PROBLEM:  Care practices that affect the fragile infant with skin breakdown, wounds and ostomies in the Neonatal Intensive Care Unit (NICU) present major dilemmas for care providers.  It is important to consider issues of pain management and developmental support, in addition to absorptive toxicity and the fragile nature of neonatal skin in product choices.  Neonates have many of the same skin, wound and ostomy complications that children and adults do with fewer safe and reliable care options.  OBJECTIVE:  To create a safe alternative pouching system that minimizes stress to the fragile infant while allowing wound healing and stool containment.  SOLUTION:  A bordered soft silicone dressing was chosen as a skin barrier.  The wound was cleaned with sterile water and the periwound area was cleaned with sterile saline wipes.  Any depth to the wound was filled with a calcium alginate and the dressing was cut to accommodate the infant’s stoma/stomas.  A neonatal pouch was then adhered to the dressing to contain stool.  The pouch system was then changed every 3-24 hours as needed.  To aid staff, dressing-packets were put together in plastic bags with supplies, precut dressings and detailed instructions on each bag.  OUTCOME:  Because of the hydrophobic nature of the dressing, this pouching system did not adhere to the wound or to grafts while controlling wound fluid and periwound maceration.  Stool was easily contained while the wound was protected and there was no observable evidence of epidermal stripping on removal.  This system did not damage fragile healing skin and infants were minimally stressed.  Staff and caregivers were put at ease with the convenience and simplicity creating greater consistency and desirable patient outcomes.