In this section
Note: This guideline is currently under review.
Preserving the skin integrity of the neonate is important to maintain the function of the skin, protect against potential wounds and avoid skin disorders in the future.
Definition of terms
Preterm baby Less than 37 weeks gestational age
Term baby 37- 40 weeks gestational age
Neonate Less than 4 weeks age (post term)
Infant Young children, 1 month to 12 months age
TEWL Trans Epidermal Water Loss
Atopy Predisposition toward developing certain allergic hypersensitivity reactions
Emollient A substance that softens & moisturizes the skin
Erythema Redness of the skin
Stratum Corneum (SC) The outermost layer of the epidermis acting as a mechanical barrier
Xerosis Skin dryness
Vernix Waxy white substance on newborn skin
Rediwipes Absorbent disposable towels (available from
Equipment Distribution Centre)
Assess skin condition on admission and commencement of each shift (and at each nappy change as needed). Be proactive. Observe and clean areas such as the neck, behind the ears, axillae and groin. Dry, red or itchy skin is an indication that skin integrity may be impaired. If a pustular, vesicular or purulent skin lesion is noted, communicate with the appropriate medical team for management.
Consider the following factors that may increase the risk of skin trauma and breakdown;
To maintain skin integrity and minimise heat loss consider the following -
Examples of appropriate pH neutral cleansers: QV Wash, QV Gentle Cleanser, Hamilton Wash, Cetaphil Gentle Skin Cleanser, Avene Trixera Cleansing Gel, Kenkay Body Wash, Dermaveen Baby Soap Free Wash
Examples of appropriate emollients: QV Cream, QV Kids balm, QV Intensive, Hydraderm Cream, Cetaphil Cream, Aqueous cream, Avene Trixera Cream, Dermeze Ointment, Kenkay Extra Relief Cream, Dermaveen Baby Moisturising Cream, Mustela Stelatopia Moisturising Cream
Nappy area care
Examples of appropriate barrier creams: 10% Olive Oil in Zinc Paste, Covitol, Desitin, Sudocream, Bepanthan Nappy Ointment
Examples of appropriate adhesives: Mepitac, Comfeel, Duoderm, Siltape, Transparent adhesive dressings (Tegaderm), Hydrocolloids, Gel Electrodes, Silicone adhesives
Special considerations for premature neonates
Ensure vital signs and temperature are stable before the first bath. Neonates
<1000g or < 32 weeks sponged in plain water only every 3-4 days. Use soft materials such as cotton balls. Avoid rubbing. Consider immersion bathing for stable infants >1800g
Emollients should not be part of routine care for infants 23-30 weeks' gestation. TEWL may be reduced by other means ie. Humidity
No nappy wipes. Cotton wool and olive oil /water only to cleanse the nappy area
No solvents for adhesive removal, toxicity may result from absorption through the skin ie. Convacare wipes
For further neonatal and Infant skin care management see:
Pressure area care
Erythema Toxicum Neonatorum
A common condition
affecting as many as half of all full term newborn infants. Most prominent on
day 2, although onset can be as late as two weeks of age. Often begins on the
face and spreads to affect the trunk and limbs. Palms and soles are not usually
Clinical features: Erythema
Toxicum is evident as various combinations of erythematous macules (flat red
patches), papules (small bumps) and pustules. The eruption typically lasts for
several days however it is unusual for an individual lesion to persist for more
than a day.
Treatment: The infant is otherwise well and requires no treatment.
Affects 40-50% of newborn babies. Few to numerous lesions.
Clinical features: Harmless cysts present as tiny pearly-white bumps just under the surface of the skin. Often seen on the nose, but may also arise inside the mouth on the mucosa (Epstein pearls) or palate (Bohn nodules) or more widely on scalp, face and upper trunk.
Treatment: Lesions will heal spontaneously within a few weeks of birth.
Miliaria (heat rash)
Arises from occlusion of the sweat ducts. In infants lesions commonly appear on the neck, groins and armpits, but also on the face.
Clinical features: 1-3mm papules (vesicular or papular).
Treatment: Remove from heated humid environment or adjust incubator temperature. Cool bathing or apply cool compresses. Topical steroids may be used to facilitate relief while the condition resolves.
Infantile acne or 'milk spots'. Affects babies within the first few weeks of life. Increased activity of the newborns' sebaceous glands cause inflammation and folliculitis.
Clinical features: Erythematous dome shaped papules and superficial pustules arise in crops, commonly affecting the cheeks, nose and forehead. This rash is not itchy.
Treatment: Will resolve within weeks without treatment or may be treated with ketoconozole shampoo (eg. Sebizole shampoo) diluted 1:5 with water, applied with a cotton bud twice a day. Rinse off with water after 10 minutes. Or apply Hydrozole cream bd to the affected areas until the rash has resolved.
For further assistance the Epidermolysis Bullosa nurse can be paged via switchboard
Please remember to
read the disclaimer
The development of this clinical guideline was coordinated by Robyn Kennedy, Registered Nurse, Dermatology. Approved by the Clinical Effectiveness Committee. Authorised by Bernadette Twomey, Executive Director Nursing Services. First published August 2009, reviewed July 2013.