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Correspondents softening Neonatal Skin Care Product Selection with changes in the standard of care - Health - Skin Care
Correspondents softening Neonatal Skin Care Product Selection with changes in the standard of care by lisaa
in Health / Skin Care (submitted 2010-06-09)
Evidence-based clinical practice guidelines and neonatal skin care products, including skin condition Neonatal Scale (NCI), was confirmed by the association of women's health, obstetric and neonatal nurses (AWHONN) and National Association of Neonatal Nurses (Nann). A guideline for the use of emollients is recommended for children under 32 weeks of the first 2-4 weeks. Infants below 30 weeks gestational age emollient use is recommended to reduce the transepidermal water loss (TEWL-e).
Revisions in the works for three decades, treatment of newborns has radically changed and new guidelines emphasize that growth and development. This area of skin care has lagged behind. A concern that remains is the question of the effects of toxic ingredients in water-based products, such as preservatives and perfumes. Although it is possible that they may be toxic, this paper presents evidence that current skin care products that contain petrolatum and lanolin may be toxic and harmful. Furthermore, using a product that is not retained, but occlusion, may make it possible microorganisms in colony-forming units multiply, this can produce systemic effects. This article aims to illuminate these issues further and provide a better understanding and discussion.
The skin is the largest organ in the body and provides a barrier between the body and its environment. In term infants, there may be issues related to skin breakdown and infection, the stratum corneum is fully developed and protects the baby. By contrast, skin and skin barrier of premature infants is not fully developed.
The skin of a newborn premature for approximately thirteen (13) percent of their body weight. This compares with three (3) percent of body weight for adult skin. The ratio body weight / skin are four (4) times higher in newborn compared with adults. As specifically related to skin care, these features in the call for newborn skin in mind:
* Fluid imbalances
* Percutaneous absorption of toxins
* Tissue injury
The structure of mature skin is understood that when embryonic and neonatal skin is not fully appreciated. Development of the skin in the uterus is complex and still under investigation. The skin is the womb of growth in two dimensions to cover the area in the developing fetus. Premature skins of the newborn have not gone through the entire development of epidermal epidermis and dermis.
Neonatal Intensive Care Unit (NICU) selection of skin care products is carefully examined. With the risks described above, the greatest care must be taken to ensure the well-being of newborns in the first hours and days of life. Skin care is one of the main areas of care for these vulnerable children. Currently recommended Nann and an AWHONN Aquaphor? A product based on Vaseline as skin care of newborn emollient.
In earlier work at Stanford University found that therapy moisturizing cream emollient premature infants to reduce erythema, without altering the microbial flora. Emollient is a substance that softens and soothes the skin. This definition is important because one of the NICUs standards of care has changed over the last three decades; selection creams have changed the pharmaceutical industry.
Ingredients of high-tech Silicon petrolatum displaced as companies have sought ways to improve compliance monitoring associated with poor treatment cosmetic formulations based on petroleum jelly. Silicones are not new in the pharmaceutical sector. They are used in transdermal delivery systems, catheters and specialized medical devices such as pacemakers.
In a trial to determine the aesthetic benefits of silicone formulas based on the formulas of Vaseline, 18 untrained volunteers were impaneled. They were asked to assess whether two products are individual differences in sensory characteristics. The evaluation was conducted on the forearm of a panelist. Each member was asked to assess the moisture, spreading, the speed of light (non-organic, just feel), gloss, film residue, fat, silky and go after perceived absorbance.
Figure I show the formulation containing silicone has been perceived as easier to spread and was much less sticky before and after absorption. A sensitive film was present on the skin for both formulations, but containing silicone formulation is less greasy, silky and smooth (lubrication better) Vaseline. The perception of higher humidity expert silicone-containing formulation has been attributed to the lower lubricity.
In a study on a hospital neonatal intensive care 48-bed private Houston, Texas, to determine why the number of systemic candidiasis (SC) per 1000 NICU patient days increased 5.1% in 1996 to17. 4% in 1997 (an increase of three times), it was determined that the increase in SC deposits were related to the use of topical petrolatum ointment (TPO). In this well-designed study investigators have continued to the hypothesis that TPO enhanced compliance of C albicans to mucocutaneous surfaces. Also in the study was a finding of S, et al, unlike petroleum jelly, skin surface lipids inhibit adherence of Candida albicans to stratum corneum.
For further discussion, let us examine more closely these two hypotheses. As noted in the study of the accession of Houston petroleum jelly, improved C. albicans to mucocutaneous surfaces. Vaseline is known as an invisible barrier. The occlusion is problematic because it blocks your breath as PIE, also blocks the cell to repair the wall. In addition, the traps of occlusion of microorganisms in petroleum jelly, which can be played in which the trapped moisture. Moreover, the natural skin lipids, such as Omega 3 to 6, for preventing the adherence of the microorganisms in the stratum corneum.
Studies linking the Vaseline with a higher incidence of infections in preterm infants are ongoing and shows mixed results. However, long-term studies reflect a concern about the use of protocols of TPO NICU. Petroleum based ointments such as Aquaphor is? 25 years old formula, are emollients of choice in the NICU. If we take into account changes in standards of care in the NICU for the past three decades, perhaps it is time to focus on new technologies in achieving the objectives of free skin care emollient aesthetics, skin epidermis challenges makes them vulnerable to chemicals and infections, prevents normal PIE and glandular secretions, prevents the repair of barrier recovery removes the barrier and decreases the epidermal proliferative response and cons of Vaseline microbial risk.
To demonstrate the effectiveness of using the products of high molecular silicones height cons Vaseline Nutrashield TM was tested in a washout Aquaphor? And another barrier of the skin from head to determine the ability of each product to maintain the protection of the skin after cleansing. As shown in Figure II Nutrashield performed well against Aquaphor?, Done, and so while providing a barrier permeable to air instead of occlusive barrier associated with Aquaphor? (A lanolin and petroleum jelly based products). In clinical trials Nutrashield proved effective in the treatment of skin breakdown in skin disorders and damage resulting from the development of wound care, compared to products already available.
Based on previous results, Medline Nutrashield than products with a level as high as 49% petroleum jelly, mineral and combines with zinc oxide 15%. In addition, both Sensi-Care Sween 2 and 24 also contain simethicone as an active ingredient (Sween 6% versus 1% in the Nutrashield). The performance of the extension is probably Nutrashield adding Divinyldimethicone copolymer / dimethicone, which has a viscosity of internal phase, which is more than 100 million of viscosity of the CST. As this is a form of emulsion, which is able to fix a thin film but consistent and solid.
In vitro, an independent laboratory research has been done to determine the effectiveness of Nutrashield and Skin Repair Cream-reducing TEWL. Collagen samples cut into 4x4 inch squares. Each square is coated first with 0.1 g of product. The product is applied by rubbing a finger of collagen material to simulate actual use for 20 seconds. The product is then dry for five minutes. Each square is placed over Payne Permeability Cups Fisher contains 3g of water. The samples were placed in an oven at 37 degrees and review every four (4) hours. 24 hours after the cups were removed and the final weight was recorded.
Figure III shows that both Nutrashield RESOURCE skin repair cream was effective in reducing the e-IEP without occlusion. Nutrashield expected to reduce the four e-PIES to control, while the skin repair cream showed an improvement of two orders. The aim of skin care intervention is not new to stop all just PIE excessive.
Skin Care Products in neonates emerging science. But since the risk reduction, child mortality is crucial to improve treatments emollients deserve thoughtful consideration. Skin care products for infants at high risk, requires knowledge of the unique characteristics and physiology of the skin. During the neonatal period, many newborns develop preventable, clinically obvious skin problems and many others, especially premature infants, morbidity experience caused by impaired skin barrier integrity. Anatomical and physiological differences of skin, premature babies and ended them at increased risk of skin lesions and distribution. All Children's Hospital, St. Petersburg, FL, sent a questionnaire to 482 nurses of the NICU to learn to describe and measure the distribution of the skin. 45% of respondents showed that extremely low birth weight (ELBW) children, 21% suffered skin lesions during the first week of life.
The reduction of microbial contamination and protection against skin breakdown has been discussed. Another critical factor is associated with the immaturity of newborn CIP barrier is the rate of CIP. A Swedish study calculated TEWL in children 24 and 25 weeks' gestation remain at a relative humidity (RH) of 50%. The study revealed that the BAP in the first days after birth (58.4 + /-14.8gm (-2) h (-1) and remained at the same level during the second day. Then decreased significantly to 48.3 + / -9.5 in the days after birth. All use of three semi-permeable as a product of skin care Nutrashield reduces excess as much as four times a PIE.
Semi permeable dressing's age was tested as a method to reduce TEWL newborns to address skin breakdown and increased requirements of joint fluid in ELBW infants. Studies have shown that the semi-permeable (breathable) barrier can be used safely in premature babies.
The uses of ingredients are considered "toxic" in infants is limited to choices within NICUs. Most literature refers to preservatives and perfumes as "not" non-use category. Both products can be remedied. Regarding the potential toxicity of ingredients found on the "recommended" products is not fully elucidated. This is interesting, since the lanolin and petroleum jelly, which occlusive barrier, is recommended. Let's take a closer look, what is recommended:
Lanolin originates as a secretion of the sebaceous glands of sheep skin. It is removed from wool scouring and high-speed centrifugal separators. Lanolin has been 33 alcohols, 36 fatty acids identified as constituents, including aliphatic hydrocarbons, alcohols and steroids triterpinoid saturated, unsaturated nonhydroxylated and hydroxhlated acid. Lanolin business is allowed to have up to 40 parts per million (ppm) of pesticide residues. But it is not clear who monitor such compliance.
Veterinary Medicine, which includes bathing sheep to control lice and other parasites in sheep, is regulated by the Environmental Protection Agency (EPA). One of the common ingredients are organic sheep dip (OC). This pesticide is based on the benzene ring with one or more atoms attached and includes chloride, DDT, lindane, dieldrin and aldrin. Other sheep dip pesticides including synthetic pyrethroids, and insect growth regulators, spinosyns, ivermectin and magnesium fluorosilicate. In 1994, Wagga, NSW, a team of woolgrower's fåreklippere successfully sued for allegedly threatening their health by improperly using chemicals. Fåreklippere become more aware of the potential risks associated with exposure to chemicals (sheep dip), particularly organophosphate group which can cause serious nervous disorder.
There are remnants of 26 pesticides in commercial lanolin. The combined effect of pesticides act through a common mechanism may be greater than the individual effect of any individual pesticide. Because children are subjected to non-food sources (such as lanolin), exposure to pesticides, it is important to consider total exposure to pesticides from all sources. Nine hundred and ninety eight (989) references to lanolin and DDT were found in a Google search in April 2005.
La Leche League International is a major advocate of breastfeeding women and their commitment has ensured thousands of children receive vital nutrients found in colostrums and breast milk. Although the organization notes that the toxins in the environment, pesticides in breast milk, and the benefits outweigh the risks. However, the organization is not recommended for external use against commercial lanolin because of its content of pesticides.
Vaseline is an oil price of petroleum fraction /. Oil is a complex mixture of chemicals that are suspected to have formed from the decomposition of marine creatures million years old. Most of the oil components are molecules of hydrocarbons, oxygen, and nitrogen and sulfur atoms. Hydrocarbon atoms take mainly four different types; paraffin's, olefins and aromatics cycloparaffins. These elements give us gasoline, kerosene, diesel, lubricating oils (like mineral oil), petroleum jelly, asphalt and tar, to name a few.
During the manufacturing process, the wax molecules no longer branched can join together to form a crystalline powder. The solids called paraffin waxes. Over time, paraffin waxes in oils and lubricants are generally removed. At lower temperatures, the molecules of shorter branched paraffin deposition also lube. Semi-solid material that forms in cold lubricating oil is petrolatum or Vaseline.
Treatment of crude oil in Vaseline removes varying amounts of toxins. Vaseline yellow is more residual than petroleum jelly. Two methods of refining are sulfuric acid and filtering soil. The acid treatment and filtration is an ancient method still used to remove impurities in the cake (Vaseline oil + technical). Another cleaning method is hydrogenation which pressurizes hydrogen through oil using a special catalyst.
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