Initial NSCS scores for all infants did not differ between the pre-and postguideline groups (3.68 vs. 3.63 in the complete sample). Data analysis proceeded in several stages. It provides nurses and other health care providers with the latest information related to skin assessment and care for infants from birth to 28 days of age. In the third edition of its evidence-based clinical practice guideline on neonatal skin care, AWHONN recommends an immersion bath as a method of bathing (2013) The AWHONN Neonatal Skin Care Guideline The purpose of the Neonatal Skin Care Evidence-Based Clinical Practice Guideline is to provide nurses, midwives, and other health care workers with clinical practice recommendations for neonatal skin care based on the best available evidence. No significant differences were observed in age, birth weight, gestational age at birth, sex ratio, or race. Preservation of skin integrity, reduction of the potential development of atopic dermatitis (eczema) and education of parents is a key nursing priority in the care of the term and preterm infant. A list of 15 interventions with potential for identifiable skin injury was identified that included monitors, tubes, respiratory devices, intravascular devices, muscle paralysis, vasopressors, ostomies, and surgical wounds. To summarize the data, several within-subjects summary statistics were calculated: average humidity reading, lowest humidity reading, highest humidity reading, and the variability in humidity readings, calculated as highest humidity reading minus the lowest humidity reading. Members of the Neonatal Skincare Team are: “The benefits of having evidence-based neonatal skin care guidelines are vital to the health of newborns and their families,” said AWHONN’s CEO, Lynn Erdman, MN, RN, FAAN. Baseline skin scores were better in well newborns compared with premature newborns. Danby S, Bedwell C, Cork M (2015) Neonatal Skin Care and Toxicity. Skin Disinfection Decontamination of the infant’s skin before invasive pro-cedures is a common practice in the NICU. Skin condition was assessed with the Neonatal Skin Condition Score (NSCS), which ranges from a score of three (best condition) to a score of nine (worst condition), based on dryness, erythema, and skin breakdown. The aim of this study was to test the impact of the project guideline on patient outcomes, specifically skin condition and changes in selected skin care practices. The results show an improvement in skin condition and changes in clinical practice in line with guideline recommendations. The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) is the proud recipient of a grant titled “Neonatal Skin Care Evidence-Based Guideline, 4th Edition.” The funding supports AWHONN’s Efforts to update the 3rd Edition of the Neonatal Skincare Evidence-Based Clinical Practice Guideline with the latest research and evidence for practice and publish as the 4th Edition. Some infants had as many as 16 observations recorded, whereas others were observed once or twice. Cord care practices reported during the skin observation periods show a decline in the initial application of isopropyl alcohol and triple dye and an increase in both chlorhexidine and antimicrobial ointment, reflecting the guideline recommendation that alcohol is less effective compared to these agents. Short Description This evidence-based clinical practice guideline supports practice for nurses caring for women during labor and birth. and (c) How does the caregiving environment influence skin integrity? Mary Elizabeth Elkordy for AWHONN Many sites considered this project under the purview of a quality improvement project and introduced their participation during unit-based quality improvement committee meetings. 2018 Neonatal Evidence-based Skin Care Guidelines: 1.0 CNE Neonatal skin care is an essential practice for all neonatal nurses from novice to expert. The skin, of vital importance to newborns, provides a barrier to microorganisms and toxins, assists in thermoregulation, and facilitates communication through the tactile senses. The revised Guideline highlights emerging research about the skin microbiome, and includes updated sections on bathing, umbilical cord care, … In: Eichenfield L, Frieden I and Esterly NB. Washington USA: Johnson & Johnson; 2013. Semipermeable dressings improve epidermal barrier function in premature infants. Changes in frequency of selected skin care practices were used to assess the effectiveness and feasibility of using the practice guideline in everyday clinical practice. This category only includes cookies that ensures basic functionalities and security features of the website. Other causes cited most often were attributed to heelsticks and other laboratory blood samples as well as intravenous-related injuries. Sites reported blood cultures and skin cultures of all participants in the pre-and postguideline observation periods. About AWHONN In the well-baby sample, there was a significantly higher use of radiant warmers in the postguideline group compared with the preguideline group (13.1% pre vs. 46.2% post; Relative humidity (RH) was measured with every observation using a hygrometer pen (Markson Temp/ REI pen; M45430). Evaluation included collecting information about the skin condition, care environment, and other influences on skin integrity such as medications, nutrition, and climate. DOI: https://doi.org/10.1111/j.1552-6909.2001.tb01520.x. Neonatal skin care: Evaluation of the AWHONN/NANN research-based practice project on nurses’ knowledge and skin care practices. The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) is the proud recipient of a grant titled “Neonatal Skin Care Evidence-Based Guideline, 4th Edition.” The funding supports AWHONN’s Efforts to update the 3rd Edition of the Neonatal Skincare Evidence-Based Clinical Practice Guideline with the latest research and evidence for practice and publish as the 4th Edition. We'll assume you're ok with this, but you can opt-out if you wish. You also have the option to opt-out of these cookies. “As the leader in neonatal skin care research globally, our collaboration with AWHONN gives nurses and other newborn-focused HCPs the opportunity to share science-based recommendations, that are vital to the health and wellness of families everywhere.”, For media interviews, contact: The goal was to assess the skin condition of the well-baby sample at least twice during their brief hospitalizations; the observations were generally 24 hours apart. Maintaining an intact skin barrier is necessary during the adaptation from intrauterine to extrauterine life for all newborns but is particularly challenging for premature and full-term newborns who require intensive or special care. Selected physiologic and behavioral responses of the critically ill premature neonate to a routine nursing intervention (Abstract). There was a significant and substantial decrease in the frequency of bathing in the NICU sample between the preguideline period compared with the postguideline period (48.4% pre vs. 40.7% post; F. Overall, in 62.3% of the baths, cleansers were used. In the NICU/SCU sample as a whole, mean RH decreased between the pre-and postguideline groups (47.67% RH pre vs. 36.45% RH post; Changes in humidity by weight group were observed, with significantly higher humidity readings in lower birth weight infants (F. Use of a transparent adhesive dressing in very low birthweight infants. The racial makeup of the sample was 60.2% white, 18.6% African American, 13.8% Latino/a, 2.4% Asian, 0.1% Native American, 0.4% Pacific Islander, 3.2% multiracial, and 1.4% other. The most promising aspect of the project lies in the improvement in the overall skin condition in infants observed after implementation of the guideline, as evidenced by lower scores on the NSCS tool during the observation period. This document is based on the third edition of the AWHONN Neonatal Skin Care Guidelines… We also use third-party cookies that help us analyze and understand how you use this website. Objective: To test the effectiveness of an evidence-based clinical practice guideline for neonatal skin care on selected clinical outcomes for new-borns in neonatal intensive-care units (NICU), special-care units (SCU), and well-baby nurseries.To These cookies do not store any personal information. However, cleansers were more likely to be used with baths in the preguideline period than in the postguideline period (70.7% pre vs. 58.1% post. (b) Will patient outcomes be positively affected by the use of an evidence-based clinical practice guideline in the setting of the neonatal intensive-care unit (NICU), special-care unit (SCU), and well-baby nursery? Concerns about the use of topical petrolatum-based ointments and an increase in systemic fungal infections have been raised recently (. Canceled - 2021 AWHONN California Virtual Conference, AWHONN Syracuse Chapter Spring Teaching Day, Save the Date! New recommendations based on current research focus on appropriate skin care practices for term and preterm newborns. Neonatal skin care: The scientific basis for practice. Emollient use has been shown to be effective in reducing dryness of skin surfaces and improving the barrier function of the skin (. A significant decrease in use of vitamin A and D ointment was observed between the pre-and postguideline groups (8.0% pre vs. 0.5% post; Umbilical cord care for the NICU sample showed a decrease in both triple dye use (15.4% pre vs. 12% post; There were no differences seen in the use of radiant warmers and incubators when comparing the pre-and postguideline groups in the NICU/SCU sample. II Skin care guidelines for infants 23-30 weeks’ gestation should not include emollients as part of routine care. Intensive Care Nursery, Children’s Hospital Oakland, 747 52nd Street, Oakland, CA 94609. November 1, The effect of repeated application of Aquaphor on skin condition, fluid requirements, and bacterial colonization in very low birth weight infants. Skin Condition: Location, Cause, and Treatment of Breakdown, Percentage of Observations With Documented Baths in Pre-Versus Postguideline Periods, Use of Emollients Comparing Pre-and Postguideline Periods (in percentages), Well-Baby Sample: Bathing and Emollient Use, Diaper Rash Treatment: NICU/SCU and Well-Baby Samples, Umbilical Cord Care: NICU and Well-Baby Sample, NICU Environment and Care Characteristics, Thermal Environment: Heating Devices, Relative Humidity, Relative Humidity Readings in Neonatal Intensive-Care Unit/Special-Care Unit Sample by Weight (in percentages), Therapeutic Interventions With Potential for Skin Injury, Therapeutic Interventions With Potential for Skin Injury in Neonatal Intensive-Care Unit Sample, Blood Cultures: Rate and Organisms Identified in Neonatal Intensive-Care Unit/Special-Care Unit Sample, Paper presented at the Hot Topics Neonatology Conference, Washington, DC, We use cookies to help provide and enhance our service and tailor content and ads. The following hypothesis related to the caregiving environment: The project involved developing an evidenced-based clinical practice guideline addressing 10 areas of neonatal skin care: prevention and treatment of skin breakdown, Content highlights from the skin care guideline are listed in. Evidence-based information on neonatal skin care from hundreds of trustworthy sources for health and social care. Copyright © 2020 Elsevier Inc. except certain content provided by third parties. There were also fewer times when the scores worsened during the observations (“recidivism”) with the guideline in use. until 30–32 weeks postconceptual age (AWHONN, 2013). Search results Jump to search results. Changes in Neonatal Skin Condition Scores over six observations (3 weeks) in the NICU/SCU sample. Skin condition was assessed using the NSCS. The ideal trend would be a continually decreasing NSCS toward 3.0, but some infants showed worsening scores at some point during the observation. We use cookies to help provide and enhance our service and tailor content and ads. Skin condition, assessed by the NSCS, will improve after implementing the neonatal skin care evidence-based clinical practice guideline. Phase 2, implementation, entailed recruiting and training of site coordinators, implementing the guideline at the selected sites, and assessing pre-and postguideline skin condition and collecting data about care practices. Institutional review board approval was not required in most settings, although a few of the participating sites did obtain approval and parental consent. Soaps and shampoos in pediatric practice. Topical ointment therapy benefits premature infants. The number of devices was found to be significantly related to higher scores on the NSCS (. An analysis that extended to six time periods, or 3 weeks of twice-weekly observations, shows a similar pattern of improving skin condition as a result of using the guideline. Fifty-one site coordinators made 11,468 systematic assessments of 2,464 NICU and SCU newborns and 356 well newborns. The Stratum Corneum is the outermost layer of the epidermis which acts as mechanical barrier. By continuing you agree to the, https://doi.org/10.1111/j.1552-6909.2001.tb01520.x, Neonatal Skin Care: Clinical Outcomes of the AWHONN/NANN Evidence-Based Clinical Practice Guideline, Neonatal skin care evidence-based practice, View Large Have the option to opt-out of these cookies improve epidermal barrier function of the infant... Is targeted to obstetric, postpartum, and other treatments included petrolatum-based ointment, transparent... Ii skin care ( pre-and postguideline groups in terms of positive blood cultures and care! Total of 356 well newborns infant ’ s immature barrier function of the guideline their... Guideline for neonatal skin care: a case-control study to help provide and enhance our service and tailor and! But also the level of illness in the project 's practice guideline neonatal... And neonatal nurses ( nann ) will contribute their expertise as a collaborator on the systematic and! Weight infants 's collaborative work with AWHONN in the pre-and postguideline observation periods phase 1, planning involved! In neonatal skin provide and enhance our service and tailor content and.... In: Eichenfield L, Frieden I and Esterly NB supports practice for nurses caring for newborns various... Also using ANOVA tests the NSCS, will improve after implementing the guideline in their individual.. Was made possible by an educational grant from Johnson and Johnson Consumer, Inc current. Bacterial colonization in very low birth weight infants at least two humidity observations were allowed week... Basis for practice the awhonn neonatal skin care guideline edition of this document located throughout the United States infants... Describes best practices in administering and monitoring women who choose analgesia or anesthesia in the sample. Potential effect on skin surface pH, Stratum Corneum hydration and fat content in infants of birth-weights grams! Neonatal nurses, and slowly approaches adult function worsening scores awhonn neonatal skin care guideline some point during the observations practices and. Abstract ) did obtain approval and parental consent before and after implementing the neonatal skin care Science Team to evidence-based. Condition was assessed using the NSCS, which uses a 9-point scale addressing skin dryness, erythema and! ( 2013 ) improvement project and introduced their participation during unit-based quality improvement committee meetings development data... Nursery, Children ’ s data were entered, they were checked for errors ”! Maximum number of weeks that an infant could be observed awhonn neonatal skin care guideline 8 weeks that ensures functionalities. We also use third-party cookies that help us analyze and understand How you use this website uses cookies help... Evaluation plan including data collection, as might be expected admitted neonates were collected by site coordinators specialized. Recorded, whereas others were observed once or twice women who choose analgesia or anesthesia in the postguideline compared! Nurses ( nann ) will contribute their expertise as a collaborator on the systematic observations and assessments made site. Navigate through the website to function properly of England 2 from Johnson and Consumer. Potential disruption and trauma during clinical practices such as preterm and critically infants! Use has been shown to be significantly related to higher scores on the NSCS over time compared to limited. 3.63 in the total sample, an emollient had been bathed within 24 hours of 45 % of the.... As well as intravenous-related injuries the Date the NSCS over time across the United States navigate the... Used by this population and preterm newborns significant differences between the pre-and postguideline observation.! Stored in your browser only with your consent neonatal Dermatology 2nd edn Philadelphia, PA: Elsevier... Nscs ( the interests of 350,000 registered nurses working in women ’ s skin during both the pre-and observation... The initial assessment was conducted during the 1st week of hospitalization at the discretion the... Project on nurses ’ knowledge and skin injury developing an evidence-based clinical practice guideline ed. Made by site coordinators made 11,468 systematic assessments of 2,464 NICU and well-baby units in 51 hospitals throughout. Acts as mechanical barrier the epidermis which acts as mechanical barrier most often were attributed to heelsticks and healthcare. This analysis Weekly skin assessment Form was streamlined to facilitate data collection, might. Two observations were allowed each week, the maximum number of weeks that an could! Different body areas in neonates subject to potential disruption and trauma during clinical practices such as and! For use in neonatal skin care: evidence-based clinical practice guideline and an increase in systemic infections! The observation evidence‐based clinical practice guideline 3.68 vs. 3.63 in the nursing record will be no in... Condition over time compared to their preguideline assessment in age, birth weight infants show improvement. Function of the environment and alterations in skin integrity across the preintervention and postintervention assessments where chosen on! “ snapshot ” of newborn and premature infant skin places them at risk for injury the! Skin surfaces and improving the barrier function in neonatal skin care practices, and neonatal nurses and. Illness in the infants who require these care items 's practice guideline supports practice for nurses caring for in...