NNASA together with SOMSA, NEA as well as Consultants from paediatrics and dermatology at UCT formed the working groups that drafted the 1st South African Neonatal Skin Care Guideline.
The aim of this skin care guideline is to provide evidence based, contextualized guidelines for the care of full term, healthy neonatal skin.
Complications in skin conditions and special populations, such as preterm and critically ill infants are outside the scope of this document.
This document is based on the third edition of the AWHONN Neonatal Skin Care Guidelines, however all sources and recommendations were checked by the working groups, updated and contextualized for the South African context. This was done with permission of AWHONN following a presentation by AWHONN representatives at a consultative meeting in April 2017 where the AWHONN Neonatal Skincare Guidelines were launched.
Topics discussed :
- A. Vernix caseosa
- B. Cord care
- C. Bathing
- D. Buttock Care
- E. Neonatal Male Circumcision
- F. Disinfectant
- G. Emolients
- H. Medical Adhesives.
A. Vernix caseosa recommendations:
- Do not remove vernix caseosa from newborn skin.
- Even when blood, meconium or faeces have to be removed, it should be done gently to protect the vernix, since vernix protects the infant against infection, decreases in skin permeability and Trans Epidermal Water Loss (TEWL), cleanses and moisturises the skin, protects the acid mantel, acts as epidermal barrier, aids skin rejuvenation and contributes to temperature control.
B. Cord care recommendations:
- Ensure a clean birth
- Apply 4% chlorhexidine gluconate as a single application following birth to the cord.
- Use cooled-down, boiled water or breastmilk to clean the cord with each nappy change (natural drying).
- The cord may be submerged when the infant is bathed and washed with water and soap when soiled.
- Keep the cord uncovered/lightly covered and dry until separated.
- In case of infection, treat the infection systemically.
- Prolonged and routine cleaning with surgical spirits is not recommended.
C. Bathing recommendations:
- Delay the first bath for 6 – 24 hours until the infant is physiologically stable and do not remove the vernix. The exception would be the neonate excposed to HIV, who would need an early bath as part of infection control.
- Bath the infant in such a way as to prevent heat loss and stress; immersion bathing and swaddle bathing are both acceptable.
- Use a mild, nonirritant cleanser and regulate the bathwater temperature at 37-37,5 degrees Celcius.
- Potential irritants such as chlorhexidine gluconate are not recommended for whole body use.
D. Buttock care recommendations:
- Clean the nappy area whenever wet or soiled, with mild cleanser or soap or baby wet wipes to gently wipe the perineum and buttock area from anterior to posterior.
- Dry the skin gently and apply a protective cream containing zinc oxide or petroleum jelly.
- Change nappies when wet or soiled and encourage breastfeeding.
- Treat Candida albicans with antifungal ointment or cream, and with systemic antifungals if very resistant.
- Do not use talcum powder or corn starch.
E. Neonatal Male Circumcision recommendations:
- Neonatal male circumcision should only be performed by skilled practitioners, in healthcare settings with good infection control measures.
- The penis should be cleansed with cooled, boiled or sterile water only for the first 3-4 days and petroleum jelly applied to the raw areas.
- No lubricants and dressings should be used when plastic circumcision devices were used.
F. Disinfectants recommendations:
- Clean newborn skin with the best available product, considering potential toxicity and potential skin irritations or burns.
- 4% chlorhexidine gluconate and 10% povidine iodine are generally less irritant than isopropyl alcohol.
- Consider the application techniques and remove all disinfectants after the procedure with sterile water or saline.
G. Emollients recommendations:
- Appropriate emollients should be applied routinely to newborn skin without friction and specifically at the first sign of dryness or in those with a family history of eczema.
- Olive and sunflower oil are not routinely recommended to treat dry skin conditions.
- Until further research is conducted, caution should be exercised when recommending oils for neonatal skin (Cooke et al., 2016: I).
- Emollients should not be used when infants are receiving phototherapy.
H. Medical Adhesives recommendations:
- Routine use of skin barrier protective films and avoidance of direct tape to skin contact lowers the rate of epidermal stripping.
- Medical adhesives should be selected to cause the least tissue trauma, yet effectively securing medical devices.
- Medical adhesives should be removed slowly, pulling on a horizontal plane, using moistened gauze.
- Mineral oil or petrolatum can also be used to loosen tape.
- Application should be avoided whenever possible and the following products should be avoided: alcohol/organic-based products, oil-based solvents, enhancing bonding agents and adhesive bandages after venepuncture.