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.
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.