Maintenance of intact skin is the tiny infant's most effective barrier against infection, insensible fluid loss, protein loss, and blood loss and provides for more effective body temperature control. Minimal use of tape is recommended because the infant's skin is fragile, and tears often result with removal. Zinc-based tape can be used. Alternatives to tape include the use of a hydrogel adhesive, which removes easily with water. Hydrogel adhesive products also include electrodes, temperature probe covers, and masks. In addition, the very thin skin of the tiny infant allows absorption of many substances. Skin care must focus on maintaining skin integrity and minimizing exposure to topical agents. Transparent adhesive dressings can be used over areas of bone prominence, such as the knees or elbows, to prevent skin friction breakdown and under adhesive monitoring devices that are frequently moved. Use of humidity helps maintain skin integrity until skin is mature (2–3 weeks). Humidity can be weaned as tolerated after 2 weeks. Note: When the skin appears dry, thickened, and no longer shiny or translucent (usually in 10–14 days), these skin care recommendations and procedures may be modified or discontinued.
Use a hydrogel skin probe or cut servo-control skin probe covers to the smallest size possible (try a 2-cm diameter circle). This will help to reduce skin damage resulting from the adhesive.
Monitoring of O2 therapy is best accomplished by use of a pulse oximeter. The probe must be placed carefully to prevent pressure sores. The site should be rotated a minimum of every 8 hours. Alternative means of O2 monitoring include umbilical catheter blood sampling.
Urine bags and blood pressure cuffs. These should not be used routinely because of adhesives and sharp plastic edge cuts. Bladder aspirations should be avoided.
Eye ointment for gonococcal prophylaxis. Should be applied per routine admission plan. If the eyelids are fused, apply along the lash line.
Cleansing for required procedures (eg, umbilical artery or chest tube). Use minimal povidone-iodine solution to cleanse the area. After the procedure is completed, the solution should be sponged off immediately with warm sterile water. The use of chlorhexidine in the ELBW infant is controversial and should be used per institution guidelines.
Attach ECG electrodes using as little adhesive as possible. Options include the following:
Consider using limb electrodes.
Consider water-activated gel electrodes.
Use electrodes that have been trimmed down and secured with a flexible dressing material.
An initial bath. Not necessary, but if HIV is a consideration, those infants should receive a mild soap bath when the infant's temperature has stabilized. Warm sterile water baths are given only when needed during the next 2 weeks of life.
Avoid the use of anything that dries out the skin (eg, soaps and alcohol). Bonding agents should be avoided.
Sterile water-soaked cotton balls. Helpful for removing adhesive tape, probe covers, and electrode covers.
Environmental. Use of mattress covers or blankets in humidified environments helps prevent skin breakdown.
Treatment of skin breakdown
Clean skin breakdown/excoriated area with warm sterile water, leaving open to air.
Apply topical antibiotic over broken-down infected areas, leaving open to air.
Apply transparent dressings over excoriated areas.
Administer IV antibiotics if necessary.