Management of IAD (incontinence associated dermatitis) in the Neonatal Population

Problem:  Neonatal skin is fragile and sensitive.  Effects of the diaper environment can include over-hydration and enzyme damage leading to IAD. Minor skin damage in the neonate population increases the likelihood for further skin breakdown.  Neonates experiencing abstinence syndrome are at great risk related to frequent episodes of caustic diarrhea.  The following neonates had IAD related to frequent episodes of diarrhea.  

Solution:  Develop a protocol to prevent and treat IAD in the NICU population.  Because neonatal skin is fragile and sensitive, extra care was taken in selecting a product to manage IAD.  When diapered skin is in contact with caustic stool it significantly increases the risk of IAD.  A skin barrier needs to provide protection from caustic stool, yet be gentle to the skin.  We chose to use a skin protective barrier* with petrolatum and zinc oxide to reduce and prevent the caustic effluent from coming in contact with skin.  The skin protective barrier seals out wetness from skin, yet maintains proper hydration.  The skin protective barrier forms a physical barrier between the stool and skin allowing denuded skin to heal.

Results:  After 3 days, all neonates had healed with the use of the skin protective barrier.  Skin was no longer denuded. 

Conclusion:  When a protective skin barrier was implemented in routine incontinence care with IAD, denuded diapered skin was able to heal.  The barrier prevented caustic diarrhea from being in contact with the skin therefore allowing it to heal.  The skin protective barrier was continued until frequency of diarrhea subsided and the stool less caustic. As the neonate with abstinence syndrome recovered, episodes of caustic diarrhea decreased.  Because of the success of the skin protective barrier in helping to heal denuded skin, it is now included in the IAD protocol and applied to all neonates with denuded diapered skin.