Neonatal skin readapts rapidly to dry, aerobic conditions at birth, while skin function gradually matures throughout infancy. A newborns skin must habituate and mature to provide protection against toxins, trans epidermal water loss (TEWL), changes in temperature, infection and ultraviolet (UV) radiation. Bathing and skin moisturizing, diaper and umbilical cord area care and sun protection are the critical areas of infant skin care.

A recent study published in Current Opinion in Pediatrics aimed to review infant skin carerecommendations relevant to pediatric practice.

Full-term infant skin care practices were elucidated, as follows:

• Bathing – Babys first bath must be delayed until thermal stability is achieved. The vernix should be left undisturbed and therefore, dry wiping and gentle bathing is ideal. Bathing twice or thrice a week is ideal for full-term neonates.
• Umbilical cord care – The umbilical stump should be kept clean and dry and diaper edges should be folded below it. Skin to skin contact to promote colonization with normal skin flora should be initiated. Application of chlorhexidine (CHG) to the umbilical stump daily is recommended to prevent infection in developing countries with high neonatal mortality rates.
• Moisturizers –Skin moisturizers should be applied in a thin layer to avoid accumulation under skin folds. Regular use reduces the risk of developing atopic dermatitis.
• Diaper area care – Diaper area should be kept dry and clean with repeated changes. To clean non-irritated skin in diaper area, diaper wipes with pH-buffers should be used. Treatment of diaper dermatitis and prophylaxis can be done using barrier ointments.
• Sun Protection – For infants below six months of age, protective clothing and sun avoidance is recommended and application of sunscreen is not recommended.

Regarding preterm infant skin care practices – it was stated that:

• Thermal instability and stress are some of the issues faced when bathing a premature infant. Hence, they must be bathed every 4 days to maintain skin integrity and skin flora.
• Catheter site hygiene is of utmost importance as nosocomial sepsis is linked to the use of central venous catheters.
• To minimize skin damage, chemical adhesive removers should be avoided, and adhesive bandages should be removed by stretching the bandage horizontally along the skin surface to gently break adhesive bonds with removal.

Skin care guidelines for newborns with genetic skin disorders are:

• Epidermolysis bullosa

0 Gentle and minimal patient handling is essential to avoid worsening skin erosions

0 Apply white petroleum ointment on gloves before handling the patients

0 Lifting instead of sliding the patient is ideal

0 Regular bathing is essential to reduce infections

0 Larger blisters should be decompressed by cleaning the affected skin with alcohol, piercing the blister with a sterile needle and gently expressing the blister fluid while leaving the blister roof in place as a biological dressing

0 Nonadherent foams, modified absorbent pads, hydrocolloid dressings and contact layers can be used for protection and to treat non-exudative wounds

• Epidermolytic ichthyosis

0 Patients should be handled only when necessary

0 Gloves should be lubricated well with white petrolatum

0 Daily baths followed by liberal emollient use and non-stick wound dressings is advised

0 Use of adhesives should be minimized

• Collodion baby 

0 Neonates should be placed in a humidified incubator shortly after birth until the collodion membrane sheds with humidity

0 Daily bathing and application of white petroleum should be advised

0 Serum electrolytes, temperatures, urine output, albumin, blood urea nitrogen, daily weights and creatinine levels should be monitored closely

It was inferred that gentle skin care for infants supports skin function and ongoing postnatal skin maturation. Special skin care precautions are required for bathing and handling of premature infants as well as infants born with severe skin manifestations of genetic disease. Delay of the first bath till thermal stability is achieved was recommended. Meanwhile, skin emollient use from birth in at-risk full-term infants helps prevent atopic dermatitis.

Source: Johnson E., Hunt R. Infant skin care: updates and recommendations. Curr Opin Pediatr. 2019 Aug;31(4):476-481