Care of Skin in Neonate (Neonatal Skin Care Guidelines)

Introduction

Neonatal skin experiences a progressive adaptation to the extrauterine environment during which special care is needed. The immaturity of the epidermal barrier in the neonatal period may cause dry skin, vulnerability to trauma, rapid onset of microbial colonization and percutaneous drug toxicity [1].

Neonatal skin suffers a progressive adaptation to the extrauterine environment and special care is needed during this period. This skin is very sensitive, thin and fragile. Immaturity of the epidermal barrier reduces the defence against the excessive proliferation of microbes and makes the skin more vulnerable to trauma and percutaneous drug toxicity. Because of the peculiar characteristics of new born, infant and children's skin, the use of cosmetic products designed for hygiene and protection requires caution. In order to preserve the integrity of neonatal and child's skin, this article reviewed basic preventive care practices in relation to hygiene, bathing, cleansing agents, topical products and their percutaneous toxicity [2]. The purpose of skin care is maintenance of skin integrity promotes the following: provides a barrier against substances such as microbial organism and chemicals; regulation of fluid and electrolyte balance and body temperature; provide tactile stimulation, and facilitate parental bonding.

Definition

Neonatal skin is fragile, and the premature infant's skin is also underdeveloped. The skin may be highly susceptible to skin breakdown. Increased skin permeability is a major concern that allows the infant to absorb topical medication, chemical preparations, and lotions through their skin, thus placing the infant at risk for toxicity and infections. This increase in skin permeability places the infant at risk for insensible water loss and temperature instability. The neonate’s skin does not mature for approximately 2 weeks. The premature infant skin does not mature for 2-3 weeks.

Protective Mechanism: Acid Mantle

The functional capacity of the skin to form an acid mantle (i.e. surface pH<5) results in protective barrier to the environment as long as the skin stays intact. An acid skin surface is credited with bactericidal qualities against some pathogens and helps in defense against infection. In the newborn the skin pH immediately after birth is 6.34 with a decline to 4.95 within 4 days; whereas in the low birth weight infants the mean skin pH is 6.7 at birth and 5.0 by the eighth day of life.

Immediately following birth colonization with microbial organisms also begins. These organisms grow in a state of equilibrium providing protection against invading pathogenic organisms. A rise in pH towards neutral (7.0) causes an increase in the total number of bacteria and changes in the flora present. Washing infants with soap can change the pH of the skin, destroying the skin mantle. After bathing the infant with soap and water it takes at least one hour for the acid mantle to be replaced putting the infant at risk for infections during this time period. Lotion and cream can also destroy the composition of the acid mantle and bacterial flora.

Neonatal Skin Condition Score (NSCS)

The Neonatal Skin Condition Score (NSCS) is reliable when used by single and multiple raters to assess neonatal skin condition, even across weight groups and racial groups. Validity of the NSCS could be demonstrated by confirmation of the relationship of the skin condition scores with birth weight, number of observations, and prevalence of infection [3].

It can facilitate assessment of neonatal skin condition. It is very easy to use, and should be a part of daily skin assessment documentation.

Bathing

Newborns lose four times more heat per unit body weight than adults [4]. Many of the thermal care practices were suboptimal. Of particular note was the near universal early bathing of babies in both Nigerian sites, the length of time babies are left undressed during bathing in Ethiopia, and a common belief that bathing with warm water keeps the baby warm. The link between delayed bathing and body odour later in life has been found in other West African countries [5] Bathing includes care of perianal area, cord, eye and oral care. Purpose to provide reduced antimicrobial colonization of the new-borns skin, while at the same time utilizing principles related to neonatal skin physiology, in order to maintain skin integrity. Initial Bath every new born is to get a bath with a mild, low-alkaline soap once the infant's temperature and physiologic condition are stable. Avoid contact with eyes, If needle stick must be performed prior to the initial bath, cleanse the area well with an antimicrobial prep (such us alcohol) to remove blood and other contaminants. Initial bath may be delayed for 48-72 hours if baby is not stable and not unusually soiled. Selective cleaning of soiled parts is then carried out. Special Considerations are Bath infants as soon as possible after the infant's temperature and physiologic condition have stabilized. Alkaline soaps affect The skin pH and disrupt the protective acid mantle of the skin. Soaps and shampoos containing perfumes and dyes are not recommended for newborns during the first 2-4 weeks of life. Rinse skin surface well after bathing. Rubbings skin surfaces should be avoided to prevent chafing and irritation. Immersion bath (tub baths) may be given for stable full-term infants and clinically stable preterm infants after umbilical cord and circumcision sites healed. Extremely low birth weight and unstable infants should receive a gentle sponge hath in incubator or under warmer bed. Bathing may be delayed as long as 48 hours unless baby is soiled. Remove blood from face, head and meconium from the perineal area using water soaked sponges. Vernix need not be removed till dry, when it will fall off by belt.