Evidence-Based Consensus Recommendations for Skin Care in Healthy, Full-Term Neonates in India

Abstract

Purpose

Neonatal skin care practices guided by personal experience and preferences might be substantially different across different hospital settings. The aim of this consensus recommendation is to provide clinical practice guidance to healthcare practitioners on evidence-based neonatal skin care practices from delivery-to-discharge, in hospital settings.

Patients and Methods

A Scientific Advisory Board meeting on “Evidence-based Neonatal Skin Care Practices and Protocols” was held in December 2020 with an expert panel comprising neonatologists, pediatricians, obstetricians and gynecologists and pediatric dermatologist. Comprehensive literature search was performed up to 23 March 2021 using PubMed and Google Scholar to retrieve relevant evidence.

Results

Recommendations were developed on critical aspects of skin care in healthy full-term neonates including cleansing at birth, skin-to-skin care, cord care, diaper area care, initial and routine bathing, cleansers and emollients use, and criteria to choose appropriate skin care products. Recommendations include inclusion of skin assessment in routine neonatal care, first bath timing after cardio-respiratory and thermal stabilization, 6–24 hours after birth; bathing with water alone or adding a mild liquid cleanser could be considered appropriate as it does not impact the developing skin barrier; use of emollients is recommended for neonates with higher risk of development of eczema to maintain and enhance skin barrier function and integrity; and inclusion of skin care advice in neonatal discharge checklist. Importance of rigorous quality control, high-quality clinical trials for assessment of baby products, usage of products that are formulated appropriately for newborns, and full label transparency for baby products were highlighted. The panel identified gaps in literature and discussed the scope for future research.

Conclusion

These recommendations may help to standardize evidence-based skin care for healthy full-term neonates in Indian hospital settings to improve the quality of care that neonates receive in hospital and facilitate improvement in overall neonatal health outcomes.

Keywords:

• baby products
• bathing
• cleanser
• emollient
• hospital setting
• neonatal skin care practices

Abbreviations

AWHONN, Association of Women’s Health, Obstetric and Neonatal Nurses; HIV, Human immunodeficiency virus; IAP, Indian Academy of Pediatrics; MoHFW, Ministry of Health and Family Welfare; NSCS, Neonatal Skin Condition Score; PEG-80, polyethylene glycol-80; TEWL, trans-epidermal water loss; UNICEF, United Nations International Children’s Emergency Fund; WHO, World Health Organization.

Acknowledgments

Akshada Deshpande, PhD and Rabi Panigrahy, PhD, ISMPP provided medical writing assistance, and Sangita Patil, PhD, ISMPP, CMPP^TM (all from SIRO Clinpharm Pvt Ltd, India) provided additional editorial support for this manuscript.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, design, execution, data analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Priti Thakor and Ankita Pandita are employees of JNTL Consumer Health (India) Pvt Ltd. Dr Ankita Pandita reports the advisory board was conducted by JNTL Consumer Health (India) Pvt Ltd. All other authors declare that they have no competing interests.

Additional information

Funding

This research is funded by JNTL Consumer Health (India) Pvt Ltd. Authors did not receive any financial support from the funder related to this work. The funder did not influence the content of the guideline.