Managing Diaper Dermatitis in the Neonatal Population

Diaper Dermatitis (DD) “is one of the most common skin conditions in neonates and infants. Its prevalence is estimated to be between 25% and 50%” (Blume-Peytavi, M.D. et al., 2014, p. 413).  A newborns stratum corneum, the upper most skin layer is “30% thinner than an adults” (Jones, 2013, p. 244).  This is important because the stratum corneum regulates “the body’s fluids and electrolytes, it maintains thermoregulation, prevents toxin absorption and protects the skin surface from microorganisms” (Jones, 2013, p. 244). 

Appropriate cleansing of Diaper Dermatitis is controversial, although the consensus is that “barrier ointments are generally more effective than creams or lotions as they provide a more effective barrier” (Jones, 2013, p. 245). The AWHONN guidelines state to use “petrolatum-based ointments or skin barriers containing zinc oxide at every diaper change in infants at risk for developing diaper dermatitis” (Houska Lund, MS, RN FAAN, Team Leader, Brandon, Ph.D., RN, CCNS, FAAN, Holden, BScN, MScT, RN. et.al., AWHONN, 2013, p. 38). 

With an increase in diaper dermatitis in our Neonatal Intensive Care Unit, the request was made for a more standardized management plan.  Through surveys we were able to identify the current practice of bedside nurses for prevention and treatment of diaper dermatitis as well as collecting two months of data on patients identified as having DD.   This information was collected both pre and post education to determine the efficacy of the education.

 Education was given to staff nurses through quarterly staff meetings, one on one interaction, along with attending monthly unit specific shared leadership team meetings over approximately one year.  Data was collected two years after initial collection which revealed a decrease in diaper dermatitis by 37%.