Neonatal skin care why change is vital

Figure 1. Clinical features : Harmless cysts present as tiny pearly-white bumps just under the surface of the skin. Often seen on the nose, but may also arise inside the mouth on the mucosa Epstein pearls or palate Bohn nodules or more widely on scalp, face and upper trunk. Treatment : Lesions will heal spontaneously within a few weeks of birth. Figure 2. Arises from occlusion of the sweat ducts. In neonates, lesions commonly appear on the neck, groins and armpits, but also on the face.

Clinical features : mm papules vesicular or papular. Treatment : Remove from heated humid environment or adjust incubator temperature. Cool bathing or apply cool compresses. Topical steroids may be used to facilitate relief while the condition resolves. Neonatalacne or 'milk spots'. Affects babies within the first few weeks of life. Increased activity of the neonates' sebaceous glands cause inflammation and folliculitis. Clinical features : Erythematous dome shaped papules and superficial pustules arise in crops, commonly affecting the cheeks, nose and forehead.

This rash is not itchy. Treatment : Will resolve within weeks without treatment or may be treated with ketoconazole shampoo i.

Sebizole shampoo diluted with water. Apply with a cotton bud twice a day. Rinse off with water after 10 minutes. Or apply Hydrozole cream bd to the affected areas until the rash has resolved.

Evidence table for the Neonatal and Infant Skincare guideline can be viewed here. Please remember to read the disclaimer. Updated May The Royal Children's Hospital Melbourne. Aim To maintain skin integrity and minimise heat loss in the neonate requiring hospitialisation.

Vernix Caseosa - Waxy white substance on newborn skin Layers of the Skin - Epidermis, Dermis and Hypodermis subcutaneous tissue Assessment Assessment of neonate skin should be undertaken daily, or more frequently as clinically indicated.

A dermatology referral may also be appropriate. Management Nappy Care The perineal environment is prone to changes in the skin barrier causing skin irritation. Nappy changes should occur at regular intervals where clinically appropriate to avoid irritation to the perineal skin environment Evaluation of the perineal area is required at each nappy change to ensure early identification of perineal dermatitis and candida infections Disposable nappies are preferred Cotton balls or soft disposable towels i.

If exudate appears, eyes should be wiped from the inner corner outwards with a single-use cotton ball soaked in 0. Minimum 4 hourly cleaning of the eyes with 0.

Routine assessment should be utilised to identify abnormalities. The neonate requiring regular oropharyngeal suction; intubation or other oral supportive devices i. Bathing General Bathing Principles Implement safety principles when bathing neonates Use standard precautions, including wearing gloves until after the neonates first bath Ensure bath equipment is not a source of cross contamination among neonates Implement environmental controls to create a neutral thermal environment and to minimise heat loss The choice of bathing technique depends on the neonates gestational age and clinical status Swaddled-Immersion Recommended technique for neonates Benefits include a reduction of behavioural and physiological stress including temperature variation.

The technique includes swaddling the neonate in a light swaddling cloth i. Sponge bathing The least recommended technique as this method can result in haemodynamic compromise i.

If sponge bathing is required, ensure the neonate is kept contained where possible to reduce behavioural distress, a warm environment is utilised i. First Bath applies to all neonates, additional considerations for preterm neonates given below Provide the first bath once the neonate has achieved cardiorespiratory and thermoregulatory stability Delaying the first bath to at least hours after birth is preferential For neonates born to a HIV-positive mother, the first bath should occur as soon as possible after birth Use warm tap water temperature should be Do not use alcohol wipes Cleanse with water and a pH neutral cleanser if soiled with urine or stool Fold the nappy down below the umbilicus Cord clamp may remain in situ until separation Where possible the umbilical stump should be kept exposed to air or loosely covered with clean clothing to avoid irritation and promote healing Avoid exposing the periumbilical skin to chemicals in order to prevent periumbilical burns Regular assessment is necessary to differentiate between normal umbilical cord healing and potential problems including infection Emollients Emollients restore lipid levels, improve hydration, preserve natural moisturising factors and offer significant buffering capacity to normalise skin pH and maintain skin microbiome.

Apply an emollient top to toe daily at the first sign of dryness, fissures or flaking Maintain sterility by ordering patient specific containers or decanting products on to paper towel prior to application Emollient use is not associated with negative thermal effects or burns and may be used in conjunction with phototherapy or radiant heat Emollients should contain well- tolerated preservatives Emollient use may interfere with the use of adhesives Preterm Neonate Considerations Some evidence states that prophylactic emollient use in preterm neonates weighing grams or less is associated with an increased risk of infection.

Few to numerous lesions. References Albahrani, Y. Newborn Skin Care. Pediatric Annals. Neonatal, Paediatric and Child Health Nursing, 14 1 , Blackburn, S. Pediatric Dematology. Chalmers, J.

Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial. The Lancet. Published online Feb 19, Clemison, J. Topical emollient for preventing infection in preterm infants review. Cochrane Database of Systematic Reviews , Issue 1. DOI: Etiologic factors in diaper dermatitis: the role of feces.

Bouwstra JA, Ponec M. The skin barrier in healthy and diseased state. Biochimet Biophys Acta ; : — Neonatal and Infant Dermatology , 3rd edn. J Obstet Gynecol Neonatal Nurs ; 30 : 30— Adam R. Skin care of the diaper area. Pediatric Dermatol ; 25 : — Skin care in the NICU patient: effects of wipes versus cloth and water on stratum corneum integrity.

Neonatology ; 96 : — Effects of petrolatum on stratum corneum structure and function. J Am Acad Dermatol ; 26 : — Effects of repeated application of emollient cream to premature neonates' skin. Pediatrics ; 92 : — Soll R, Edwards W. Topical ointment for preventing infection in preterm infants.

Cochrane Database Syst Rev Topical umbilical cord care at birth. Stewart D, Benitz W. Umbilical cord care in the newborn infant. Pediatrics ; : e1—e5. Download references. We would like to thank the nurses and nurse managers of the newborn nurseries and mother—baby units at the hospitals throughout the state of Maryland who participated by completing our survey.

SK conceptualized and designed the study, coordinated and supervised data collection, carried out the initial analyses, drafted the initial manuscript and approved the final manuscript as submitted. WCG and BAC conceptualized and designed the study, coordinated and supervised data collection, reviewed and revised the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

You can also search for this author in PubMed Google Scholar. Correspondence to B A Cohen. BAC serves as a consultant for Proctor and Gamble. The remaining authors declare no conflict of interest. Supplementary Information accompanies the paper on the Journal of Perinatology website. Reprints and Permissions. Khalifian, S. Skin care practices in newborn nurseries and mother—baby units in Maryland.

J Perinatol 37, — Download citation. Received : 01 March Revised : 06 September Accepted : 12 September Published : 22 December Issue Date : June Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative. Advanced search. Skip to main content Thank you for visiting nature. Subjects Paediatrics Preventive medicine Risk factors. Abstract Objective: Skin provides several important homeostatic functions to the developing neonate.

Study Design: We performed a study of skin and umbilical cord care including bathing practices, vernix removal and antiseptic cord application in newborn nurseries and mother—baby units throughout the state of Maryland to determine practices in a variety of clinical settings and assess if uniformity in skin care exists.

Conclusion: The frequent departures from evidence that occur regarding the aforementioned practices are likely due to a lack of consensus on these issues as well as limited data on such practices, further highlighting the need for data-driven guidelines on newborn skin care. Access through your institution.

Buy or subscribe. Rent or Buy article Get time limited or full article access on ReadCube. Figure 1. Article Google Scholar Download references. Acknowledgements We would like to thank the nurses and nurse managers of the newborn nurseries and mother—baby units at the hospitals throughout the state of Maryland who participated by completing our survey.

Author contributions SK conceptualized and designed the study, coordinated and supervised data collection, carried out the initial analyses, drafted the initial manuscript and approved the final manuscript as submitted. View author publications. Additional information Supplementary Information accompanies the paper on the Journal of Perinatology website.

Supplementary information. Supplementary Material PDF 98 kb. Supplementary Material 1 PDF 34 kb. Supplementary Material 2 PDF 33 kb. Supplementary Material 3 PDF 37 kb. Supplementary Material 4 PDF 33 kb. Rights and permissions Reprints and Permissions. About this article. Cite this article Khalifian, S. Copy to clipboard.