Everything You Need to Know About Neonatal Skin Care!

Introduction:

Skin, the major protector of the body, being immature at birth, is susceptible to infections and pathogens. A proper skincare routine is vital for all, especially for neonates. Neonates, particularly preterm infants, are susceptible to potential injury and infections. Therefore special care is required to minimize the breakdown of skin integrity.

What Are the Layers of Skin?

The skin consists of different layers, namely:

• Stratum corneum.

• Epidermis.

• Dermis.

Stratum corneum is the uppermost layer of the skin. It is about 10 to 20 layers thick in adults and term neonates, whereas only two to three layers thick in preterm infants. The stratum corneum is responsible for protecting the skin against pathogens, irritants, and other external factors. This reduction in layers of the stratum corneum, in turn, makes preterm infants more vulnerable to infections. Also, preterm infants have a higher risk of water loss and inability to maintain homeostasis.

Below the stratum corneum are the basal layer and dermis, which is also largely underdeveloped when compared to the adult skin, making it more permeable, at higher risk of fluid loss, and having a lesser capacity for thermoregulation. Hence special care should be taken in neonates to prevent damage to the skin barrier and further infections.

Other normal skin structures found in neonates include :

• Vernix Caseosa: It is a white, creamy layer occurring naturally; its function is to protect the skin in utero; it is shed after birth without any intervention.

• Peeling of Skin: This can occur one to three weeks after birth. It is a normal phenomenon; the extension of peeling will depend on whether the infant is preterm, term, or overdue.

What Are the Different Functions of Skin?

The skin has various protective properties and functions, such as:

• Protective barrier against loss of water.

• Helps synthesize vitamin D3.

• Thermoregulation of the body as it possesses sweat glands.

• Immunological properties, such as primary barrier against pathogens.

How to Care For Preterm Infants?

Already immature skin of preterm neonates may be at higher risk of infection, thereby needing more care and concern. Topical ointments and oils are observed to have beneficial effects in preventing infections as they prevent the breakdown of the skin barrier and thereby preventing infections.

How to Care for the Skin in NICU?

• Hospitalized neonates or NICU patients are at risk of loss of continuity of the skin barrier due to premature birth. Therefore special care has to be taken to prevent or minimize damage, help improve the skin structure and development and reduce the risk of infections.

• Diaper changes should occur at regular and frequent intervals, as the perineal environment is prone to infections. Disposable diapers are preferred.

• Cotton balls or disposable soft towels with warm water are an ideal cleaning method. Wipes should be avoided; if used, they have to be free of alcohol and fragrance. Use of wipes in already broken down skin is not encouraged.

• Barrier creams should be used to reduce friction and, thereby, dermatitis. This, too, should be devoid of fragrance and alcohol.

What Is the Basic Skin Regime to Be Followed for Neonates?

Complete development of skin will continue up to 12 months after birth; for the same reason, care should be given when cleaning and bathing the infant's skin.

• It has been found that immersion bathing is, to some extent, better than the use of a washcloth and wipe for the infant. And the use of mild liquid cleansers is said to have a better advantage than soaps to a certain degree.

• Alkaline soaps are not preferable because of their effect on the pH of the skin. It may further cause skin drying or irritation.

• Cleaners containing emollient may have additional beneficial effects.

• Bathing may have other psychological advantages for the parent as well as the infant.

• Bathing using a pH-neutral liquid cleanser is the preferred cleaning regime, with special care to avoid irritation to the eyes.

How to Care for the Cord?

The umbilical cord is what acts as a lifeline between the fetus and the mother in utero. After birth, the umbilical cord is cut. But a remnant or stalk is seen in neonates. This will be naturally shed in ten to five days. The neonate should only be wiped with a clean damp cloth in the cord area. Care should be taken to prevent any water from retaining in the areas, to prevent any infection. It is preferable to withhold tub baths till the cord is shed so as to prevent water from reaching the cord.

What Is the Ideal Moisturizing Regime?

As recent studies have shown that disruption of the skin layer is a cause of dermatitis,

The use of moisturizer helps to maintain the skin barrier and prevent the said disruption. It can therefore prevent allergic disorders and eczema.

Moisturizers prevent transepidermal loss of water and also improve skin damage. Humectants (substances that help retain moisture) trap the water and prevent it from escaping through the skin.

Some studies also suggest the use of natural oils such as coconut oil for the preservation of the skin's integrity. Petroleum jelly is another suggestion as it helps prevent water loss. While selecting moisturizers, be careful to avoid products with fragrances, dyes, and other such chemicals.

What Are the Causes of Diaper Rash?

• Prolonged exposure to body waste.

• Increased hydration or moisture content.

• Alteration in skin pH.

• Alteration in skin integrity or barrier.

It is characterized by an attack on the skin by chemical and microbial agents in the napkin area. The skin barrier is affected by the increased microbial load, which is facilitated by a rise in skin pH and increased skin hydration. The skin is in a compromised state and is susceptible to chemical and physical assaults.

How to Prevent Diaper Rashes?

Diaper rashes, napkin rashes, or irritant diaper dermatitis is a common form of contact dermatitis found in neonates. It occurs in the nappy area as a consequence of prolonged exposure to feces and urine. It is a frequently occurring condition in neonates that occur in the first months after birth and is best managed by prevention.

• Prevention of Diaper Rashes Includes: Bathing with liquid cleanser to reduce the microbial load and the use of super-absorbent diapers to reduce moisture content in that area and thereby reduce the rash.

• Improving Napkin Rash Includes: Diapers with increased absorption and pH balancing wipes. The application of ointments containing zinc oxide or petroleum jelly with or without vitamin A helps supplement the treatment of the rash. Creams help to improve the situation but are not a substitute for diaper changes. Frequent diaper-free time is also said to have beneficial effects.

Conclusion:

Neonates, in many forms, are fragile and delicate. So is their skin. And because of the same special care and protection are required. Care for neonatal skin has long-term benefits, such as helping prevent future allergic disorders such as eczema, promoting other dermatological benefits, and also ensuring the prevention of infection in frail beings.