title: Skin care in the NICU patient: effects of wipes versus cloth and water on stratum corneum integrity.
abstract: BACKGROUND
  NICU patients are at risk of skin breakdown due to prematurity, irritant exposure, medical status and stress. There is a need to minimize damage, facilitate skin development and reduce infection risk, but the literature on the effects of skin care practices in NICU patients is limited.
  
  
  OBJECTIVE
  To test the hypothesis that baby diaper wipes with emollient cleansers and a soft cloth would minimize skin compromise relative to cloth and water.
  
  
  METHODS
  In 130 NICU infants (gestational age 23-41 weeks, at enrollment 30-51 weeks), measurements of skin condition, i.e., skin erythema, skin rash, transepidermal water loss (TEWL) and surface acidity (pH), within the diaper and at diaper and chest control sites were determined daily for 5-14 days using standardized methods. Treatments were randomly assigned based on gestational age and starting skin irritation score: wipe A, wipe B, and the current cloth and water NICU standard of care.
  
  
  RESULTS
  Perineal erythema and TEWL were significantly lower for wipes A and B than cloth and water beginning at day 5 for erythema (scores of 1.11 +/- 0.05, 1.2 +/- 0.05, and 1.4 +/- 0.06, respectively) and day 7 for TEWL (28.2 +/- 1.6, 28.8 +/- 1.6, and 35.2 +/- 1.6 g/m(2)/h, respectively). Wipe B produced a significantly lower skin pH (day 5, 5.47 +/- 0.03) than wipe A (5.71 +/- 0.03) and cloth and water (5.67 +/- 0.04). The starting skin condition, stool total, age and time on current standard impacted the outcomes.
  
  
  CONCLUSIONS
  Both wipes are appropriate for use on medically stable NICU patients, including both full and preterm infants, and provide more normalized skin condition and barrier function versus the cloth and water standard. Wipe B may facilitate acid mantle development and assist in colonization, infection control and barrier repair. Neonatal skin continues to change for up to 8 weeks postnatally, presumably as it adapts to the dry extra-uterine environment.
authors.affiliation: Skin Sciences Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. marty.visscher@cchmc.org
authors.forename: Marty
authors.initials: M
authors.lastname: Visscher
authors.forename: Mauricio
authors.initials: M
authors.lastname: Odio
authors.forename: Teresa
authors.initials: T
authors.lastname: Taylor
authors.forename: Tamina
authors.initials: T
authors.lastname: White
authors.forename: Shelly
authors.initials: S
authors.lastname: Sargent
authors.forename: Linda
authors.initials: L
authors.lastname: Sluder
authors.forename: Louise
authors.initials: L
authors.lastname: Smith
authors.forename: Teresa
authors.initials: T
authors.lastname: Flower
authors.forename: Beth
authors.initials: B
authors.lastname: Mason
authors.forename: Maureen
authors.initials: M
authors.lastname: Rider
authors.forename: Amy
authors.initials: A
authors.lastname: Huebner
authors.forename: Pattie
authors.initials: P
authors.lastname: Bondurant
mesh_terms: D001494:Baths; D003963:Diaper Rash / Q000473:pathology / Q000517:prevention & control; D004643:Emollients / Q000008:administration & dosage*; D004817:Epidermis / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D004890:Erythema / Q000473:pathology / Q000517:prevention & control; D005260:Female; D005865:Gestational Age; D006795:Household Products; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000295:instrumentation* / Q000379:methods; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D010502:Perineum / Q000473:pathology; D017592:Skin Care / Q000295:instrumentation* / Q000379:methods; D012879:Skin Physiological Phenomena / Q000187:drug effects; D014867:Water / Q000008:administration & dosage* / Q000378:metabolism; D014870:Water Loss, Insensible / Q000187:drug effects
chemical_list: D004643:Emollients; D014867:Water