Protocol Page 1 of 8 NICU/NBN - Department of Nursing - University ...

Protocol Page 3 of 8NICU/NBN – Unit Practice ManualJohn Dempsey Hospital – Department of NursingThe University of Connecticut Health CenterPROTOCOL FOR: Skin Care: Neonatalb. An initial bath using mild low-alkaline or neutral pH soap willbe given once the infant’s temperature has stabilized and theinfant’s condition permits. For infants in the NICU, this bathwill be given in an isolette or on an open warmer.1) Temperature should be stable and within the normal range for 2to 4 hours before the first bath. The infant should bephysiologically stable because hypothermia related to bathingcan cause increased oxygen consumption and respiratorydistress.2) Do not remove vernix from the skin. Vernix may provideantibacterial protection and promote wound healing.c. Warm water baths will be given when needed during the first weekof life for all infants in the NICU.1) Use sterile water for cleansing after diaper changes andbathing of infants < 26 weeks gestation. Avoid rubbing theskin surface.2) For the infant > 30 weeks gestation, low alkaline soap shouldbe used 2-3 times a week after the first week of life.3) For the infant < 30 weeks gestation, low alkaline soap shouldbe used 2 to 3 times per week after the second week of life.4) Rinse well to reduce irritation. The degree of irritation tothe skin from soap depends partially on the length of contactto the skin and the frequency used.d. Use developmentally appropriate swaddling methods for prematureinfants when bathing.e. Immersion bathing in tub may be beneficial, if clinicallypossible in full term or healthy preterm, because it removessloughed skin cells and re-hydrates the skin.f. Infants older than 2 months, regardless of gestational age, maybe bathed every other day or as needed using a low alkaline soapas long as clinical condition permits.g. Moisten mucous membranes with water soaked gauze or cotton tippedapplicator every 4 hours for infants who are NPO or receivinggavage nutrition.CORD CARE: 1. Wash hands before handling umbilical cord area. During the firstbath, clean the cord and surrounding skin with the mild, lowalkalinesoap that is used for bathing. Rinse thoroughly.a. Cleanse cord and surrounding skin with sterile water if first bathis delayed.b. Keep cord clean and dry. If the cord becomes soiled with urineor stool, cleanse with water.