Bathing and cleansing in newborns from day 1 to first year of life: recommendations from a European round table meeting

Vernix caseosa reveals mechanistic clues linking maternal obesity to atopic dermatitis pathogenesis

BACKGROUND

Maternal overweight and obesity have been associated with an increased risk of atopic dermatitis (AD) in the offspring, but the underlying mechanisms are unclear. Vernix caseosa (VC) is a proteolipid material covering the fetus produced during skin development. However, whether maternal prepregnancy weight excess influences fetal skin development is unknown. Characterizing the VC of newborns from mothers with prepregnancy overweight and obesity might reveal AD-prone alterations during fetal skin development.

OBJECTIVE

We sought to explore AD biomarkers and staphylococcal loads in VC from the offspring of mothers who were overweight/obese (O/O) before pregnancy versus in those from offspring of normal weight mothers.

METHODS

The VC of newborns of 14 O/O and 12 normal weight mothers were collected immediately after birth. Biomarkers were determined by ELISA and staphylococcal species by quantitative PCR.

RESULTS

The VC from the O/O group showed decreased expression of skin barrier proteins (filaggrin and loricrin) and increased levels of proinflammatory biomarkers (IgA, thymic stromal lymphopoietin [TSLP], S100A8, IL-25, and IL-33). No differences in concentrations of antimicrobial peptides and enzymes were detected. The VC from the O/O group had a lower Staphylococcus epidermidis and Staphylococcus hominis commensal bacterial load, whereas Staphylococcus aureus bacterial load was not significantly different between the 2 groups. Maternal body mass index was negatively correlated with VC filaggrin expression and S epidermidis load and was positively associated with TSLP concentration. One-year follow-up established that the offspring of O/O mothers had a higher incidence of AD that was specifically linked with decreased VC filaggrin expression and lower S epidermidis load.

CONCLUSIONS

VC from neonates of mothers with prepregnancy overweight and obesity exhibit skin barrier molecular alterations and staphylococcal dysbiosis that suggest early mechanistic clues to this population's increased risk of AD.

Evidence-Based Consensus Recommendations for Skin Care in Healthy, Full-Term Neonates in India

Purpose

Neonatal skin care practices guided by personal experience and preferences might be substantially different across different hospital settings. The aim of this consensus recommendation is to provide clinical practice guidance to healthcare practitioners on evidence-based neonatal skin care practices from delivery-to-discharge, in hospital settings.

Patients and Methods

A Scientific Advisory Board meeting on "Evidence-based Neonatal Skin Care Practices and Protocols" was held in December 2020 with an expert panel comprising neonatologists, pediatricians, obstetricians and gynecologists and pediatric dermatologist. Comprehensive literature search was performed up to 23 March 2021 using PubMed and Google Scholar to retrieve relevant evidence.

Results

Recommendations were developed on critical aspects of skin care in healthy full-term neonates including cleansing at birth, skin-to-skin care, cord care, diaper area care, initial and routine bathing, cleansers and emollients use, and criteria to choose appropriate skin care products. Recommendations include inclusion of skin assessment in routine neonatal care, first bath timing after cardio-respiratory and thermal stabilization, 6-24 hours after birth; bathing with water alone or adding a mild liquid cleanser could be considered appropriate as it does not impact the developing skin barrier; use of emollients is recommended for neonates with higher risk of development of eczema to maintain and enhance skin barrier function and integrity; and inclusion of skin care advice in neonatal discharge checklist. Importance of rigorous quality control, high-quality clinical trials for assessment of baby products, usage of products that are formulated appropriately for newborns, and full label transparency for baby products were highlighted. The panel identified gaps in literature and discussed the scope for future research.

Conclusion

These recommendations may help to standardize evidence-based skin care for healthy full-term neonates in Indian hospital settings to improve the quality of care that neonates receive in hospital and facilitate improvement in overall neonatal health outcomes.

In vitro eye irritation testing models may play pivotal role in effort to pursue mild baby cleansers

In recent years, mild baby cleansers have experienced ever-growing demand from caregivers. In the meantime, formulation developers are in practical need for a method(s) to screen mild formulations. In the present study, we aim to repurpose the HET-CAM and SkinEthic™ models to further classify in vivo nonirritant baby cleansing formulations into mild and less mild categories. Both methods were modified to best describe the samples' irritation potential. The results showed that both models successfully classified the formulations into mild and less mild categories according to our customized criteria. For the HET-CAM, the medians of mean irritation scores (IS) were 3.0 for mild formulations (with 0 ≤ mean IS ≤4.5), and 5.0 for less mild formulations (with mean IS values all equaled 5), respectively. And for the SkinEthic™ model, the median relative viabilities were 69.46% for less mild formulations (with 46.80% ≤ mean relative viability ≤84.76%), and 99.96% for mild formulations (with 90.57% ≤ mean relative viability ≤124.58%). Thirty out of 35 formulations were predicted consistently between the HET-CAM and SkinEthic™ model. Statistical analysis of the agreement between predictions made by the two models demonstrated substantial agreement with a Cohen's kappa coefficient of 0.713 (P < 0.001). We conclude that the HET-CAM and SkinEthic™ models are promising in vitro alternatives for screening mild formulations.

Maintaining Skin Integrity in Neonates with Sunflower Seed Oil and Liquid Vaseline: A Prospective Randomized Controlled Study

OBJECTIVE

To test the effectiveness of sunflower seed oil (SSO) and liquid Vaseline (LV) in maintaining skin integrity in term and preterm neonates in the neonatal ICU. Because the skin of the neonate is still immature, disruption of skin integrity is a commonly observed problem.

METHODS

In this randomized controlled study, 90 preterm and term neonates in the neonatal ICU of a state hospital were equally divided into three groups. The skin condition of the neonates in all three groups was assessed using the Neonatal Skin Condition Score (NSCS); assessments were made a total of nine times at 48-hour intervals. The skin of the neonates in the first group was moisturized with SSO, and the second group was moisturized with LV, once a day, a total of 16 times. Moisturizer was not applied to the skin of the third group of neonates (the control group).

RESULTS

The median gestational age was 37.0 weeks (range, 36.0-38.0 weeks). After the third evaluation, the median NSCS scores for the neonates in the SSO and LV groups were significantly lower than for those in the control group (P < .001). The control group's median NSCS scores did not change throughout the period of the study.

CONCLUSIONS

Both SSO and LV are harmless to the skin of neonates and can be used to maintain their skin integrity. More advanced studies are needed to evaluate the effects of topical oils on maintaining skin integrity.

European guideline (EuroGuiDerm) on atopic eczema - part II: non-systemic treatments and treatment recommendations for special AE patient populations

The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This second part of the guideline includes recommendations and detailed information on basic therapy with emollients and moisturizers, topical anti-inflammatory treatment, antimicrobial and antipruritic treatment and UV phototherapy. Furthermore, this part of the guideline covers techniques for avoiding provocation factors, as well as dietary interventions, immunotherapy, complementary medicine and educational interventions for patients with atopic eczema and deals with occupational and psychodermatological aspects of the disease. It also contains guidance on treatment for paediatric and adolescent patients and pregnant or breastfeeding women, as well as considerations for patients who want to have a child. A chapter on the patient perspective is also provided. The first part of the guideline, published separately, contains recommendations and guidance on systemic treatment with conventional immunosuppressive drugs, biologics and janus kinase (JAK) inhibitors, as well as information on the scope and purpose of the guideline, and a section on guideline methodology.

Maternal Stress, Early Life Factors and Infant Salivary Cortisol Levels

Background: Salivary cortisol (SC), a commonly used biomarker for stress, may be disrupted by negative events in pregnancy, at birth and in infancy. We aimed to explore if maternal perceived stress (PSS) in or after pregnancy and SC levels in pregnancy were associated with SC in early infancy, and, secondly, to identify early life factors associated with infants’ SC levels (iSC). Methods: At 3 months of age, SC was analyzed in 1057 infants participating in a Nordic prospective mother-child birth cohort study. Maternal PSS was available from questionnaires at 18- and 34-week gestational age (GA) and 3-month post-partum, and SC was analyzed at 18-week GA. Early life factors included sociodemographic and infant feeding from questionnaires, and birth data from medical charts. Associations to iSC were analyzed by Spearman correlation and multinomial logistic regression analyses. Results: In this exploratory study neither PSS at any time point nor maternal SC (mSC) were associated with iSC. Higher birth weight was associated with higher levels of iSC, while inverse associations were observed in infants to a mother not living with a partner and mixed bottle/breastfeeding. Conclusions: Maternal stress was not associated with iSC levels, while birth weight, single motherhood and infant feeding may influence iSC levels.

Randomized trial with soaps - what happens to a newborn baby's skin?

OBJECTIVE

Evaluate the effectiveness of a children's soap with physiological pH in maintaining cutaneous pH and moisture of the newborn (NB)'s skin after the first bath.

METHODS

Randomized, controlled and double-blind clinical trial in a rooming-in of a tertiary maternity hospital in southern Brazil with 204 newborns > 34 gestational weeks. Gestational and obstetric history was evaluated, and newborns were randomized into two groups according to the product applied in the bath: the control group (CG), which used common liquid soap with pH 7.0 and experimental group (EG), which used children's liquid soap with pH 5.8. Evaluation was made immediately before and after bath with skin pH measurement, corneometry and clinical parameters (erythema, scaling and moisture), on the forehead, abdomen and thigh.

RESULTS

There was no difference between groups regarding gestational, obstetric and family history (p > 0.05). In CG, skin pH increased in the abdomen and thigh (p < 0.05). In EG there was an improvement in clinical parameters after bathing with: increased moisture, less erythema and less scaling (p < 0.05). On the forehead, there was a significant increase in pH after bathing (p < 0.001) similar in both groups, although no use of soap. There was no difference in corneometry between groups after bathing.

CONCLUSION

Children's liquid soap with physiological pH maintained the acidic skin pH and moisture of the newborn's skin after the first bath, which reinforces the importance of using products with physiological pH in the hygiene of newborns. Registration number RBR-9ky84vd.

Expert consensus on ceramides containing skincare in newborns and infants and potential mitigation of atopic dermatitis

INTRODUCTION

The vulnerable skin of neonates and infants is still developing anatomically and functionally and more susceptible to skin barrier disruption. The current consensus paper explores challenges in caring for neonates and infants' skin, skincare use and evaluates the role of ceramides (CERs) containing cleansers and moisturizers.

EVIDENCE AQUISITION

A panel of eight clinicians who treat neonates and infants developed a consensus paper on new-born and infant skin barrier integrity and CERs-containing skincare importance. The consensus process consisted of a modified Delphi technique. The selected information from the literature searches, coupled with the panel's opinion and experience, was used to adopt statements to provide clinical data for paediatric dermatologists, dermatologists, and paediatric healthcare providers who treat neonates and infants.

EVIDENCE SYNTHESIS

Increasingly, evidence supports skincare starting early in life, recognizing the benefits of ongoing daily use of non-alkaline cleansers and moisturizers to maintain skin barrier function. Skincare for neonates and infants should be safe, effective, and fragrance as well as sensitizing agent-free. Skincare with CERs may benefit the stratum corneum's lipid and water content.

CONCLUSIONS

When applied from birth onwards, gentle cleansers and moisturizers containing barrier lipids help maintain the protective skin barrier and soothe the skin with long-term moisturizing benefits.

Variation in Newborn Skincare Policies Across United States Maternity Hospitals

OBJECTIVE

Newborn skincare influences levels of beneficial factors from vernix and vaginal secretions but also the emergence of potential skin pathogens. However, evidence-based national guidelines for newborn skincare do not exist, and actual hospital practices for newborn skincare have not been described. In this study, we test the hypothesis that US maternity hospitals follow differing policies with regard to newborn skincare.

METHODS

A 16-question survey querying skin care practices was distributed to nursery medical directors at the 109 US hospital members of the Better Outcomes through Research for Newborns network. Data from free text responses were coded by 2 study personnel. Survey responses were analyzed by using descriptive statistics and compared by region of the United States.

RESULTS

Delaying the first newborn bath by at least 6 hours is a practice followed by 87% of US hospitals surveyed. Discharging newborns without a bath was reported in 10% of hospitals and was more common for newborns born in nonacademic centers and on the West Coast. Procedures and products used for newborn skincare varied significantly. Parental education on tub immersion and soap use was also inconsistent and potentially contradictory between providers. Evidence cited by hospitals in forming their policies is scant.

CONCLUSION

In this study, we identify similar and strikingly different newborn skincare policies across a national network of US maternity hospitals. Research is needed to identify effects of differing skincare routines on skin integrity, infection rates, and childhood health outcomes to improve the evidence base for the care of newborn skin.

Effects of Temperature and Position Change on Neonatal Brain Regional Oxygen Saturation in Tub Bathing: A Prospective Study

INTRODUCTION

A major goal in neonatal medicine is to reduce stress as much as possible in routine care. Bathing is one of the important routine cares for neonates, but it makes a big environmental change for them. We aimed to examine whether water temperature, room temperature, and position changes in tub bathing serve as noxious stimuli to neonates.

METHODS

This prospective trial was performed in full-term and non-low-birth-weight neonates admitted to the hospital between July 2020 and March 2021. Those with underlying diseases, fetal distress, infection, and other medical conditions were excluded. Measurements were taken during the neonates' first tub bath since birth, which was performed by a trained nurse. Changes in regional oxygen saturation (rSO₂), determined using near-infrared spectroscopy, and water and room temperature, were examined at five different time points: upon entering the bath, head washing, position change, exiting the bath, and during the 3 min after bathing.

RESULTS

In total, 17 neonates were analyzed. No changes in rSO₂ due to head washing or position change were observed; however, rSO₂ significantly decreased upon entering (78.5 ± 4.1% vs. 75.7 ± 4.1%, p < 0.001) and exiting the bath (75.8 ± 5.7% vs. 74.4 ± 5.4%, p < 0.04). The rate change in rSO₂ upon entering the bath showed a significant inverse correlation with water temperature (r =  - 0.53, p < 0.03), and there were no significant correlations between rSO₂ and water or room temperature upon exiting the bath. There was no change in body skin temperature before and after bathing, but rSO₂ gradually decreased during the 3 min after bathing.

CONCLUSIONS

Neonates may perceive certain temperatures during bathing as noxious stimuli. Therefore, methods to minimize stress associated with bathing should be implemented to reduce the difference between water temperature and room temperature during bathing.

TRIAL REGISTRATION

This trial has been registered at UMIN repository with the trial number UMIN000041045 ( https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046500 ). The date of the final dataset was April 01, 2021.

Bathing or Not Bathing: Which Is Better for Umbilical Cord Separation Time and Bacterial Colonization in Neonates?

Background: Sepsis is the third cause of death in the first month of life, and the umbilical cord is an important source for sepsis Objectives: We compared the effects of bathing or not bathing on bacterial colonization and cord separation time. Methods: A quasi-experimental study assessed term newborns at Golestan hospital, Tehran, Iran, from 2019 to 2020 in three groups. Bath (B) group included neonates who were bathed with tub water every two days (n = 90). Clean product (CP) group neonates were bathed with cleaners every two days (n = 87). Dry care cord (D) group neonates were not bathed during the first 10 days (n = 63). Periumbilical cord swabs were collected on the 10th day and cultured in blood agar and Eosin methylene blue agar. Bacterial sensitivity tests were done by disk diffusion. Results: The average time to cord separation was 8.2 ± 1.74 days (group B: 9.1 ± 2.1 days, group CP: 8.7 ± 1.82 days, group D: 6.8 ± 1.3 days), which was shorter in group D (P= 0.048). The positive culture rates were 77.8% in group B, 78.1% in group CP, and 74.6% in group D, which were not significantly different between the groups (P = 0.073). Staphylococcus aureus was the most common isolated species. Staphylococcus epidermis and Escherichia coli were the other most common species. Conclusions: Bathing with or without cleaners is safe. No-bath and water bath with or without cleaners had no difference in the rate and type of bacterial culture in umbilical cord but the cord separation time was shorter in the no-bath group. Therefore, in the first week, if a mother does not believe in bathing her baby, she should not be denounced and told that she did something wrong with cord hygiene.

Effect of newborn bathing training with the swaddled and tub bathing methods given to primiparous pregnant women on the mother's experience, satisfaction and newborn's stress during the first bathing of the newborn at home: A mixed method study

AIM

The aim of this study is to compare the effect of two different bathing methods training given during pregnancy on the mother's experience, satisfaction and newborn's physiological and behavioral parameters during the first bathing of the newborn at home.

METHODS

A mixed methods research was used in this study. The groups were determined as swaddled bathing (SB) (n = 31) and tub bathing (TB) (n = 31). After training given to the groups, the first bath of the newborn in both groups was built by the mothers. The body temperature, heart rate, oxygen saturation, respiration rate, crying times, stress parameters of the newborns and mother satisfaction in both groups were evaluated. The open-ended questions were used to determine mothers' experiences.

RESULTS

There was a statistically significant difference between the groups in terms of oxygen saturation, respiration rate, crying time, face/forehead grimacing, unrest and maternal satisfaction. Four categories and 14 subcategories made up the qualitative part of the study which includes the experiences of the mother about two different bathing methods. "The feelings and worries of the mothers about first bathing" refers to the participants in both groups how they feel during the first bathing; "Positive aspects of this method compared to other bath method" and "Negative aspects of this method compared to other bath method" refers to positive and negative aspects of different bathing methods applied to groups; "Difference between the applied bathing method and other methods" refers to differences they observed when compared to other bathing methods. The mothers in the SB group had less fear of drowning hazard and injuring the newborn, and the fear of uneasiness and the newborn slipping down from hands were more frequent in the TB group.

CONCLUSION

It was determined that both bath methods reduced body temperature, the SB method decreased the stress of newborns and had a positive effect on mother satisfaction and experience.

BATHING, MAKE-UP, AND SUNSCREEN: WHICH PRODUCTS DO CHILDREN USE?

Objective:

To evaluate the hygiene practices and frequency of use of personal hygiene products, cosmetics, and sunscreen among children and adolescents.

Methods:

Cross-sectional study with interviews about skincare conducted with caregivers through closed-ended questions. We included patients up to 14 years of age waiting for consultation in pediatric outpatient clinics of a tertiary hospital. We performed a descriptive statistical analysis and applied the Kruskal-Wallis test and Fisher’s exact test to compare the practices according to maternal schooling.

Results:

We conducted 276 interviews. The median age of the participants was age four, and 150 (54.3%) were males. A total of 143 (51.8%) participants bathed once a day and 128 (46.3%) bathed two or more times a day, lasting up to ten minutes in 132 (47.8%) cases. Adult soap was used by 103 (37.3%) children and bar soap by 220 (79.7%). Fifty-three (19.2%) participants used sunscreen daily. Perfume was used by 182 (65.9%) children, hair gel by 98 (35.5%), nail polish by 62 (22.4%), and some type of make-up by 71 (25.7%) - eyeshadow by 30 (10.8%), lipstick by 52 (18.8%), face powder and mascara by 13 (4.7%). Make-up use started at a median age of 4 years. Henna tattoo was done in eight children.

Conclusions:

The children studied used unsuitable products for their skin, such as those intended for adults, used sunscreen inadequately, and started wearing make-up early, evidencing the need for medical orientation.

A Randomized Pilot Clinical Assessment Of Three Skincare Regimens On Skin Conditions In Infants

Introduction

Few data are available on the comparison between the effects on infant skin of skin care products and those of water alone.

Patients and methods

In this single-center, evaluator-blind, parallel-group pilot study, healthy infants were randomized to near-daily washing for 12 weeks (starting in the summer and finishing in the winter months) with a mild liquid baby wash followed by use of baby lotion (wash+lotion), water followed by baby lotion (water+lotion), or water alone. Clinical and instrumental assessments of skin moisturization and barrier function were made.

Results

As expected the skin condition in all groups was affected by the change of the season. The skin of infants in all groups was mildly deteriorated (clinical grading) and with reduced moisture levels and increased barrier function. Instrumental measurements indicated that skin moisture and barrier function were better maintained in the wash+lotion and water+lotion groups than in the water-only group at week 12. Clinical assessment scores increased slightly over 12 weeks in all groups (P<0.05). At week 12, the wash+lotion group (n = 44) had significantly less change from baseline in overall skin condition and softness (lower scores) than did the water+lotion (n = 43) or water-only (n = 43) groups. The wash+lotion regimen maintained stable erythema and rash scores with lower mean values over time than in the other groups.

Conclusion

A regimen of a liquid baby wash and a baby skin lotion for 12 weeks resulted in less detrimental changes in instrumental and clinical measures of skin than using water and lotion or water alone.

A high-emollient liquid cleanser for very dry and atopic-prone skin: Results of an in-use tolerance and efficacy study conducted under dermatological, pediatric, and ophthalmological supervision

BACKGROUND

Emollients play a key role in the treatment of eczematous lesions and xerosis such as in atopic dermatitis. However, studies that show the actual benefits of cleansers are few and far between.

AIMS

This study aims to evaluate the tolerance and efficacy of a high-emollient liquid cleanser (HELC) designed for very dry and atopic-prone skin, in the absence of any additional skin care. The product is a soap-free and fragrance-free liquid cleanser, containing mild surfactants and a ternary system of selected emollients: glycerin, vaseline, and paraffin.

METHODS

In-use study was conducted under dermatological, pediatric, and ophthalmological supervision in 50 subjects (infants, children, and adults) with "dry to very dry and atopic-prone" skin. The primary objective of this monocentric, open, and intra-individual study was to assess the dermatological and ophthalmological tolerance of HELC after 21 days of using it at least once a day on the face and body. The secondary objectives were to evaluate its efficacy based on a clinical score (SCORAD), assess its short- and long-term moisturizing effect by measuring hydration rates (Corneometer^® ), and ascertain its cosmetic acceptability through a subjective evaluation questionnaire.

RESULTS

The study validates the good dermatological and ophthalmological tolerance of HELC. Its efficacy was demonstrated by improvements in the SCORAD and moisturizing scores. Furthermore, the product was very well accepted by the subjects.

CONCLUSION

The fragrance-free HELC tested in this study for 21 days on "dry to very dry and atopic-prone skin" improves skin dryness and pruritus while ensuring good tolerance.

Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology

BACKGROUND

Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis.

OBJECTIVES

The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis.

METHODS

Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel.

RESULTS/CONCLUSION

The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.

Effects of Underrunning Water Bathing and Immersion Tub Bathing on Vital Signs of Newborn Infants: A Comparative Analysis

BACKGROUND

Newborn infants are susceptible to hypothermia during bathing due to environmental conditions.

PURPOSE

This study examined the effects of 2 common newborn bathing methods used in Turkey, underrunning water bathing (URWB) and immersion tub bathing (ITB), on infant heart rate (HR), oxygen saturation, and body temperature.

METHODS

In this randomized controlled study, 44 newborns were allocated to the ITB group and 36 newborns to the URWB group. Body temperature, HR, and oxygen saturation values of the newborns were compared between groups every hour during 4 hours before the bath to evaluate infants' vital sign stability. All measurements were compared at 10, 20, 40, and 60 minutes after the bath too.

RESULTS

No statistically significant differences were found in vital signs performed prior to bathing as compared with after bathing; however, changes in oxygen saturation at 20 minutes after the bath were significantly higher in the ITB group (P < .05).

CONCLUSION

Although both bathing methods decreased overall infant body temperature, ITB positively affected newborn oxygen saturation and HR to a greater degree compared with URWB.

IMPLICATIONS FOR PRACTICE

ITB facilitated maintenance of oxygen saturation and HR during the bath and should be preferred for newborn infants to feel more relaxed.

IMPLICATIONS FOR RESEARCH

These findings indicate a need for additional studies with larger sample sizes to further evaluate the effect of different bathing methods on newborn comfort.

Estimating infants' and toddlers' inhalation exposure to fragrance ingredients in baby personal care products

Fragrance ingredients are commonly added to many personal care products to provide a pleasant scent, including those intended for babies. While fragrance chemicals have a long history of safe use, at sufficiently high concentrations some may act as respiratory irritants or sensitizers. Little data have been reported on the inhalation exposures to fragrance compounds to infants and toddlers during bathing and lotion applications. This study demonstrates an in vitro method for measuring breathing zone air concentrations of fragrances from bath products and lotions. It employed simulated infant bathing and lotion application events and a robot to mimic a toddler's movement within a bathroom setting. The air concentrations in an infant's breathing zone were between <1 and 5 μg/m³ for each of seven common fragrance ingredients, while that in the breathing zone of toddlers in the bathroom was ≤ 1μg/m³. The air concentrations from the bathing additive were linearly related to their Henry's law constants and from the lotion inversely related to their octanol-air coefficients. The proposed approach can help refine risk estimates from inhalation exposure to fragrances used in baby products and guide future risk assessments of new products' safety for their use in baby bath products.

Natural Oils for Skin-Barrier Repair: Ancient Compounds Now Backed by Modern Science

Natural plant oils are commonly used as topical therapy worldwide. They are usually easily accessible and are relatively inexpensive options for skin care. Many natural oils possess specific compounds with antimicrobial, antioxidant, anti-inflammatory, and anti-itch properties, making them attractive alternative and complementary treatments for xerotic and inflammatory dermatoses associated with skin-barrier disruption. Unique characteristics of various oils are important when considering their use for topical skin care. Differing ratios of essential fatty acids are major determinants of the barrier repair benefits of natural oils. Oils with a higher linoleic acid to oleic acid ratio have better barrier repair potential, whereas oils with higher amounts of irritating oleic acid may be detrimental to skin-barrier function. Various extraction methods for oils exist, including cold pressing to make unrefined oils, heat and chemical distillation to make essential oils, and the addition of various chemicals to simulate a specific scent to make fragranced oils. The method of oil processing and refinement is an important component of selecting oil for skin care, and cold pressing is the preferred method of oil extraction as the heat- and chemical-free process preserves beneficial lipids and limits irritating byproducts. This review summarizes evidence on utility of natural plant-based oils in dermatology, particularly in repairing the natural skin-barrier function, with the focus on natural oils, including Olea europaea (olive oil), Helianthus annus (sunflower seed oil), Cocos nucifera (coconut oil), Simmondsia chinesis (jojoba oil), Avena sativa (oat oil), and Argania spinosa (argan oil).

Noninvasive monitoring of plant-based formulations on skin barrier properties in infants with dry skin and risk for atopic dermatitis

Background

Dry skin and the associated impaired epidermal barrier function are postulated to constitute a major element in the development of atopic dermatitis.

Objective

The aim of this study was to evaluate the effect of two plant-based formulations on the epidermal barrier function in a defined cohort of infants with a predisposition for atopic dermatitis.

Methods

Over a period of 16 weeks, 25 infants who were ages 3 to 12 months and had an atopic predisposition and dry skin received two emollients that contained pressed juice of the ice plant. The infants received both cream and lotion on the forearm, only cream on the face, and only lotion on the leg. Stratum corneum hydration (SCH), transepidermal water loss (TEWL), skin surface pH, and sebum were assessed on the infants’ forehead, leg, and forearm. The Scoring Atopic Dermatitis (SCORAD) index was used for the clinical assessment.

Results

SCH significantly increased in all body regions that were assessed. The forearm and leg revealed stable levels of pH and TEWL, but a decline in pH (week 16) and TEWL (week 4) was noted on the forehead. At week 16, sebum levels were lower on the forehead compared with those at baseline. SCORAD scores improved significantly during the study.

Conclusion

A daily application of both emollients was associated with increased SCH levels and a stable course of TEWL, pH, and sebum on the forehead except for the forehead when compared with the forearm and leg. Clinically, improved SCORAD scores were noted.

Effects of swaddled and traditional tub bathing methods on crying and physiological responses of newborns

PURPOSE

The purpose of this study was to examine the effects of two bathing methods on crying duration and physiological measurements of newborns.

DESIGN AND METHODS

A randomized trial design was used in this study. The sample consisted of newborns (n = 80) who were admitted to neonatal intensive care unit of a university hospital located in a large city. The groups were determined as swaddled bathing (SB) (n = 40) and traditional tub bathing (TTB) (n = 40) by using random number table. All newborns were bathed 24 hours after the birth. Environmental variables were organised identically in both experimental and control groups. Duration of bathing was determined as maximum 5 min in both groups. Body temperature, heart rate (HR), and O₂ saturation values were evaluated before bath, just after the bath and at 10 min after the bath. The groups were compared in terms of all vital symptoms and duration of crying during bath. Pre-bath and post-bath stress levels between newborns in both groups were compared by using the Newborn Infant Pain Scale (NIPS).

RESULTS

When the newborns were compared based on groups, it was observed that there was no statistically significant difference between SB and TTB groups in terms of the gestational week, APGAR score, postnatal age, and body weight. Body temperatures of the newborns in SB group just after the bath and 10 minutes after the bath were significantly higher than those in TTB group. HR was higher in TTB group in the post-bath period. NIPS scores of the newborns in SB group after bath decreased at a statistically significant level, but the scores of the newborns in TTB group increased. The results of the study indicated that SB was effective in maintaining body temperature, SpO₂ level, and HR of newborns within normal limits and may decrease stress experienced during the bath.

PRACTICE IMPLICATIONS

Swaddled bathing decreases behavioural stress symptoms such as crying, agitation, and pulling arms and legs back unintentionally and thus the infants feel relaxed. Swaddled bathing can be recommended because swaddled bathing method decreases behavioural stress symptoms in infants.

Recent advancement to prevent the development of allergy and allergic diseases and therapeutic strategy in the perspective of barrier dysfunction

Therapeutic strategy in late 20th century to prevent allergic diseases was derived from a conceptual framework of allergens elimination which was as same as that of coping with them after their onset. Manifold trials were implemented; however, most of them failed to verify the effectiveness of their preventive measures. Recent advancement of epidemiological studies and cutaneous biology revealed epidermal barrier dysfunction plays a major role of allergen sensitization and development of atopic dermatitis which ignites the inception of allergy march. For this decade, therapeutic strategy to prevent the development of food allergy has been confronted with a paradigm shift from avoidance and delayed introduction of allergenic foods based on the theoretical concept to early introduction of them based on the clinical and epidemiological evidences. Especially, prevention of peanut allergy and egg allergy has been established with the highest evidence verified by randomized controlled trials, although application in clinical practice should be done with attention. This paradigm shift concerning food allergy was also due to the discovery of cutaneous sensitization risk of food allergens for an infant with eczema revealed by prospective studies. Here we have recognized the increased importance of prevention of eczema/atopic dermatitis in infancy. Two randomized controlled trials using emollients showed successful results in prevention of atopic dermatitis in infancy; however, longer term safety and prognosis including allergy march should be pursued. To establish more fundamental strategy for prevention of the development of allergy, further studies clarifying the mechanisms of interaction between barrier dysfunction and microbial milieu are needed with macroscope to understand the relationship between allergic diseases and a diversity of environmental influences.

Implementing Evidence-Based Neonatal Skin Care With Parent-Performed, Delayed Immersion Baths

There has been a recent trend toward delaying newborn baths because of mounting evidence that delayed bathing promotes breastfeeding, decreases hypothermia, and allows for more parental involvement with newborn care. A multidisciplinary team from a maternal-new-born unit at a military medical center designed and implemented an evidence-based practice change from infant sponge baths shortly after birth to delayed immersion baths. An analysis of newborn temperature data showed that newborns who received delayed immersion baths were less likely to be hypothermic than those who received a sponge bath shortly after birth. Furthermore, parents reported that they liked participating in bathing their newborns and that they felt prepared to bathe them at home.

Effects of moisturizing skincare on skin barrier function and the prevention of skin problems in 3-month-old infants: A randomized controlled trial

An effective newborn skincare protocol has not been established. We aimed to evaluate the effects of moisturizing skincare, including using lotion and reducing routine bathing. Our hypothesis was that moisturizing skincare would improve skin barrier function. This randomized controlled trial included 227 healthy Asian newborns between 1 week and 3 months old. We compared moisturizing skincare (bathing every 2 days and using lotion daily; intervention, n = 113) to daily bathing without lotion (control, n = 114). We assessed the skin barrier function (transepidermal water loss [TEWL], stratum corneum hydration [SCH], skin pH and sebum secretion) as a primary outcome at 3 months old. We also assessed the incidence of skin problems according to parents' diary reports. Compared with the control, the intervention group had a lower face TEWL (mean ± standard deviation, 14.69 ± 7.38 vs 17.08 ± 8.26 g/m² per h, P = 0.033), higher face SCH (60.38 ± 13.66 vs 53.52 ± 14.55, P = 0.001) and higher body SCH (58.89 ± 12.96 vs 53.02 ± 10.08, P < 0.001). Compared with the control, newborns in the intervention group had significantly lower rates of diaper dermatitis between birth and 1 month old (6.3% vs 15.9%, P = 0.022), and tended to have lower rates of body skin problems between 1 and 3 months (42.1% vs 55.2%, P = 0.064). Moisturizing skincare was effective for improving skin barrier function and preventing newborns' diaper dermatitis. The results of our study may help parents make informed decisions about newborn skincare.

Emu oil-based lotion effects on neonatal skin barrier during transition from intrauterine to extrauterine life

Both appropriate hydration and skin surface pH are fundamental in preventing baby skin barrier damage during transition from intrauterine to extrauterine life. However, effects of topical moisturizers on neonatal stratum corneum temperature, pH, hydration, and elasticity have not been scientifically evaluated in vivo. We checked 31 full-term breastfeeding neonates by non-invasive bioengineering method, which is able to evaluate the basal skin barrier (left heel), and assessed at 6±1 hours after birth, and at 1 and 24 hours after emu oil-based topical treatment. The basal skin barrier of right heel (no oil exposure) of each newborn was considered as control. We found that a single application of an emu oil-based lotion was effective in improving heel stratum corneum hydration, which increases both skin pH and elasticity without any effect on temperature. Further studies are needed to confirm long-term beneficial effects of this treatment in a very sensitive patient population.

New Perspectives in the Treatment of Atopic Dermatitis in the Pediatric Population

Treatment of children diagnosed with atopic dermatitis (AD) is an art. Age-dependent barrier function, skin physiology, body surface:weight ratio, the compliance of patient and caregivers, and legal considerations related to the license status of topical and systemic drugs must be considered. Mild to moderate AD can usually be treated sufficiently with a personalized regimen of emollients and topical anti-inflammatory therapy consisting of topical corticosteroids (TCSs) or topical calcineurin inhibitors. Emollients containing bacterial lysates, tailored wet wrap regimen, and proactive therapy with tacrolimus ointment or some TCSs are new developments in the field. Severe AD may need systemic therapy, but all currently available systemic agents for severe AD are either not licensed for children or not advisable on the long term, or both. Therapeutic patient education based on structured, interactive sessions with patients or caregivers and a multidisciplinary team is highly effective. This publication summarizes the current therapeutic options used in the pediatric AD population.

Hard water softening effect of a baby cleanser

BACKGROUND

Hard water is associated with atopic dermatitis (eczema). We wanted to determine if a baby cleanser and its individual components altered free ionized calcium (Ca²⁺) in a simulated hard water baby bath. For these studies, an in vitro determination of free Ca²⁺ in a simulated hard water baby bath, and an in vivo exploratory study of free Ca²⁺ absorption into skin from hard water were performed.

METHODS

Free Ca²⁺ was measured with an ion-sensitive electrode in vitro in hard water (100-500 ppm, Ca²⁺) before and after addition of the cleanser and/or its components. In an exploratory study, absorption of Ca²⁺ into skin from hard water was determined in three female participants (aged 21-29 years).

RESULTS

At an in-use dilution of 1%, the test cleanser reduced free Ca²⁺ from ~500 ppm to <200 ppm; a 10% in-use dilution bound virtually all free Ca²⁺. The anionic surfactant component contributed the most to this effect. In the exploratory in vivo study, we measured a reduction of ~15% in free Ca²⁺ from simulated hard water over 10 minutes.

CONCLUSION

Baby cleansers can bind free Ca²⁺ and reduce the effective water hardness of bath water. Reducing the amount of free Ca²⁺ in the water will reduce the availability of the ion for binding to the skin. Altering or reducing free Ca²⁺ concentrations in bath water may be an important parameter in creating the ideal baby bath.

Development of stratum corneum chymotrypsin-like protease activity and natural moisturizing factors from birth to 4 weeks of age compared with adults

BACKGROUND

From birth, the functional properties of the neonatal epidermal barrier mature whereby the stratum corneum (SC) hydrates and the skin surface acidifies. The identification of a thinner infant SC compared with adults suggests underdeveloped mechanisms underlying differentiation and desquamation.

OBJECTIVES

To assess the functional properties of the neonatal SC from birth, in conjunction with the quantification of superficial chymotrypsin-like protease activity [kallikrein-7 (KLK-7)] and filaggrin-derived natural moisturizing factors (NMF).

METHODS

A total of 115 neonates recruited to the Oil in Baby SkincaRE (OBSeRvE) randomized controlled trial underwent a full evaluation of the SC at birth (< 72 h old) and at 4 weeks of age (n = 39, no oil control group) using minimally invasive instrumentation and methodology. A cohort of 20 unrelated adults was recruited for comparison.

RESULTS

At birth NMF levels correlated with SC hydration (r = 0·50) and skin-surface pH (r = -0·54). From birth to 4 weeks, transepidermal water loss (TEWL), superficial KLK-7 activity and filaggrin-derived NMF significantly elevated. Impaired epidermal barrier function at birth (> 75th percentile TEWL) was accompanied by significantly elevated chymotrypsin-like protease activity and reduced levels of NMF.

CONCLUSIONS

The biophysical, biological and functional properties of the developing neonatal SC are transitional from birth to 4 weeks of age and differ significantly from adults. The presence of impaired barrier function with elevated protease activity and reduced NMF at birth suggests why certain infants are predisposed to epidermal barrier breakdown and the development of atopic dermatitis.

Infant positioning in daily life may mediate associations between physiotherapy and child development-video-analysis of an early intervention RCT

BACKGROUND

Paediatric physiotherapy (PPT) in high-risk infants comprises family involvement, but it is unclear whether parents mediate the intervention effect. We demonstrated in a randomized controlled trial in high-risk infants comparing the family centred programme Coping and Caring for infants with special needs (COPCA) and Traditional Infant Physiotherapy (TIP) that process evaluation revealed associations between COPCA-characteristics and outcome.

AIMS

To assess whether PPT affects how parents position their infant during bathing and whether this is associated with child outcome.

METHODS AND PROCEDURES

21 infants received COPCA and 25 TIP between 3 and 6 months corrected age. Bathing sessions were videotaped at 3, 6 and 18 months. Time spent with specific infant positions was correlated with quantified PPT-actions and functional mobility at 18 months measured with the Paediatric Evaluation of Disability Inventory (PEDI).

OUTCOMES AND RESULTS

At 3 and 18 months bathing position was similar in both groups, but differed at 6 months (time spent on sitting: COPCA 77.7%, TIP 39.2%; median difference 32.0% (95% CI: 10.6-50.5%). Sitting-time at 6 months was associated with higher PEDI functional mobility scores.

CONCLUSIONS AND IMPLICATIONS

Early PPT may affect parental behaviour, such as infant positioning during bathing, which, in turn, may affect child development.

Critical assessment of the pH of children's soap

OBJECTIVE

To evaluate the pH value of children's antibacterial soaps and syndets used in children's baths and verify whether there is information regarding pH on the product label.

METHODS

Quantitative, cross-sectional, analytical observational study that included ninety soap samples, both in bar and liquid presentations, as follows: 67 children's soap (group 1), 17 antibacterial soaps (group 2), and 6 syndets (group 3). Each sample had its pH measured after 1% dilution. In addition to descriptive statistics, the Pearson-Yates chi-squared test and Student's t-tests were applied, considering the minimal significance level of 5%. The Wilcoxon-Mann-Whitney test, Fisher's exact test, and the Kruskal-Wallis test were used for inferential statistics.

RESULTS

The pH levels varied considerably between liquid and bar presentations, with lower levels (4.4-7.9) found for the liquids (p<0.05). Syndets showed pH levels close to the ideal (slightly acid) and the antibacterial soaps showed the highest pH levels (up to 11.34) (p<0.05). Only two of the soaps included in the study had information about their pH levels on the product packaging.

CONCLUSIONS

Knowledge of the pH of children's soap by doctors and users is important, considering the great pH variability found in this study. Moreover, liquid soaps, and especially syndets, are the most recommended for the sensitive skin of neonates and infants, in order to guarantee skin barrier efficacy.

Recommendations from a European Roundtable Meeting on Best Practice Healthy Infant Skin Care

BACKGROUND

European roundtable meeting recommendations on bathing and cleansing of infants were published in 2009; a second meeting was held to update and expand these recommendations in light of new evidence and the continued need to address uncertainty surrounding this aspect of routine care.

METHODS

The previous roundtable recommendations concerning infant cleansing, bathing, and use of liquid cleansers were critically reviewed and updated and the quality of evidence was evaluated using the Grading of Recommendation Assessment, Development and Evaluation system. New recommendations were developed to provide guidance on diaper care and the use of emollients. A series of recommendations was formulated to characterize the attributes of ideal liquid cleansers, wipes, and emollients.

RESULTS

Newborn bathing can be performed without harming the infant, provided basic safety procedures are followed. Water alone or appropriately designed liquid cleansers can be used during bathing without impairing the skin maturation process. The diaper area should be kept clean and dry; from birth, the diaper area may be gently cleansed with cotton balls/squares and water or by using appropriately designed wipes. Appropriately formulated emollients can be used to maintain and enhance skin barrier function. Appropriately formulated baby oils can be applied for physiologic (transitory) skin dryness and in small quantities to the bath. Baby products that are left on should be formulated to buffer and maintain babies' skin surface at approximately pH 5.5, and the formulations and their constituent ingredients should have undergone an extensive program of safety testing. Formulations should be effectively preserved; products containing harsh surfactants, such as sodium lauryl sulfate, should be avoided.

CONCLUSION

Health care professionals can use these recommendations as the basis of their advice to parents.

Self-skincare knowledge and practice described by elderly persons in the mid-west of Minas Gerais

The present study aimed to assess the knowledge and practices reported by the elderly in relation to basic care of one's skin. A cross sectional study was performed from November 2011 to August 2012 in Arcos, Minas Gerais, based on a structured questionnaire administered to 250 elderly persons, with answers statistically analyzed. Knowledge and practices of self-skincare were evaluated from the median number of ten questions answered by the elderly. Most of the sample population were women (54.8%), aged between 60 and 69 years (52.4%), with a primary education (71.6%) and working in a job where they were exposed to direct sunlight (58.0%). The majority (76.4%) said they did not use protective sun filter despite considering it important (77.6%). The use of body moisturizing creams was reported by 55.6%. An association (p<0.05) was identified between the variables practice/knowledge and gender and practice outdoor activity. Further studies can be conducted as a result of the present research to clarify factors related to non-adherence to self-skincare, and educational measures should be put in place for the entire population, regardless of age, to prevent pathological skin aging.

Skin Physiology of the Neonate and Infant: Clinical Implications

Significance: The skin is a complex and dynamic organ that performs several vital functions. The maturation process of the skin starts at birth with the adaption of the skin to the comparatively dry environment compared to the in utero milieu. This adaptive flexibility results in the unique properties of infant skin. To deliver appropriate care to infant skin, it is necessary to understand that it is evolving with unique characteristics. Recent Advances: The role of biophysical noninvasive techniques in the assessment of skin development underlines the importance of an objective evaluation of skin physiology parameters. Skin hydration, transepidermal water loss, and pH values are measurable with specific instruments that give us an accurate and reproducible assessment during infant skin maturation. The recording of these values, following standard measurement procedures, allows us to evaluate the integrity of the skin barrier and to monitor the functionality of the maturing skin over time. Critical Issues: During the barrier development, impaired skin function makes the skin vulnerable to chemical damage, microbial infections, and skin diseases, possibly compromising the general health of the infant. Preterm newborns, during the first weeks of life, have an even less developed skin barrier and, therefore, are even more at risk. Thus, it is extremely important to evaluate the risk of infection, skin breakdown, topical agent absorption, and the risk of thermoregulation failure. Future Directions: Detailed and objective evaluations of infant skin maturation are necessary to improve infant skin care. The results of these evaluations should be formed into general protocols that will allow doctors and caregivers to give more personalized care to full-term newborns, preterm newborns, and infants.

Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention

Background

Atopic dermatitis (atopic eczema) is a chronic inflammatory skin disease that has reached epidemic proportions in children worldwide and is increasing in prevalence. Because of the significant socioeconomic effect of atopic dermatitis and its effect on the quality of life of children and families, there have been decades of research focused on disease prevention, with limited success. Recent advances in cutaneous biology suggest skin barrier defects might be key initiators of atopic dermatitis and possibly allergic sensitization.

Objective

Our objective was to test whether skin barrier enhancement from birth represents a feasible strategy for reducing the incidence of atopic dermatitis in high-risk neonates.

Methods

We performed a randomized controlled trial in the United States and United Kingdom of 124 neonates at high risk for atopic dermatitis. Parents in the intervention arm were instructed to apply full-body emollient therapy at least once per day starting within 3 weeks of birth. Parents in the control arm were asked to use no emollients. The primary feasibility outcome was the percentage of families willing to be randomized. The primary clinical outcome was the cumulative incidence of atopic dermatitis at 6 months, as assessed by a trained investigator.

Results

Forty-two percent of eligible families agreed to be randomized into the trial. All participating families in the intervention arm found the intervention acceptable. A statistically significant protective effect was found with the use of daily emollient on the cumulative incidence of atopic dermatitis with a relative risk reduction of 50% (relative risk, 0.50; 95% CI, 0.28-0.9; P = .017). There were no emollient-related adverse events and no differences in adverse events between groups.

Conclusion

The results of this trial demonstrate that emollient therapy from birth represents a feasible, safe, and effective approach for atopic dermatitis prevention. If confirmed in larger trials, emollient therapy from birth would be a simple and low-cost intervention that could reduce the global burden of allergic diseases.

Effect of diaper cream and wet wipes on skin barrier properties in infants: a prospective randomized controlled trial

The effect of different diaper care procedures on skin barrier function in infants has been minimally investigated and may be assessed using objective methods. In a single-center, prospective trial, 89 healthy 9-month-old infants (±8 wks) were randomly assigned to three diaper care regimens: group I used water-moistened washcloths at diaper changes (n = 30), group II additionally applied diaper cream twice daily (n = 28), and group III used wet wipes and diaper cream twice daily (n = 31). Transepidermal water loss (TEWL), skin hydration (SCH), skin pH, interleukin 1α (IL-1α) levels, and microbiologic colonization were measured in diapered skin (upper outer quadrant of the buttocks), nondiapered skin (upper leg), and if diaper dermatitis (DD) occurred, using the most affected skin area at day 1 and weeks 4 and 8. Skin condition was assessed utilizing a neonatal skin condition score and diaper rash grade. On diapered skin, SCH decreased in groups II and III, whereas TEWL values were reduced in group II only. Skin pH increased in groups II and III. In general, SCH, skin pH, and IL-1α levels were higher in healthy diapered skin than in nondiapered skin. The incidence and course of DD was comparable in all groups. Areas with DD had greater TEWL and skin pH than unaffected skin areas. Infants who received diaper cream had lower SCH and TEWL and higher pH levels in the diapered area than on nondiapered skin. No correlation with the occurrence of DD was found.

Educative practice with nurses, with a view to humanized care for the newborn in the obstetric center

This experience report aimed to describe the development of the educational practice undertaken with nurses for the elaboration of a care proposal directed towards newborns in the obstetric center of a public hospital, based in good practices. It describes: strategies, stages of the workshops, consensuses of the care provided to the newborn, and evaluation of the process. The workshops were constituted of: embracement; interacting and raising awareness; planning, validating and defining paths; problematizing the issue; integrating; sharing and defining consensuses; and reviewing and redirecting conducts. The issues problematized were: divergences relating to skin-to-skin contact, clamping of the umbilical cord, administration of the credé method and konakion (phytomenadione), and bathing, among others. The group educational practice was an important instrument for the nurses to reflect critically on and problematize their health practices collectively, and is configured as a space for democratic relationships favorable to the socialization of knowledges, partnerships, negotiations, consensuses regarding the care and continuous education, allowing the creation and re-creation of knowledges, with a view to transforming and innovating the care for the newborn.

Prevention of diaper dermatitis in infants--a literature review

Diaper dermatitis (DD) is one of the most common skin conditions in neonates and infants, with a peak between the ages of 9 and 12 months. Appropriate skin care practices that support skin barrier function and protect the buttocks skin from urine and feces are supposed to be effective in the prevention of DD. Despite many recommendations for parents and caregivers on proper diaper skin care, there is no up-to-date synthesis of the available evidence to develop recommendations for DD prevention practice. Therefore we performed a systematic literature review on the efficacy of nonmedical skin care practices on the diapered area of healthy, full-term infants ages 0 to 24 months. We identified 13 studies covering skin care practices such as cleansing, bathing, and application of topical products. DD prevalence and incidence and physiologic skin parameters were used as efficacy parameters. The results of this review indicate that cleansing of the diaper area using baby wipes or water and a washcloth have comparable effects on diapered skin. Bathing with a liquid baby cleanser twice weekly seems comparable with water alone. The application of ointments containing zinc oxide or petrolatum with or without vitamin A seems to have comparable effects on DD severity. There seems to be no information on whether single skin care practices such as cleansing, bathing, and application of topical preparations can prevent DD. High-quality randomized clinical trials are needed to show the effectiveness of skin care practices for controlling and preventing DD.

Diaper dermatitis: etiology, manifestations, prevention, and management

Pediatricians and parents report diaper dermatitis (DD) to be one of the most common skin diseases that affects almost every child at some point during the early months and years of life. Diapered skin is exposed to friction and excessive hydration, has a higher pH than nondiapered skin, and is repeatedly soiled with feces that contains enzymes with high irritation potential for the skin. The combination of these factors frequently results in skin damage, leading to visible erythematous lesions that can be irritating and painful to the child. Behavioral changes such as increased crying and agitation and changes in eating and sleeping patterns indicate emotional distress. Appropriate skin care can help to prevent the occurrence of DD and to speed up the healing of affected skin. This includes frequent diaper changes and aeration, gentle cleansing, and the use of a barrier cream. Mild to moderate cases usually resolve after a few days of following this routine, but the use of harsh cleaning products can exacerbate DD.

Tolerance of skin care regimen in healthy, full-term neonates

Purpose

To assess the tolerance of a baby cleanser and lotion (both lightly fragranced) on healthy, full-term neonates.

Materials and methods

Twenty-six infant–mother pairs were enrolled in a 6-week, nonrandomized, controlled-use study that took place in the routine setting of a pediatric clinic and mothers’ homes. During study weeks 1 to 6, neonates were bathed by their mother with water and a test cleanser (JOHNSON’S® HEAD-TO-TOE® Baby Wash). During study weeks 1 to 3, mothers also applied test lotion (JOHNSON’S® Baby Lotion) to the babies’ skin immediately after bathing and one to three times/day on bathing and non-bathing days. During study weeks 4 to 6, no lotion was applied. At baseline and weeks 3 and 6, the infants’ pediatrician or mother or both performed visual skin assessments.

Results

Twenty-three infant–mother pairs completed the study. The mean age of neonates at enrolment was 17.4 days (range, 13–28 days). Pediatrician observations found no clinical signs of irritation, erythema, or dryness with any significant difference in scores of these parameters compared with baseline throughout the study. Assessment of skin softness, smoothness, dryness, and overall skin condition was very good at baseline and remained so with minimal changes throughout the study. Mothers reported improvements versus baseline (P ≤ 0.05) in overall skin appearance, moisturization, softness, and smoothness on the arms and legs at weeks 3 and 6. A total of four (15.4%) subjects experienced adverse events. For three of the subjects, the investigator suspected that the adverse events were unrelated to either of the test products. In one participant, the cause of the adverse event could not be determined.

Conclusion

The use of a lightly fragranced nonstinging baby cleanser, with or without a lightly fragranced baby lotion, was well tolerated by newborns and resulted in observable skin benefits per the pediatricians’ and mothers’ assessment.

Newborn skin care

Many organ systems undergo significant and rapid changes during the transition from an intrauterine to an extrauterine environment, especially those which serve as interfaces between the infant and the external environment. Historically the skin care methods employed during and after this period of rapid physiologic change have been derived from individual anecdotal experience or cultural tradition, rather than evidence-based or pathomechanistically derived data. While research in this area has historically been limited, it is increasing in scope and volume, and recent work has shed light on the changes experienced by the cutaneous organ during this period of transition. This increased understanding has driven new recommendations in skin care protocols for newborn infants and neonates.

Effect of olive and sunflower seed oil on the adult skin barrier: implications for neonatal skin care

Natural oils are advocated and used throughout the world as part of neonatal skin care, but there is an absence of evidence to support this practice. The goal of the current study was to ascertain the effect of olive oil and sunflower seed oil on the biophysical properties of the skin. Nineteen adult volunteers with and without a history of atopic dermatitis were recruited into two randomized forearm-controlled mechanistic studies. The first cohort applied six drops of olive oil to one forearm twice daily for 5 weeks. The second cohort applied six drops of olive oil to one forearm and six drops of sunflower seed oil to the other twice daily for 4 weeks. The effect of the treatments was evaluated by determining stratum corneum integrity and cohesion, intercorneocyte cohesion, moisturization, skin-surface pH, and erythema. Topical application of olive oil for 4 weeks caused a significant reduction in stratum corneum integrity and induced mild erythema in volunteers with and without a history of atopic dermatitis. Sunflower seed oil preserved stratum corneum integrity, did not cause erythema, and improved hydration in the same volunteers. In contrast to sunflower seed oil, topical treatment with olive oil significantly damages the skin barrier, and therefore has the potential to promote the development of, and exacerbate existing, atopic dermatitis. The use of olive oil for the treatment of dry skin and infant massage should therefore be discouraged. These findings challenge the unfounded belief that all natural oils are beneficial for the skin and highlight the need for further research.