skin care of preterm babies

1. SKIN CARE FOR PRETERM BABIES
DR PARTHA KR CHAUDHURI
ASSOCIATE PROFESSOR (RIMS)

2. WHY IS PREMATURE SKIN DIFFERENT
1. Increased risk of infection.
2. Premature infant has more transepidermal water loss as a term infant.
3. Preterm babies have little fat resulting in decreased ability to maintain body temp • Brown fat (for
temp regulation) begins to differentiate in the 7th month of gestation.
4. Less blood supply to the epidermis.Fewer fibrils connect the dermis and epidermis, & they are more
fragile• Risk of ischemic injury from tape, monitor ,presssor and handling. • Ex. Removal of the
outermost layer of the dermis with removal of tape or electrodes.
5. Preterm skin is thinner and more permeable. • absorbs topically applied meds and chemicals
6. Sweat glands are present at birth, but full functioning is not present until 2nd/3rd year of life. •
Newborn has limited ability to tolerate excessive heat. • Vasodilatation to increased heat loss can
result in hypotension and dehydration, which is attributed to increased insensible water loss

3. Reducing IWL
• Use occlusive polyethylene bag to cover torso and extremities
• Use transparent dressing to cover body surfaces.
• Apply petrolatum based ointment every 6 hourly to body surface
• Use polyethylene tents and blankets, that do not touch the skin, to
trap the moisture.
• Studies say that in preterm VLBW application of coconut oil twice a
day for 1st week reduces TEWL by as much 46%.
• Do not remove vernix

4. PREVENTION OF INJURY
• Apply adhesive safely –Choose adhesives that cause the least trauma whilst still
effectively securing medical devices, smaller tape, minimum amount in contact
with skin, deactivate not required adhesive with cotton ball, do not use bonding
agent, avoid bandage after heel picks
• Adhesive products- TEGADERM,DUODERM,PECTIN BARRIERS, HYDROGEL
ELECTRODES, DYNAPLAST
.
• Removing adhesives- Remove using warm water with soft paraffin with help of
cotton balls, avoid solvents

5. PREVENTION OF INJURY
• Support using soft bedding, turn and position 2-4 hourly
• Nasal CPAP- use appropriate sized prong ,inspect and massage skin 4
hourly
• ET Tube – use Tegaderm, dynaplast to fix
• Probes and electrodes – change site, do not apply continuously if
possible

6. SKIN DISINFECTANT
• Increased permeability of the skin allows for absorption of some
meds and products
• Alcohol and betadine; can lead to chemical burns. Wash off well with
water.
• Studies have shown that povidone iodine can be absorbed through
premature skin and can lead to hypothyroidism
• Chlorhexidine Gluconate aqueous solutions (0.1% Chlorhexidine
Gluconate) are preferred in the preterm infant.

7. BATHING
• Bathing not recommended in NICU admitted babies.
• Defer sponging till clinically stable / cord falls ; start conventional
baths when > 2.5 kg.
• Water used for sponging NICU babies should be sterile.
• Soap is avoided in early life and avoid vigorous rubbing. Handle infant
gently and minimally to avoid trauma. Need infrequent sponging to
avoid excessive drying of the skin

8. USE OF OIL MASSAGE & EMOLLIENTS
• Studies have shown that coconut oil massage has beneficial effect on weight gain of
preterm compared to mineral oil massage(sankarnarayan et al .IP.)
• Another study showed -Sesame oil group had significant increase in length, mid-arm
and mid-leg circumferences by 1.0, 0.9 and 0.7 cm respectively, p < 0.05(Agarwal KN,
Gupta A, Pushkarna R, et al. Indian J Med Res 2000;112:212-217 )
• Another stdy reports a)Improved daily weight gain by 5.1g (95% CI 3.5, 6.7) b)Reduced
length of stay in hospital by 4.5 days (95% CI 2.4, 6.5) c)Positive effects on postnatal
complications & weight at 4 – 6 months. [Vickers A, Ohlsson A, Lacy JB, et al. Cochrane
Database Syst Rev. 2004;(2):CD000390
• There was better weight gain in oil massage group. Other parameters were comparable
(Arora J, Kumar A, Ramji SIndian Pediatr. 2005 Nov;42(11):1092-100)
• Emollient creams, free of preservatives and perfumes may be of benefit by decreasing
transepidermal water loss, improves skin condition,decreases nasocomial infection and
skin breakdown when cracking, excessive dryness, or fissures are present.

9. • LASTLY AND MOST IMPORTANTLY SKIN TO SKIN CONTACT
(KANGAROO MOTHER CARE )
&
HAND WASHING BEFORE TOUCHING PREMATURE BABY

10. THANK YOU