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What is Evidence-Based Care?
Evidence-based practice is a way of providing care for patients based on scientific research and the opinions of respected experts. Data derived from research, along with significant clinical experience help create practice recommendations. Guidelines provide you with appropriate interventions and decisions based on the best available evidence.
What Are The Latest Updates in The Neonatal Skin Care: Evidence-Based
Clinical Practice Guideline?
Among other updates, the Neonatal Skin Care Guideline features important updates on:
- The need for nurses to perform frequent skin assessments to detect risk for alterations in skin integrity
- Immersion bathing benefits
- Diaper dermatitis assessment and care
- Implications of CHG-containing skin antiseptics
- Use of medical adhesives
- Updated considerations regarding product selection
The Power of pH
Is Water Enough to Wash a Baby?
For most healthy newborns, bathing with warm tap water is all that's needed. Mild cleansers may also be used. They have been found to be more effective than water alone at removing urine, feces, and microorganisms from the skin surface. Preterm infants less than 32 weeks gestation should only be bathed with warm tap water for the first week of life because they are at particular risk for skin disruption from applied substances. In cases of skin breakdown, preterm infants should be bathed with sterile water.
As you will see in the bathing section of Neonatal Skin Care: Evidence-based Clinical Practice Guideline, 3rd Edition (starting on page 12), recommendations for using a mild cleanser go into great detail
The Safety in Baby Soap
Baby skin is quite different from adult skin, and it is important for nurses and other health care professionals to understand these differences. Soap can alter newborn skin pH, causing skin breakdown and irritation. For example,the Neonatal Skin Care: Evidence-based Clinical Practice Guideline, 3rd Edition recommends the following considerations for cleansers:
- Choose cleansers that are the least irritating to the skin, do not disrupt the skin surface's normal pH, or cause stinging or irritation of the eyes.
- Select mild cleansers that have a neutral or mildly acidic pH range of 5.5-7.0.
- Choose cleansers with preservatives that have demonstrated safety and tolerability for newborns. Preservatives prevent the overgrowth of microorganisms that can occur with normal use, but some preservatives can cause skin irritation or contact dermatitis from time to time.
- Ideally cleansers should not cause skin irritation, disrupt the normal pH of the skin surface, or cause stinging or irritation of the eye
The Neonatal Skin Care Guideline shares a great deal of information on the use of soap. Read the bathing section, beginning on page 12.
Neonatal Skin Care Guideline can help you determine which products are most suitable for developing newborn skin.
Choosing Cleansers
Can some cleansers disrupt the skin barrier?
Yes. The epidermis, the outermost layer of skin with the stratum corneum at the surface, functions as a physical barrier in first-line protection against bacterial infection. Some soap-based cleansers can compromise the skin barrier, drying or irritating infant skin. Antimicrobial soaps can also adversely affect normal skin colonization.
The use of cleansers that meet evidence-based skin care guidelines can help protect an infant's skin. The Neonatal Skin Care: Evidence-based Clinical Practice Guideline, 3rd Edition has specific recommendations (see page 14 and 15) for nurses and other health care professionals regarding cleansers:
- Use skin cleansers with the least irritating formulation
- Choose products containing preservatives that have demonstrated safety and tolerability in newborns
- Avoid antimicrobial cleanser whenever possible
Evaluating Ingredient Safety
Consult evidence-based guidelines, and other reliable sources, to determine which products and product categories are appropriate and safe for your patients' needs.
To help you make more informed decisions about selecting skin care products for babies, nurse experts recommend:
- Reading product labels
- Assessing parents' personal and family histories
- Limiting the number of products applied on infants
- Selecting products that ideally have been safety-tested on neonates or infants
- Consulting professional associations and federal resources
Be sure to flip to the new Product Selection Considerations section (see page 91) of the Neonatal Skin Care Guideline for additional information.
Are There Considerations Regarding Emollients?
Yes, the Neonatal Skin Care: Evidence-based Clinical Practice Guideline, 3rd Edition includes an entire section on emollients and recommendations for nursing clinical practice. You can find additional information on page 46 of the Neonatal Skin Care Guideline. The following is just a sampling:
- Emollients may be used to restore integrity to dry or cracking skin
- Routine emollient use may be indicated in healthy, full-term newborns with 'cradle cap' or atopic dermatitis (eczema)
- Select products that ideally have been safety-tested on neonates and infants. Products containing preservatives should have a demonstrated safety and tolerability in newborns. Mild products are preferable
Neonatal Skin Care Guideline can help you determine which products are most suitable for developing newborn skin.
Are There Evidence-Based Bathing Procedures?
Yes, recent evidence-based science has compelled nurse experts to recommend procedures for both first baths and routine bathing. These procedures include swaddled-bathing, which reduces the infant's exposure during cleansing and rinsing. As you will see in the bathing section of Neonatal Skin Care: Evidence-based Clinical Practice Guideline, 3rd Edition (starting on page 12), recommendations for a baby's first bath go into great detail:
Sponge-bathing:
- Place baby on a soft surface
- Keep baby wrapped in a towel
- Gently expose one body part at a time for cleansing and rinsing with warm water
Tub (immersion) bathing:
- Fill the tub with warm water deep enough to keep the baby's shoulders covered
- Hold baby firmly under the buttocks and the back of the neck and gently lower her or his body, except head and neck, into the water
- Wash baby's face first with warm water and a clean cloth
- Wash the rest of baby from the top down
- Gently rinse baby
Swaddled-bathing:
- Place baby in a flexed, midline position, swaddled in a blanket or soft towel
- Immerse baby in a tub of warm water
- Unwrap and gently wash one body part at a time
Also included is helpful guidance on what to avoid. For example, do NOT:
- Use bathing equipment that has not been disinfected
- Place baby under a faucet for bathing
- Choose a cleanser that causes skin irritation, disrupts the normal pH of the skin, or causes stinging or irritation of the eyes
- Select products that do not have demonstrated safety and tolerability in newborns
- Use antimicrobial soaps
- Bathe the baby for more than 10 minutes (5 to 10 minutes is the usual range for the healthy newborn)
NOTE: Special considerations may apply for bathing in developing countries. Read the full Guideline for more information.
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