Neonatal Skin Care

Neonatal Skin Care : 

Neonatal Skin Care DR.MAULIK SHAH MD.(PED) ASSOCIATE PROFESSOR OF PEDIATRICS M.P.SHAH MEDICAL COLLEGE, JAMNAGAR.

What does the skin do? : 

What does the skin do? 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 is neonatal skin different ? : 

Why is 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 a maulik shah presentation

Why is neonatal skin different ? : 

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 Why is neonatal skin different ? a maulik shah presentation

How does it imply in NICU ? : 

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 a maulik shah presentation

Why neonatal skin different ? : 

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 Why neonatal skin different ? a maulik shah presentation

Goals of Skin Care : 

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 a maulik shah presentation

Why to prevent IWL ? : 

Why to prevent IWL ? vessel cell interstitium cell Na Na Na Na Na

How to reduce IWL : 

How to reduce IWL a maulik shah presentation

Reducing IWL : 

Reducing IWL At birth, use occlusive polyethylene bag to cover body torso and extremities Cover body surfaces with transparent dressings a maulik shah presentation

Reducing IWL : 

Reducing IWL 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 : 

Do not Remove Vernix A Natural barrier. Prevents heat loss. Prevents trans epidermal water loss. A Natural moisturizer. It does not infect. a maulik shah presentation

Coconut oil application : 

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. a maulik shah presentation

Sunflower seed oil : 

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. a maulik shah presentation

Prevention of injury : Bed : 

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 a maulik shah presentation

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3 4 2 1 a maulik shah presentation

Injury prevention – Adhesive application : 

Injury prevention – Adhesive application a maulik shah presentation

Applying Adhesive safely. : 

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 a maulik shah presentation

Nasal CPAP & Skin Care : 

Nasal CPAP & Skin Care a maulik shah presentation

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 a maulik shah presentation

ET Fixation : 

ET Fixation While fixing ET tube, apply tegaderm Tape on the skin before putting dynaplast It will prevent avulsion of skin while removing tape a maulik shah presentation Image courtesy : WHOCC -AIMS

Removing Adhesive : 

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 : 

Adhesive Products Hydrogel Electrodes and Adhesive Strips Pectin Barriers Stretchy Gauze and Other Wraps-Dynaplast Transparent Dressings-Tegaderm. Hydro colloid - Duoderm. a maulik shah presentation

New Generation Adhesives : 

New Generation Adhesives Tegaderm Duoderm a maulik shah presentation

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. Tegaderm a maulik shah presentation

DuoDerm : 

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. a maulik shah presentation

DuoDerm : 

DuoDerm Uses: 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. a maulik shah presentation

Skin Disinfectants : 

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. a maulik shah presentation

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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 a maulik shah presentation

Povidone Iodine & hypothyroidism : 

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.” a maulik shah presentation 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 : 

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.” a maulik shah presentation 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 : 

Skin preparation 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. a maulik shah presentation - old Image courtesy : WHOCC -AIMS

The auckland dist. health board guidelines : 

The auckland dist. health board guidelines a maulik shah presentation

Prevention of Infection : 

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 a maulik shah presentation

Use of Emolients : 

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. a maulik shah presentation

Emollient Use & EBM : 

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 a maulik shah presentation

Oil massage : 

Oil massage Vegetable oils are better. “Coconut oil massage has beneficial effects on the weight gain in preterm neonates compared to mineral oil massage.” a maulik shah presentation Sankaranarayanan, et al. Oil Massage In Neonates, Indian Pediatrics.

Bathing : 

Bathing First Bath should be delayed at least 24 hrs. Tub/ pouring water bath after 15 days. Sponge bath can be allowed keeping umbilical area dry. Use only warm sterile water for preterms. Soap is best avoided in early life. Avoid rubbing skin surface. a maulik shah presentation

Some common care : 

Some common care Extravasations . Umbilical cord care. Diaper rashes Boils /abcess Circumcision a maulik shah presentation

Selection of Baby products : 

Selection of Baby products Baby Powder Baby soap Baby oil Baby lotions. a maulik shah presentation

I conclude… : 

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. a maulik shah presentation

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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 a maulik shah presentation