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Neonatal skin care: the scientific basis for practice
Insights
Neonatal skin requires specialized care due to its vulnerability. This review synthesizes evidence to establish best practices for maintaining infant skin integrity and health.
Area of Science:
- Neonatal dermatology
- Pediatric nursing
- Skin integrity research
Background:
- Neonatal skin possesses unique anatomical and physiological characteristics that predispose it to barrier disruption.
- Infant skin is susceptible to trauma, toxicity, and breakdown, necessitating specific care protocols.
Purpose of the Study:
- To conduct a comprehensive literature review on neonatal skin care practices.
- To identify evidence-based recommendations for maintaining healthy infant skin.
- To inform the development of clinical practice guidelines for neonatal skin management.
Main Methods:
- Systematic literature search of MEDLINE and CINAHL databases, supplemented by reference citation analysis.
- Inclusion of articles published after 1963, with a focus on recent findings (1993-1999).
- Data extraction and organization covering skin anatomy, physiology, differences in neonates, nutritional factors, care practices, and breakdown management.
Main Results:
- Newborn skin is at high risk for barrier disruption from external factors and trauma.
- Evidence supports specific guidelines for bathing, lubrication, disinfection, and adhesive removal in neonates.
- Recommendations emphasize maintaining skin integrity, minimizing exposure to toxins, and promoting long-term skin health.
Conclusions:
- The review provides a foundation for a new, comprehensive clinical practice guideline for neonatal skin care.
- Ongoing evaluation of this guideline is being conducted across multiple clinical sites in the U.S.
Objective:
To review the literature addressing the care of neonatal skin.
Data Sources:
Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included neonatal skin differences; neonatal skin and care practices for skin integrity; neonatal skin and toxicity; permeability; and contact irritant sensitization.
Study Selection:
Articles and comprehensive works relevant to key concepts and published after 1963, with an emphasis on new findings from 1993 to 1999. One hundred two citations were identified as useful to this review.
Data Extraction:
Data were extracted and organized under the following headings: anatomy and physiology of the skin; physiologic and anatomic differences in neonatal skin; nutritional deficiencies; skin care practices; and care of skin breakdown.
Data Synthesis:
Newborns' skin is at risk for disruption of normal barrier function because of trauma. In light of available evidence about differences in neonatal skin development, clinical practice guidelines are suggested for baths, lubrication, antimicrobial skin disinfection, and adhesive removal. In addition, basic care practices are suggested for maintaining skin integrity, reducing exposure to potentially toxic substances, and promoting skin health beyond the neonatal period. Preventive care recommendations are made for reducing trauma, protecting the skin's immature barrier function, and promoting skin integrity.
Conclusions:
This review generated evidence with which to create a new and comprehensive practice guideline for clinicians. Evaluation of the guideline is under way at 58 U.S. sites.