Neonatal Skin

NEOCON Hyderabad 2019

Eszter Jozsa RN, IBCLC, CNE

The skin as an organ

• Largest organ of the body

• Appearance and condition provides information about

–nutritional status, hydration, tissue oxygenation, diseases and dysfunctions, gestational age and emotions

Physiology and structure

• Three morphologically different layers

Function of the skin

The immature skin

• pink-red, transparent, shiny

• visible veins close to the surface

• water retention and tissue edema due to

collagen instability

• thin epidermis, dermis, hypodermis

• density of Stratum Corneum

• fragility

• permeability

• adherence between dermis and epidermis

• minimal elastin and collagen fibres

• pH after birth

• potential for absorption of topical agents

Skin injuries of the neonates

• Trauma to the skin = serious consequences

• Promoting skin integrity is one of the most important aspect of care

– Minimise irritation

– Prevent skin breakdown and epidermal stripping

Concepts of securing devices

on neonatal skin

• Decide the best possible device to use

• Decide the best possible place

• Use the right adhesive tape

• Use correct application techniques

• Use appropriate removal techniques

• Use barriers between skin and tape

Interventions

• Assess the skin for color, perfusion,

appearance and temperature

Interventions

• Keep skin clean and dry

Interventions

• Use protective barrier between the skin and adhesive tape

Interventions

• Alternate electrode placement

Interventions

• Apply safe removal technique

Interventions

• Limit the use of chemicals on skin

• 15 seconds drying time after application of

cleaning solution

Interventions

• Maintain body temperature

Interventions

• Prevent extravasations

Interventions

• Deliver optimal CPAP and High Flow therapy

Interventions

• Preventing pressure damage

– Comfortable, but fitting hat

• Check ears

– Correct size interface

– Chin strap or dummy

– Correct size mask and prongs

– Correct position

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Complications

Necrosis of the forehead Transection

Interventions

• Provide adequate nutrition

– Promotes wound healing.

– Enhances the maturation of the skin.

• Practice minimal handling

– Reduces the possibility of mechanical skin

trauma.

Interventions

• Minimal use of adhesive and tape– Assess the need for adhesive tape used

– Chose the appropriate adhesive tape

– Use sterile products and technique to decrease the risk of infection

– Appropriate taping technique reduces mechanical injuries

– Assess skin condition regularly

Common taping problems and

their prevention

• Tension mechanical injury

– Stretching or pulling the tape as applied

– Failing to reposition or replace tape as swelling

indicates

Common taping problems and

their prevention

• Non-tension mechanical injury

– Skin irritation due to incorrect tape applied

– Improper tape removal technique

Common taping problems and

their prevention

• Skin stripping

– Removal of the epidermis with adhesive tape

– Repeated application of tape over the same site

Common taping problems and

their prevention

• Chemical injury

– Irritating chemical entrapped between the skin

and the tape

Know your products!

Products used

• Comfeel Plus Transparent

– semi-permeable

– semi-transparent

– waterproof

– oxygen and water vapour permeable

– hydrocolloid adhesive

Products used

• Tegaderm

– water and bacteria proof

– transparent polyurethane film backing

– polyacrylate adhesive

– hypoallergenic

Products used

• Leukoplast elastic

– aggressive zinc oxide adhesive

– flexible tape

– residue after removal

Products used

• Durapore

– Bidirectional tear

– Hypoallergenic

– Latex free

– Silk-like cloth

– No-strech

– Solvent based adhesive

Products used

• Surgistrip

– polyamid backing

– polyacrylate adhesive

– sterile

Products used

• Cavilon

– breathable, transparent coating

– acrylate polymere

– pH7

Products used

• Melolite

– nylon coated

– absorbent

– non-adherent

Products used

• Mefix

– Skin friendly water based,

– Latex free

– Solvent free

– Polyacrylate adhesive

– Non-absorbent, non-woven fabric made of

spunlace polyester

– Water repellent

Products used

• Mepitec

– Silicon based, gentle adhesive

– Reusable for the same baby

– Conforms well to body contours

– Waterproof

– Breathable to prevent maceration of the skin

– Leaves no residues on the skin after it’s removed

Thank You

Any questions?