Neonatal Epidermolysis Bullosa (EB), a group of inherited skin disorders, presents with severe blisters. There are three types EB Simplex, Junctional EB, and Dystrophic EB. Blistering occurs because of specific abnormalities in the epidermal basement membrane zone (NIAMS, 2006). This study case describes a full term newborn with the most severe form of EB Simplex.

PAST MANAGEMENT Can you image the nurse's fright as layers of skin sloughed off during the baby her first bath? Can you imagine the transport team's fear as the baby's temperature slowly decreased as more oozing ulcers appeared? Can you imagine the anxiety of the Neonatal Intensive Care Unit (NICU) staff because no one had ever seen EB before? Can you imagine the panic of the WOC nurse as she gazes upon the baby in an incubator with full-body ulcers, no dressings and temperature of 35.6 degrees?

NICU TEAM MOBILIZES: µ Knowledge: Medline searches and consultations to colleagues across the country µ Daily dressings: ionized silver powder, silicone open weave dressing, hydrogel sheet µ Pain management: morphine, non-adherent dressings µ Temperature managed: one-half the baby's body dressed q 12 hours µ Prevent infection: detailed instructions for consistent care and ionized silver powder. µ Consistent support and teaching to family from Primary Nurses.

OUTCOME MEASUREMENTS: µ Upon completion of the initial wound care, the baby's temperature began to normalize and remained stable. µ No infection µ No scarring µ 80% resolution of ulcers at time of discharge µ Minimum appearance of new ulcers µ Mother bonded and learned baby's cares µ Mother independent in wound care CONCLUSIONS: µ Newborns with EB require wound care similar to a burn patient. µ Epithelialization of EB Partial thickness wounds enhanced with moist environment. µ Dressing design encourages baby's mobility, development, and bonding with parents.