Neonatal Emollient Flammability by Darlene McCord, Ph. D.

Neonatal skin maturation requires the proper development dermis, epidermis and the semipermeable barrier provided by the stratum corneum1. The stratum corneum becomes fully keratinized in utero between 32 and 34 weeks gestational age2. Premature neonates are frequently delivered with severely underdeveloped stratum corneum and epidermal skin layers. The delay in tissue maturation disallows the numerous protective functions provided by fully developed skin.

The Evidence-Based Clinical Practice Guideline for neonatal skin care recommends 2-4 weeks of emollient application in order to prevent excessive transepidermal water loss (e-TEWL) in preterm neonates delivered prior to 32 weeks gestation. The Guideline has been validated by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the National Association of Neonatal Nurses (NANN). Currently, the AWHONN and the NANN recommend Aquaphor, a petrolatum based mixture containing lanolin and mineral oil, as the neonate skin care emollient of choice.

Neonatal incubators provide oxygen-rich environments to preterm infants while monitoring humidity, oxygen saturation and inspired oxygen concentration. Premature infants may receive oxygen from low-flow, reservoir, high-flow and enclosure systems. The systems utilize endotracheal tubes, nasopharyngeal catheters, specialized nose masks and head-box set-ups provide the proper oxygenation requirements.