to allow the infants= shoulders to be well covered

• $aintain an ade3uately heated environment

• p> neutral cleanser may be used if needed or plain water 

• Carefully dry the skin folds including armpits, groin, neck and behind the ears

•  Allow vernix to wear off with normal care and handling

• &isinfect bath e3uipment before and after use

E"ample of appropriate p neutral leaner* ?7 !ash, ?7 @entle Cleanser, >amilton !ash,

Cetaphil @entle #kin Cleanser, Avene Trixera Cleansing @el, enkay 4ody !ash, &ermaveen 4aby #oap

<ree !ash

Cord Care

• !ash hands before handling umbilical cord

• eep cord area clean with water. ;o need for alcohol wipes

• Cleanse with water and p> neutral cleanser if soiled with urine or stool

• eep nappy folded under the cord to facilitate drying

• Identify signs of infection such as inflammation or an offensive odour 

• The cord usually separates from the baby ( to /+ days after birth

7/17/2019 Neonatal and Infant Care

http://slidepdf.com/reader/full/neonatal-and-infant-care 4/10

• Cord clamp may remain insitu until separation

• ducate staff and families about normal mechanism of cord healing

mollients

•  At the first sign of dryness, fissures or flaking, apply an emollient twice a day or as

needed

• mollients should be applied as a preventative therapy at least daily to newborns and

infants with a family history of atopy

• mollients should not be shared and always dispensed from a hospital pharmacy in

patient)specific containers

• #poon emollient on to paper towel prior to use to maintain sterility of the container-

• mollients are safe to be used for infants under radiant heat or for infants receiving

treatment such as phototherapy

• mollients may interfere with the adherence of adhesives

• Choose emollients without fragrances, dyes or preservatives

E"ample of appropriate emollient*  ?7 Cream, ?7 ids balm, ?7 Intensive, >ydraderm Cream,

Cetaphil Cream, A3ueous cream, Avene Trixera Cream, &erme%e 5intment, enkay xtra 2elief Cream,

&ermaveen 4aby $oisturising Cream, $ustela #telatopia $oisturising Cream

;appy Area Care

•  Assess neonate for risk factors for skin breakdown. ie. loose stools, fre3uent stooling,

drug withdrawal, medications that alter stool fre3uency or composition. $onitor skin condition

closely

• Change nappies fre3uently, usually every ') * hours or when soiled

• 9se disposable nappies

• ;appy wipes may cause irritation and should be reserved for healthy looking skin

• @ently clean nappy area with water and 2ediwipes or cotton wool

•  A p> neutral cleanser, sorbolene cream, a3ueous Cream or olive oil may be used to help

cleanse the nappy area

7/17/2019 Neonatal and Infant Care

http://slidepdf.com/reader/full/neonatal-and-infant-care 5/10

• To maintain skin integrity, apply a thick barrier cream that contains %inc oxide at every

nappy change

• Complete removal of barrier ointments with nappy changes is not necessary, rather apply

another layer 

•  Assess for presence of infection ie candida albicans, and need for topical antifungal

• &o not use talcum powder 

• &o not use creams with fragrances or unnecessary additives such as tea tree oil

•  Allow as much Bnappy offB time as possible

• If the area is red, a mild hydrocortisone / ointment may need to be applied bd, prn e.g.

#igmacort / ointment. A prescription is not needed for this

• <or further information see ;appy 2ash Clinical Practice @uideline

E"ample of appropriate barrier ream* /+ 5live 5il in Dinc Paste, Covitol, &esitin, #udocream,

4epanthan ;appy 5intment

 Adhesives

• $inimal use of adhesives on all neonates

• &elay the removal of adhesive for at least 0*hrs after application

• Tape should be backed with cotton wool where possible

•  A semipermeable dressing should be used between the skin and adhesive to secure

nasogastric tubes, intravascular devices, nasal cannulas or central venous catheters

• 4arrier films should not be used on premature neonates or infants E * weeks of age ie.

#mith 1 ;ephew #kin Prep Protective 4arrier !ipes, Convacare Protective 4arrier !ipe, '$

Cavilon ;o #ting 4arrier <ilm -

• @ently and slowly remove adhesives with warm water soaked cotton balls, peeling back

parallel to the skin surface. Avoid solvents

• #olvents ie. Convacare wipes- must not be used on premature neonates. If re3uired to

aid adhesive removal on term neonates, the area should be rinsed with warm water immediately

after use

• <or transparent adhesives, stretch to release adherence

7/17/2019 Neonatal and Infant Care

http://slidepdf.com/reader/full/neonatal-and-infant-care 6/10

• 9se wraps such as stretchy gau%e or oban to anchor probes, electrodes or limbs to arm

boards

• 9se only gel electrodes

E"ample of appropriate a$hei+e* $epitac, Comfeel, &uoderm, #iltape, Transparent adhesivedressings Tegaderm-, >ydrocolloids, @el lectrodes, #ilicone adhesives

 

#pecial Considerations for Premature ;eonates

• Ensure vital signs and temperature are stable before the rst bath.

Neonates <1000g or < 32 weeks sponged in plain water only every 3! days."se soft materials su#h as #otton balls. $void rubbing. %onsider immersionbathing for stable infants &1'00g

• Emollients should not be part of routine #are for infants 2330 weeks(gestation. )E*+ may be redu#ed by other means ie. ,umidity

• No nappy wipes. %otton wool and olive oil -water only to #leanse thenappy area

• No solvents for adhesive removal to/i#ity may result from absorptionthrough the skin ie. %onva#are wipes

,or ,urther Neonatal & Infant kin Care ana'ement ee*

En+ironmental umi$ty

• Clinical management as per nvironmental >umidity for Premature ;eonates Clinical

@uideline

E"tra+aation Care

• Clinical management as per ;eonatal xtravasation Clinical @uideline

7/17/2019 Neonatal and Infant Care

http://slidepdf.com/reader/full/neonatal-and-infant-care 7/10

Woun$ Care

• Clinical management as per !ound Care Clinical @uideline

Preure Area Care

•  Assessment and clinical management as per Pressure In8ury Prevention and

$anagement Clinical @uideline

Common Ne%born #ahe

• Erythema To"ium Neonatorum

 A common condition affecting as many as half of all full term newborn infants. $ost prominent on day 0,

although onset can be as late as two weeks of age. 5ften begins on the face and spreads to affect the

trunk and limbs. Palms and soles are not usually affected.

Clinial featureF rythema Toxicum is evident as various combinations of erythematous macules flat

red patches-, papules small bumps- and pustules. The eruption typically lasts for several days however it

is unusual for an individual lesion to persist for more than a day.

Treatment* The infant is otherwise well and re3uires no treatment.

 

• Neonatal ilia

 Affects *+)G+ of newborn babies. <ew to numerous lesions.

7/17/2019 Neonatal and Infant Care

http://slidepdf.com/reader/full/neonatal-and-infant-care 8/10

Clinial featureF >armless cysts present as tiny pearly)white bumps 8ust under the surface of the skin.

5ften seen on the nose, but may also arise inside the mouth on the mucosa pstein pearls- or palate

4ohn nodules- or more widely on scalp, face and upper trunk.

Treatment* "esions will heal spontaneously within a few weeks of birth.

 

• iliaria (eat rah)

 Arises from occlusion of the sweat ducts. In infants lesions commonly appear on the neck, groins and

armpits, but also on the face.

Clinial feature* /)'mm papules vesicular or papular-.

Treatment* 2emove from heated humid environment or ad8ust incubator temperature. Cool bathing or

apply cool compresses. Topical steroids may be used to facilitate relief while the condition resolves.

7/17/2019 Neonatal and Infant Care

http://slidepdf.com/reader/full/neonatal-and-infant-care 9/10

 

• Pityrooprum folliuliti

Infantile acne or =milk spots=. Affects babies within the first few weeks of life. Increased activity of the

newborns= sebaceous glands cause inflammation and folliculitis.

Clinial feature* rythematous dome shaped papules and superficial pustules arise in crops, commonly

affecting the cheeks, nose and forehead. This rash is not itchy.

Treatment* !ill resolve within weeks without treatment or may be treated with ketocono%ole shampoo

eg. #ebi%ole shampoo- diluted /FG with water, applied with a cotton bud twice a day. 2inse off with water

after /+ minutes. 5r apply >ydro%ole cream bd to the affected areas until the rash has resolved.

 

7/17/2019 Neonatal and Infant Care

http://slidepdf.com/reader/full/neonatal-and-infant-care 10/10

http--www.r#h.org.au-r#h#pg-hospital#lini#alguidelineinde/-Neonatalnfantki

n%are-

 )he 4oyal %hildren(s ,ospital 5elbourne