5-swpec-neonatal-skin.ppt

8/9/2019 5-SWPEC-Neonatal-Skin.ppt

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Neonatal Skin Care

Prepared by: LCDR Belinda Rand, RN, RNC


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Objectives

Name three !nctions o the skin"

Describe t#o #ays in #hich the skin o a ne#born or preterminant diers rom that o an ad!lt"

$dentiy three actors that aect the appearance o the

neonate%s skin" $dentiy t#o n!rsin& interventions that provide protection or

the preterm inant%s skin"

Reco&ni'e three common skin lesions that are normalvariations in the ne#born inant" Describe their appearanceand treatment, i any"

Describe three common vasc!lar lesions in the neonate, theirappearance, and appropriate treatment"

$dentiy t#o syndromes associated #ith vasc!lar lesions"


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Clinical Si&niicance

Care!l assessment o the skin is an important element o theneonatal physical e(amination" )he appearance o the skin&ives the n!rse important cl!es re&ardin& the &estational a&e,n!tritional stat!s, !nction o or&ans s!ch as the heart andliver, and the presence o c!taneo!s or systemic disease" $t isimportant or the RN to be amiliar #ith normal variances inthe skin o the ne#born inant, as #ell as those variances thatsi&niy disease"

Proper care o the neonate%s skin can directly aect mortality

and morbidity, especially in the preterm inant" )he skin is theirst line o deense a&ainst inection" Proper skin care canprotect the inte&rity o the skin and prevent breakdo#n"


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*natomy and Physiolo&y o the skin

)hree main layers +pidermis: o!termost layer, #hich !nctions as a barrier rom

o!tside penetration"

Dermis: directly !nder the epidermis, to - cm thick at birth"

Contains blood vessels and nerves that carry sensation. heat,to!ch, pain, and press!re, s#eat &lands and hair shats"

Colla&en and elastic ibers that connect the epidermis and dermis,and provide the skin #ith the ability to stretch and ret!rn tonormal shape"

S!bc!taneo!s layer: atty tiss!e !nctions as ins!lation, protectiono internal or&ans, and calorie stora&e"


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Layers and Str!ct!res o /!man Skin

$nsert 0i&!re here


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0!nctions o the Skin

Physical Protection 1echanical

provides a protective barrier a&ainsttransepidermal #ater loss and eternalinvasions"

Process o slo!&hin& prevents coloni'ation

o the skin s!race by bacteria and otheror&anisms"


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Physical Protection Chemical2 bacterial

*cidic s!race 3p/4 deends a&ainst bacteriaand microor&anisms

Prod!ction o melanin protects a&ainstdama&e rom 56 li&ht radiation"


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/eat Re&!lation

Prod!ction and evaporation o s#eat"

Dilatation and constriction o blood vessels" $ns!lation o body by s!bc!taneo!s at"

Sense Perception

/eat, to!ch, pain, and press!re"


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Dierences in Ne#born 7 Preterm Skin

Basic str!ct!re is same as that o the ad!lt

)he less mat!re the inant, the less mat!re

is the !nctionin& o the skin" )he earlier the a&e, the more thin and

&elatino!s is the skin" 8rad!al mat!rin&.ho#ever, at - #ks o a&e a 9 #k inant has

t#ice the transepidermal #ater loss as aterm inant"


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S!bc!taneo!s at is acc!m!latedpredominantly d!rin& the thirdtrimester" Preterm babies have little at res!ltin& in

decreased ability to maintain body tempand blood &l!cose levels"

Bro#n at 3or temp re&!lation4 be&ins todierentiate in the ;th month o&estation"


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Ne#born skin is thinner and more

permeable" $nants, esp" preterm,

topically applied meds and chemicals"

*llo#s or &reater insensible #ater loss

in the preterm inant"


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0e#er ibrils connect the dermis andepidermis, 7 they are more ra&ilethan that o an ad!lt"

Risk o inj!ry rom tape, monitor, andhandlin& is increased"

+(" Removal o the o!termost layer othe dermis #ith removal o tape orelectrodes"


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S#eat &lands are present at birth, b!t!ll !nctionin& is not present !ntilnd 2=rd year o lie" Ne#born has limited ability to tolerate

e(cessive heat"

6asodilatation to increased heat loss can

res!lt in hypotension and dehydration,#hich is attrib!ted to increasedinsensible #ater loss"


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Care o Ne#born Skin

)erm Ne#born $nitial bath #ith #ater and a mild soap"

Soaps containin& he(achlorophene havebeen sho#n to be absorbed thro!&h theskin" Don%t !se"

Bacteriostatic soap saety has not been

established" 5se #ith ca!tion, rinsecompletely"

Parents may #ant to &ive the irst bath"


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Care o Ne#born Skin

)erm $nant Need a stable body temp to bathe $nant

3>=?"9 C4 @hen stable it is advisable to

bathe inant to red!ce care&iver%se(pos!re to bloodAborne patho&ens"

6erni( is &ood )he verni( caseosacontains lar&e amo!nts o ats, #hichprotect and ins!lates the skin, sho!ldnot be scr!bbed o #ith bath"


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Care o Ne#born Skin

)erm $nant Ro!tine !se o emollients is not

recommended" Creams and lotions

contain per!mes and are dryin& and canirritate the skin"

Some prod!cts can chan&e the p/ o theskin and decrease bacteriostatic

properties" *void p!nct!rin& skin #hen s!spicio!s o

maternal inection"


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Care o Preterm Skin

Preterm inant eep skin clean #ith #ater, mild non

alkaline soap may be !sed"

/andle inant &ently and minimally toavoid tra!ma"

Need inre

+(cessive dryin& o the skin *void over stim!lation,

Stress and ati&!e


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Care o Preterm Skin

Preterm $nants 1inimi'e the !se o tape, removin& tape can

strip the epidermis"

)ransparent adhesive dressin&s can be !sed or#o!nds, abrasions, to sec!re $6%s etc"

Saety o adhesive solvents is !ncertain, cottonballs soaked #ith #arm #ater can be !sed"

$ncreased permeability o the skin allo#s orabsorption o some meds and prod!cts. alcoholand betadine. can lead to chemical b!rns" @asho #ell #ith #ater"


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Care o Preterm Skin

Preterm Skin +mollient creams, ree o preservatives

and per!mes may be o beneit by

decreasin& transepidermal #ater lossand skin breakdo#n #hen crackin&,e(cessive dryness, or iss!res arepresent"

)ent #ith #arm mist may protect theskin and decrease insensible #ater lossin the very lo# birth #ei&ht inant"


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*ssessment o Ne#born $nant Skin

0actors aectin& the appearance o the skin

8estational a&e

Postnatal a&e

N!tritional stat!s and hydration

Racial ori&in

)ype and amo!nt o available li&ht

/emo&lobin and bilir!bin levels

+nvironmental temperat!res

O(y&enation stat!s


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*ssessment o Skin

Deinitions to describe skin lesions 1ac!le. pi&mented, lat spot that is

visible b!t not palpable"

Pap!le. solid, elevated, palpable lesion,#ith distinct borders > cm in si'e

Pla

#ith distinct borders > cm in si'e Nod!le. a solid lesion, elevated #ith

depth, !p to cm in si'e


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*ssessment o Skin

Deinitions )!mor. solid lesion, elevated #ith depth > cm

is si'e"

6esicle. elevated lesion or blister illed #ithsero!s l!id and E cm in diameter"

B!lla. l!id illed lesion lar&er that cm"

P!st!le. a vesicle illed #ith clo!dy or p!r!lentl!id"

Petechiae. s!bepidermal hemorrha&es, pinpointin si'e, that do not blanch"


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*ssessment o Skin

Deinitions +cchymosis. a lar&e area o

s!bepidermal hemorrha&e"

@heal. area o edema in the !pperdermis, creatin& a palpable, sli&htlyraised lesion"

5lcer. erosion o skin #ith dama&e o theepidermis into the dermis" @ill leave ascar ater healin&"


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Common Skin Lesions

Normal variations in ne#born skin C!tis marmorata

Bl!ish mottlin& or marblin& eect o skin

Physiolo&ic response to chillin& ca!sed bydilation o capillaries

Disappears #hen inant is re#armed

1ay be si&n o stress or overstim!lation inne#born"


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Common Skin Lesions

Normal 6ariations +rythema to(ic!m 3Ne#born Rash4

Small #hite or yello# p!st!les s!rro!ndedby an erythemato!s base 3redness ca!sedby a histamine release4

Dierential Dia&nosis. may resemble a

staphylococcal inection, 3conirmed by asmear o aspirated p!st!les sho#in&increased eosinophils4"


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Common Skin Lesions

Normal 6ariations 1ilia

1!ltiple yello# or pearly #hite pap!lesabo!t mm in si'e. Fincl!sion cystsG,!s!ally on bro#, cheeks, and nose"

Observed in abo!t -HI o ne#born inants"

No treatment needed, resolvespontaneo!sly d!rin& the irst e# #eeksater birth"


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Common Skin Lesions

Normal 6ariations +pstein pearls

Oral co!nterpart o acial milia" Can be seenon the midline o palate or on the alveolarrid&es"

Occ!rs in appro( ?HI o neonates"

No treatment needed"


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Lesions rom )ra!ma

0orceps marks Red or br!ised areas seen over the

cheek, scalp, or ace o inant ollo#in&

orceps delivery" On assessment look or !nderlyin& tiss!e

dama&e or other si&ns o birth tra!ma.scalp abrasions, ract!red clavicles, oracial palsy"


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Lesions rom )ra!ma

Scalp Lacerations 1ay occ!r d!rin& delivery, #ith

placement o scalp electrodes, or etal

blood p/ samplin&" )reatment consists o keepin& the area

clean and dry, and assessin& orinection"


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Lesions rom )ra!ma

$ntraveno!s e(travasations 6asc!lar access sites in inants sho!ld be

assessed ho!rly, eval!ate or patency

and e(travasations" $ apparent or ipatency is not certain remove $6catheter immediately"

$ e(travasation occ!rs, elevatee(tremity" *void heat or moist dressin&s")opical antimicrobial ointments may aid"


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Pi&mented Skin Lesions

/yperpi&mented mac!les 3mon&olianspots4 Lar&e mac!les or patches, &ray or bl!eA

&reen, seen most commonly over theb!ttocks, lanks, or sho!lders"

1ost common lesion seen at birth,occ!rrin& in JHI o black, *sian, and

/ispanic babies, in A9I o #hite babies" D!e to increased presence o

melanocytes dispersed in the dermis"


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Pi&mented Skin Lesion

Cae%Aa!Alait spots )an or li&ht bro#n patches #ith #ellA

deined borders"

Less that = cm in len&th and less that ?in n!mber, no patholo&ical si&niicance"

? or more spots may be an indication one!roibromatosis 3+ichenield 7 8ibbs,

HH4" )!mors #hich orm on c!taneo!snerves 7 alon& the thoracic, brachial,and l!mbar nerve tr!nks"


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6asc!lar Lesions

Nev!s simple( FStork biteG mac!lar pink areas o

distended capillaries o!nd on the nape

o the neck, !pper eyelids, nose, or the!pper lip"

)hey have di!se borders, blanch #ithpress!re, and become pinker #ithcryin&"

)end to ade, b!t may persist"


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6asc!lar Lesions

PortA#ine stain 0lat vasc!lar nev!s, present at birth" 5s!ally

pink, may be p!rple or red" 1ay be small or maycover almost hal the body" 0lat, sharply

delineated, and blanches minimally" 0aciallesions are most common"

Stains consist o mat!re capillaries that aredilated and con&ested directly belo# theepidermis" Ca!se not kno#n"

Nev!s does not &ro# in area or si'e" $ #ill notresolve and sho!ld be considered permanent"1ay become darker and thicker"


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6asc!lar Lesions

Stra#berry /eman&ioma Raised, lob!lated, sot, bri&ht red t!mor

located on the head, neck, tr!nk, or

e(tremities" 1ay occ!r in the throat, canlead to air#ay obstr!ction"

Ca!sed by dilated capillaries occ!pyin&the dermal and s!bdermal layers #ith

endothelial prolieration" HA=HI are present at birth, and JHI

are evident by # month o a&e"


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Stra#berry /eman&ioma

5s!ally #ill increase in si'e in the irst ?months, then become stable in si'e beore&rad!al spontaneo!s re&ression, most

leave no trace" @ill take several years" Oten there is more than one lesion"

)reatment is to allo# spontaneo!sre&ression" $ lesion eects vision, is

bleedin&, or !lceratin&, impin&in& on othervital !nctions !rther treatment sho!ld beconsidered"


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$nectio!s Lesions

)hr!sh 0!n&al inection o the mo!th or throat,

ca!sed by Candida albicans, very

common in inants" Sho#s as patches o adherent #hite

material scattered over the ton&!e andm!co!s membranes"

)reated #ith oral anti!n&al preparationss!ch as nystatin 31ycostatin4"


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$nectio!s Lesions

Candida diaper dermatitis 0!n&al inection o skin in the diaper

area, b!ttocks, &roin, thi&hs, and

abdomen" 3check or thr!sh as #ell4 Ca!sed by or&anism C" *lbicans"

Sho#s as moist, erythemato!s er!ption,oten #ith #hite or yello# satellite

p!st!les" )reatment is anti!n&al cream or

ointment preparation, nystatin"


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$nections Lesions

Systemic Candida inection 6ery lo# birth #ei&ht inants are at risk

o havin& systemic, invasive !n&al

inections #ith invasion o the !n&!sbeyond the strat!m corne!m"

)(: $mprove barrier !nction o the skinby minimi'in& tra!ma and maintainin& asterile environment may help preventonset o illness"


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$nections Lesions

/erpes Neonatal herpes simple( inection is one

o the most serio!s viral inections in the

neonate" Rash appears as vesic!lar or p!st!lar

rash"

;HI o inants #ith herpes #ill have

s!bse


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/erpes

*bsence o rash or vesicles does noteliminate the possibility o disease"

)(: #ith antiviral a&ent s!ch asacyclovir sho!ld be&in immediately")he earlier treatment is be&!n, thebetter the o!tcome 3@eston et

al",HH4"


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Reerences

6erklan, 1" )", @alden, 1", 3+ds"4" 3HH94" NeonatalDermatolo&y" Core C!rric!l!m or Neonatal $ntensiveCare N!rsin&" 3=rd +d4" +lsevier Sa!nders"

)h!reen, P"K", Decan, K", /ernande', K"*", /all, D"1"

3HH94 *ssessment and Care o the @ell Ne#born"3nd +d4" +lsevier Sa!nders"

+ichenield, L"0" and 8ibbs, N"0": /yperpi&mentationDisorders" )e(tbook o neonatal dermatolo&y"Philadelphia, HH, Sa!nders, pp" =;HA=J-"

@eston, @"L", Lane, *")", and 1orelli, K")": Colorte(tbook o pediatric dermatolo&y 3=rd ed"4" St Lo!is,HH, 1osby"

5-swpec-neonatal-skin.ppt

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