Neonatal Skin Care

DR.MAULIK SHAH MD.
(PED)
ASSOCIATE PROFESSOR OF PEDIATRICS
M.P.SHAH MEDICAL COLLEGE, JAMNAGAR.
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Why is it important ?
• Serves as barrier against infection and
protects internal organs
• Plays major role in thermoregulation and
storage of fat
• Regulates insensible water loss, also secretes
electrolytes & water
• Provides tactile sensory input and sensations
of touch, pressure, temperature, pain & itch
a maulik shah presentation
Why neonatal skin different ?

• Skin of the premature neonate accounts for
13% of their body weight as compared to 3% of
the body weight of an adult
• Premature neonate has body surface/weight
ratio ~ five times greater than that of an adult

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Stratum Corneum
• SC- 10-20 layers in full
term infants
• 2-3 layers at 30 weeks
gestational age
• Virtually no layers are
present at less than 24
weeks of gestation
How does it imply in NICU ?
• Increased Infections and skin irritation
• Increase in insensible water loss
• Increased evaporative water loss
• Toxicity from topically applied substances
• Epidermal stripping

• Premies prone to edema
due to less collagen and
fewer elastin fibers in the
dermis
• increased risk of ischemic
injury and pressure
necrosis due to reduced
blood flow to the
epidermis
Goals of Skin Care

• Prevention of trans epidermal water loss.
• Reduce traumatic injury
• Prevent Infection
• Prevent dryness
• Avoid exposure to toxins
• Minimize exposure to unnecessary substances
• Promote normal skin development
How to reduce IWL

Reducing IWL
• At birth, use occlusive
polyethylene bag to cover
body torso and extremities
• Cover body surfaces with
transparent dressings
• Apply petrolatum-based
ointment every 6 hours to
body surface
• Use polyethylene tents or
blankets, that do not touch
the skin, to trap moisture a maulik shah presentation
Do not Remove Vernix

• A Natural barrier.
• Prevents heat loss.
• Prevents trans epidermal water loss.
• A Natural moisturizer.
• It does not infect.

Coconut oil application
“preterm VLBW babies using topical coconut oil
application twice a day for the first week of
life reduced the TEWL by as much as 46%.”
Nangia S, Paul VK, Chawla D, Deorari A.

Topical coconut oil application reduces transepidermal water loss in preterm
very low birthweight neonates: A randomized controlled trial. Pediatrics
2008;121:S139.

Sunflower seed oil
• “ sunflower seed oil might enhance skin barrier
function and improve outcome in neonates with
compromised barrier function.”
• “A single application of sunflower seed oil

significantly accelerated skin barrier recovery within
1 h; the effect was sustained 5 h after application.”
Darmstadt GL, Mao-Qiang M, Chi E, Saha SK, Ziboh VA, Black RE, Santosham M, EliasPM.
Impact of topical oils on the skin barrier: possible implications for neonatal
health in developing countries. Acta Paediatr. 2002;91:546-54.
Prevention of injury : Bed
• Provide appropriate bedding
• support using soft bedding.
• Turn and position the infant
• Sick infants with intact skin: Turn 3-4 hourly
• Infants with skin breakdown: Turn 2 hourly

1
4

Injury prevention – Adhesive application

Applying Adhesive safely.
• Minimize amount of adhesive in contact with skin
• Use smaller pieces of tape
• Use “double-backed” tape
• Deactivate adhesive with cotton balls when full
adhesion not required
• Do not use bonding agents (benzoin) to enhance
adhesion
• Avoid bandages after heel sticks. Use pressure with
a cotton ball or gauze
Nasal CPAP & Skin Care

Nasal CPAP & Skin Care

1. Use of appropriate sized prongs to make an effective seal
for the transmission of pressure
2. Avoidance of pressure on the nares to create a seal
3. Suction and inspection of the skin every 4 hours
4. Gentle massage of the skin with each inspection
5. Access to and use of equipment manual to understand and
utilize practices related to securing the device
ET Fixation
• While fixing ET tube, apply tegaderm
• Tape on the skin before putting dynaplast
• It will prevent avulsion of skin while removing
tape

Image courtesy : WHOCC -AIMS
Removing Adhesive
• Loosen adhesive with mineral
oil or petrolatum-based
emollients
• Slowly fold adhesive back onto
itself while moistening the
adhesive-skin surface with
water-soaked cotton balls
• Avoid solvents due to
potential and proven toxicity
a maulik shah presentation Image courtesy : WHOCC -AIMS
Adhesive Products
• Hydrogel Electrodes and Adhesive Strips
• Pectin Barriers
• Stretchy Gauze and Other Wraps-Dynaplast
• Transparent Dressings-Tegaderm.
• Hydro colloid - Duoderm.

New Generation Adhesives
Tegaderm Duoderm

Tegaderm
• a transparent medical dressing.
• used to cover and protect wounds and catheter
sites, long lines, Securing NG tubes or probes.
Advantages of Tegaderm
- breathability
- conformation to the skin.

DuoDerm
• generically known as a
hydrocolloid dressing, made from
a fruit pectin derivative.
• protects wounds but allows them
to heal faster.
• It is biodegradable and adheres to
the skin so no separate taping is
needed.

DuoDerm
• used to secure long lines, iv lines.
• NG tubes or CPAP masks to the patient's face,
without causing skin irritation.
• Wound & cuts which are infected.
• Colostomy areas.

Skin Disinfectants
• Disinfect skin surfaces before invasive procedures
• All disinfectants have the potential to damage tissue.
• Use with caution on underdeveloped or damaged skin
• After use always remove disinfectant with sterile water

or saline to minimize absorption and prevent tissue
damage.
Chlorhexidine gluconate (CHG)
Most effective agent to reduce catheter-related infections in adults
Has been shown to reduce colonization with bacteria in NICU patients
Povidone-iodine 10% aqueous solution (PI)

More efficacious than alcohol for skin disinfection
Can be absorbed through the skin of premature neonates and result in

thyroid suppression
Isopropyl alcohol (70%)
Use cautiously, it is irritating and drying to skin and may cause chemical burns
Do not use for removing CHG or PI

Povidone Iodine & hypothyroidism
“topical iodine-containing antiseptics,
may cause hypothyroidism during a
critical period of neurological
development in the newborn infant.
The routine use of iodine antisepsis in
VLBW infants should be avoided
because of this effect.”
Topical iodine-containing antiseptics and neonatal hypothyroidism in very-low-birthweight infants.
Smeredly P, Lim A Lancet. 1989 Sep 16;2(8664):661-4.
Chlorhexidine Vs Povidone iodine

“0.5% chlorhexidine gluconate in 70% isopropyl
alcohol appears to be more efficacious than 10%
povidone-iodine for the prevention of peripheral
intravenous catheter colonization in neonates.”
Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention
of peripheral intravenous catheter colonization in neonates: a prospective trial
Pediatr Infect Dis J. 1995 Jun;14(6):510-6.
Skin preparation - old
• First apply spirit, let it dry

then apply betadine.
• Wait for a minute then
wipe it off with spirit
• After the procedure, remove completely with
sterile water.
• Take care not to spill and collect at back of baby.
Image courtesy : WHOCC -AIMS
The auckland dist. health board guidelines
Weight Major procedure Minor procedure
< 1000 gm Chlorhexidine 0.1% Chlorhexidine 0.1%

1st Week
< 1000 gm Chlorhexidine 0.1% Alcohol wipes

2nd Week
< 1000 gm Chlorhexidine 0.5% in Alcohol wipes

3rd Week alcohol 70% (Riotane)
> 1000 gm Chlorhexidine 0.5% in Alcohol wipes

alcohol 70% (Riotane)
Prevention of Infection
Let’s wash hands properly:
• Simple, Cost effective
• Use a mild soap/solution not containing any
anti-microbial agent.

• For two minutes before entering and
• for 30 seconds before and after touching
the baby.
• Surgical scrubbing: Not recommended
Use of Emolients
• Use emollients that are petrolatum-based, water
miscible, and free of preservatives, dyes and
perfumes.
• Use on skin that is dry, with scaling, fissures or
visible cracking.
• Use to protect skin that is prone to breakdown
(in groin or thigh).
• Use single patient tubes to prevent cross-
contamination.
Emollient Use & EBM
“Prophylactic topical application of preservative-free
emollient ointment has been demonstrated to
improve skin condition but increases the risk of
coagulase negative staphylococcal infection and any
nosocomial infection in premature infants.”
Topical ointment for preventing infection in preterm infants
Conner, JM, Soll RF, Edwards WH et al.
Cochrane Review
Oil massage
• Vegetable oils are better.
• “Coconut oil massage has beneficial effects on
the weight gain in preterm neonates compared to
mineral oil massage.”
Sankaranarayanan, et al. Oil Massage In Neonates, Indian Pediatrics.

Bathing
• First Bath should be delayed at least 24 hrs.
• Tub/ pouring water bath after 15 days.
• Sponge bath can be allowed preventing
umbilicus.
• Use only warm sterile water for preterms.
• Use cleansers with a neutral pH with minimal
dyes and perfumes .
• Avoid rubbing skin surface a maulik shah presentation
Some common care

• Extravasations .
• Umbilical cord care.
• Diaper rashes
• Boils /abcess
• Circumcision

Selection of Baby products

• Baby Powder
• Baby soap
• Baby oil
• Baby lotions.

I conclude…
• Prevention of injury is most important.
• Improve practices of Adhesive application & removal.
• Trans epidermal fluid loss can be reduced with better

skin care .
• Chlorhexidine is a better disinfectant in newborns.
• Coconut oil massage is better choice in our region.

Friends, Let’s Share our views….
DR.MAULIK SHAH MD.(PED)

ASSOCIATE PROFESSOR OF PEDIATRICS
M.P.SHAH MEDICAL COLLEGE,
JAMNAGAR.
maulikdr@gmail.com
Visit : http://matrutvanikediae.blogspot.com

Neonatal Skin Care

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DR.MAULIK SHAH MD.

Why neonatal skin different ?

a maulik shah presentation

a maulik shah presentation

Goals of Skin Care

How to reduce IWL

a maulik shah presentation

Do not Remove Vernix

a maulik shah presentation

Nangia S, Paul VK, Chawla D, Deorari A.

a maulik shah presentation

• “A single application of sunflower seed oil

a maulik shah presentation

a maulik shah presentation

a maulik shah presentation

Nasal CPAP & Skin Care

a maulik shah presentation

Nasal CPAP & Skin Care

a maulik shah presentation

a maulik shah presentation

New Generation Adhesives

a maulik shah presentation

a maulik shah presentation

a maulik shah presentation

a maulik shah presentation

• All disinfectants have the potential to damage tissue.

• Use with caution on underdeveloped or damaged skin

• After use always remove disinfectant with sterile water

Has been shown to reduce colonization with bacteria in NICU patients

Povidone-iodine 10% aqueous solution (PI)

Can be absorbed through the skin of premature neonates and result in

Do not use for removing CHG or PI

Chlorhexidine Vs Povidone iodine

• First apply spirit, let it dry

< 1000 gm Chlorhexidine 0.1% Chlorhexidine 0.1%

< 1000 gm Chlorhexidine 0.1% Alcohol wipes

< 1000 gm Chlorhexidine 0.5% in Alcohol wipes

> 1000 gm Chlorhexidine 0.5% in Alcohol wipes

a maulik shah presentation

a maulik shah presentation

Some common care

a maulik shah presentation

Selection of Baby products

a maulik shah presentation

• Improve practices of Adhesive application & removal.

• Trans epidermal fluid loss can be reduced with better

• Chlorhexidine is a better disinfectant in newborns.

• Coconut oil massage is better choice in our region.

Friends, Let’s Share our views….

DR.MAULIK SHAH MD.(PED)

a maulik shah presentation

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