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MKT211375/LIT923/2.5M/K&M7

The Use of a Comprehensive SkincareProduct System on Neonatal Patientsin a Children’s Hospital

Roxana Reyna BSN, RNC-NIC, WCCDriscoll Children’s HospitalCorpus Christi, Texas

Presented a the SAWC Fall Course, Las Vegas, NV, October 2011

This study was sponsored by:

The clinical education division of

Study # LIT923

SUBJECT DEMOGRAPHICS29 Subjects Enrolled• 17 Males, 12 Females• 69% Hispanic, 24% Caucasian, 7% African American or Other• Average Body Weight: 3.06 kg (6.7 lbs)• Average Gestation (wks): 31.7• Reason for Skin Treatment

♦ 79% Skin Surface Damage Management♦ 21% Skin Surface Damage Reduction

BASELINE SKIN SCORES• Average Skin Condition Scores for Whole Body (n=29)

♦ Dryness 1.17♦ Erythema 1.07♦ Breakdown 1.00

• Average Skin Condition Score for the Perineal areal (n=29)♦ Erythema = 0.11

The Use of a Comprehensive Skincare Product System on Neonatal Patients in a Children’s Hospital

INTRODUCTION AND CLINICAL PROBLEMInfants in a typical neonatal intensive care unithave cleansing needs that require the repetitiveuse of bathing/cleansing products. Dry skin inneonates can be an issue, primarily becauseneonatal skin is not fully developed. The perinealareas in infants may be particularly prone to skindamage, usually presenting as erythema ofvarious degrees. Measures are usually taken tomanage skin damage, in the form of barriercreams, and in severe cases, zinc oxidecontaining barrier creams. A prophylacticapproach is hypothesized, so that erythema maybe prevented or attenuated at the skin surfacevia the early use of moisturizing products thatmay also display some barrier properties.

METHODSA convenience sample of 29 neonates, averageweight 6.7 lbs, average gestational age 31.7wwere studied for 14 days. Body and perineal areaswere assessed and the following products appliedbased on erythema severity present: amicronutrient containing cleanser,* a micronutrientcontaining moisturizing cream** or either amicronutrient containing silicone / natural oil film-forming cream*** or a petrolatum based ointmentbarrier containing zinc oxide.†

Information on the management of skinconditions (perineal and whole body), painscores, other skin medications in use, skin relatedadverse events and staff evaluations wherecollected. The number of patients enrolled wasbased on best clinical judgment. The expectedoutcomes of this study were based on clinicalobservation and knowledge of neonatal skin andskin care products. An improvement wasconsidered to represent a one grade decrease inan erythema score.

Perineal evaluations were made up to 8 times aday allowing for emollient adjustments (whetherthe moisturizing cream, the film-forming cream, orthe barrier cream is used) throughout the day.Body skin assessments were made once a dayduring bathing.

Changes in skin management products werebased on the erythema score for the perinealarea and the skin condition score for the body.The duration of subject treatment varied basedon the length of stay on the unit. The majority ofsubjects were treated for a period of 10-14 days.

RESULTSNo adverse events were reported from exposureof neonatal skin to any of the study products,consistent with previous observations. Theperineal area of the majority of the subjects (93%)was appropriate for moisturizer use only at studyinitiation. A certain percentage (22%) of thesesubjects required further intervention with amicronutrient silicone blend film-forming cream,and every case (100%) of increased erythemawas brought back to baseline values. Thisobservation that a film-forming cream can providea clinically satisfactory outcome in the majority ofa neonatal sample population bears furtherresearch. High levels of erythema was reported ina minority (10%) of cases, which was managedwith a petrolatum based ointment barriercontaining zinc oxide but resolution of the highlevel of erythema was not achieved within thestudy period.

In terms of managing the dryness of skin on thebody (outside the perineal area) the treatmentsprovided to a majority of the subjects kept skin atnormal baseline condition. In only a few caseswas dryness an issue that required a change intreatment. In all such cases where the film-forming cream was brought in, per the protocol,the patient still ended with the moisturizing cream,indicating that the skin condition was improved bythe film-forming skin cream.

REFERENCES1. Visscher MO. Update on the Use of

Topical Agents in Neonates. Newbornand Infant Nursing Reviews 2009 Mar; 9(1): 31-47.

2. Visscher MO. Recent advances in diaperdermatitis: etiology and treatment.Pediatric Health 2009 Feb;3(1): 81-98.

3. Pediatric Skin Exposure Study, Phytoplex,Data on file, Medline Industries Inc.

*Phytoplex Hydrating Cleansing Foam or Gel**Phytoplex Nourishing Skin Cream***Hydraguard Film-Forming Skin Cream†Soothe & Cool Skin PasteAll products available from Medline Industries Inc.,Mundelein, IL

A premature baby with dry skin over his entire body can benefit from Micronutrient containing skin care products

Micronutrient containing skin care products helps to nourish, achieve andmaintain the natural skin barrier and can be used on the entire body.

Micronutrient containing skin care products containing products canalso be used on premature infants in incubators or warmers

Babies with chronic conditions that can cause skin breakdown couldalso benefit from Micronutrient containing skin care products skin care