Neonatal Skin Care
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DESCRIPTIONNeonatal Skin Care. Prepared by: LCDR Belinda Rand, RN, RNC. Objectives. Name three functions of the skin. Describe two ways in which the skin of a newborn or preterm infant differs from that of an adult. Identify three factors that affect the appearance of the neonates skin. - PowerPoint PPT Presentation
Neonatal Skin Care
Prepared by: LCDR Belinda Rand, RN, RNC
Objectives Name three functions of the skin. Describe two ways in which the skin of a newborn or preterm infant differs from that of an adult. Identify three factors that affect the appearance of the neonates skin. Identify two nursing interventions that provide protection for the preterm infants skin. Recognize three common skin lesions that are normal variations in the newborn infant. Describe their appearance and treatment, if any. Describe three common vascular lesions in the neonate, their appearance, and appropriate treatment. Identify two syndromes associated with vascular lesions.
Clinical SignificanceCareful assessment of the skin is an important element of the neonatal physical examination. The appearance of the skin gives the nurse important clues regarding the gestational age, nutritional status, function of organs such as the heart and liver, and the presence of cutaneous or systemic disease. It is important for the RN to be familiar with normal variances in the skin of the newborn infant, as well as those variances that signify disease.
Proper care of the neonates skin can directly affect mortality and morbidity, especially in the preterm infant. The skin is the first line of defense against infection. Proper skin care can protect the integrity of the skin and prevent breakdown.
Anatomy and Physiology of the skinThree main layersEpidermis: outermost layer, which functions as a barrier from outside penetration.
Dermis: directly under the epidermis, 2 to 4 cm thick at birth. Contains blood vessels and nerves that carry sensation; heat, touch, pain, and pressure, sweat glands and hair shafts. Collagen and elastic fibers that connect the epidermis and dermis, and provide the skin with the ability to stretch and return to normal shape.
Subcutaneous layer: fatty tissue functions as insulation, protection of internal organs, and calorie storage.
Layers and Structures of Human SkinInsert Figure here
Functions of the SkinPhysical ProtectionMechanicalprovides a protective barrier against transepidermal water loss and eternal invasions.
Process of sloughing prevents colonization of the skin surface by bacteria and other organisms.
Functions of the SkinPhysical ProtectionChemical/ bacterial
Acidic surface (pH) defends against bacteria and microorganismsProduction of melanin protects against damage from UV light radiation.
Functions of the Skin
Production and evaporation of sweat. Dilatation and constriction of blood vessels. Insulation of body by subcutaneous fat.
Heat, touch, pain, and pressure.
Differences in Newborn & Preterm SkinBasic structure is same as that of the adult
The less mature the infant, the less mature is the functioning of the skin. The earlier the age, the more thin and gelatinous is the skin. Gradual maturing; however, at 4 wks of age a 25 wk infant has twice the transepidermal water loss as a term infant.
Differences in Newborn & Preterm SkinSubcutaneous fat is accumulated predominantly during the third trimester.Preterm babies have little fat resulting in decreased ability to maintain body temp and blood glucose levels. Brown fat (for temp regulation) begins to differentiate in the 7th month of gestation.
Differences in Newborn & Preterm Skin
Newborn skin is thinner and more permeable. Infants, esp. preterm, quickly absorbs topically applied meds and chemicals.Allows for greater insensible water loss in the preterm infant.
Differences in Newborn & Preterm SkinFewer fibrils connect the dermis and epidermis, & they are more fragile than that of an adult.
Risk of injury from tape, monitor, and handling is increased. Ex. Removal of the outermost layer of the dermis with removal of tape or electrodes.
Differences in Newborn & Preterm SkinSweat 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.
Care of Newborn SkinTerm NewbornInitial bath with water and a mild soap. Soaps containing hexachlorophene have been shown to be absorbed through the skin. Dont use. Bacteriostatic soap safety has not been established. Use with caution, rinse completely. Parents may want to give the first bath.
Care of Newborn SkinTerm InfantNeed a stable body temp to bathe Infant (>36.5 C) When stable it is advisable to bathe infant to reduce caregivers exposure to blood-borne pathogens. Vernix is good! The vernix caseosa contains large amounts of fats, which protect and insulates the skin, should not be scrubbed off with bath.
Care of Newborn SkinTerm Infant Routine use of emollients is not recommended. Creams and lotions contain perfumes and are drying and can irritate the skin. Some products can change the pH of the skin and decrease bacteriostatic properties.Avoid puncturing skin when suspicious of maternal infection.
Care of Preterm SkinPreterm infantKeep skin clean with water, mild non alkaline soap may be used. Handle infant gently and minimally to avoid trauma. Need infrequent bathing to avoid Excessive drying of the skinAvoid over stimulation, Stress and fatigue
Care of Preterm SkinPreterm Infants Minimize the use of tape, removing tape can strip the epidermis. Transparent adhesive dressings can be used for wounds, abrasions, to secure IVs etc.Safety of adhesive solvents is uncertain, cotton balls soaked with warm water can be used. 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.
Care of Preterm SkinPreterm Skin Emollient creams, free of preservatives and perfumes may be of benefit by decreasing transepidermal water loss and skin breakdown when cracking, excessive dryness, or fissures are present. Tent with warm mist may protect the skin and decrease insensible water loss in the very low birth weight infant.
Assessment of Newborn Infant Skin Factors affecting the appearance of the skin
Gestational age Postnatal age Nutritional status and hydrationRacial origin Type and amount of available light Hemoglobin and bilirubin levels Environmental temperatures Oxygenation status
Assessment of SkinDefinitions to describe skin lesions Macule; pigmented, flat spot that is visible but not palpable. Papule; solid, elevated, palpable lesion, with distinct borders > 1 cm in sizePlaque; solid, elevated, palpable lesion, with distinct borders > 2 cm in size Nodule; a solid lesion, elevated with depth, up to 2 cm in size
Assessment of Skin Definitions Tumor; solid lesion, elevated with depth > 2 cm is size. Vesicle; elevated lesion or blister filled with serous fluid and < 1 cm in diameter.Bulla; fluid filled lesion larger that 1 cm.Pustule; a vesicle filled with cloudy or purulent fluid. Petechiae; subepidermal hemorrhages, pinpoint in size, that do not blanch.
Assessment of Skin Definitions Ecchymosis; a large area of subepidermal hemorrhage.Wheal; area of edema in the upper dermis, creating a palpable, slightly raised lesion. Ulcer; erosion of skin with damage of the epidermis into the dermis. Will leave a scar after healing.
Common Skin Lesions Normal variations in newborn skin Cutis marmorata
Bluish mottling or marbling effect of skin Physiologic response to chilling caused by dilation of capillaries Disappears when infant is rewarmed May be sign of stress or overstimulation in newborn.
Common Skin Lesions Normal Variations Erythema toxicum (Newborn Rash)
Small white or yellow pustules surrounded by an erythematous base (redness caused by a histamine release)Differential Diagnosis; may resemble a staphylococcal infection, (confirmed by a smear of aspirated pustules showing increased eosinophils).
Common Skin LesionsNormal VariationsMilia
Multiple yellow or pearly white papules about 1mm in size; inclusion cysts, usually on brow, cheeks, and nose. Observed in about 40% of newborn infants.No treatment needed, resolve spontaneously during the first few weeks after birth.
Common Skin LesionsNormal VariationsEpstein pearls
Oral counterpart of facial milia. Can be seen on the midline of palate or on the alveolar ridges. Occurs in approx 60% of neonates. No treatment needed.
Lesions from Trauma Forceps marks Red or bruised areas seen over the cheek, scalp, for face of infant following forceps delivery. On assessment look for underlying tissue damage or other signs of birth trauma; scalp abrasions, fractured clavicles, or facial palsy.
Lesions from TraumaScalp LacerationsMay occur during delivery, with placement of scalp electrodes, or fetal blood pH sampling. Treatment consists of keeping the area clean and dry, and assessing for infection.
Lesions from TraumaIntravenous extravasations Vascular access sites in infants should be assessed hourly, evaluate for patency and extravasations. If apparent or if patency is not certain remove IV catheter immediately. If extravasation occurs, elevate extremity. Avoid heat or moist dressings. Topical antimicrobial ointments may aid.
Pigmented Skin LesionsHyperpigmented macules (mongolian spots) Large macules or patches, gray or blue-green, seen most commonl