Diaper Rash

[LRN_RN]

We are a level III NICU. When we fortify, there is a greater chance for breakdown in the diaper area. What products does your NICU use to to combat this?

We use a barrier cream called ILEX, but it doesn't always cut it. I'd love to hear what you do.

(As a side note I have always worked in a Level IV and we used a purple liquid in a vial. We'd snap the vial and rub it over the breakdown and then wait for it to dry. I can not for the life of me remember what it's called. Any ideas?)

[BittyBabyGrower, MSN, RN]

We use skin prep and Sensicare.

[Baby Wrangler]

We use a zinc barrier cream called Zincofax, but that's just for like mild diaper rashes. We also use Aquaphor, which is glycerin mixed with sterile water, or Critic aid cream for worse rashes. Once I had a primary baby with a really bad bum rash though which didn't improve after days on the above, and we put colostomy powder mixed with zinc cream and the rash was gone after three days. Yup, we somehow got colostomy powder from adult ICU. What can I say, nurse are resourceful . It worked wonders though.

[bcandygurl]

Desitin or Greer's Goo for the cases where it is so bad it is bleeding. We also prop the baby's butt up and expose to air if it is really bad.

[Elvish, BSN, DNP, RN, NP]

We just initiated this skin care protocol that seems to have helped a lot. For everyone with zero problem to begin with, we do vaseline on their butt after every diaper change.

If there is any breakdown at all, we d/c the vaseline and give them daily 'butt baths' (either a bum soak or a wipedown with water and soft cloths) and let them air dry, then we do stomadhesive powder and barrier ointment. Works like a charm.

For the bigger NAS kids that get really bad breakdown (like, bleeding raw) we have been known to put them bum-up in the radiant warmer to get them air and heat. A couple episodes a day of that and we notice a huge change.

[Bezoars]

We use that purple stuff in the vial too... it's called Marathon. BUT, it has to slough off after several days and tends to look stained and yucky after a few changes. We also do desitin, powder, and the butt-in-the-air-to-light-and-heat method. I like the stoma powder and cream idea!

[NICU Guy, BSN, RN]

Stoma powder and Critic-aid paste.

[BittyBabyGrower, MSN, RN]

Our pharmacy makes a mix of desitin, stoma powder and nystatin. Or Questran paste works also, our pharmacy makes it also.

[jennylee321]

Yes stoma powder mixed with zinc oxide seems to work really well, I think because it gives you a thicker and less greasy barrier cream

[aerorunner80, ADN, BSN, MSN, APRN]

We have available Desitin, A&D. We also have pharmacy mix cholestyramine for when it is getting worse. It has a steroid in it to reduce inflammation. When it gets super bad such as bleeding, we have a crusting protocol. We use stomahesive powder, cavilon spray (skin protectant) and Desitin to form a protective crust on the bottom. Works really well.

[LRN_RN]

I forgot we also employ a hair dryer to completely dry bums that are raw and bleeding. Thank all! Fantastic feedback.

[TiffyRN, BSN, PhD]

I was about to start a thread on this topic, but actually did a search first and found this had just been discussed.

My best go-to method is exposing to air. I detailed it here on a recent discussion of the use of oxygen:

https://allnurses.com/nicu-nursing-neonatal/oxygen-use-for-1021994-page2.html

If things aren't so bad, or you have a kid who can't be positioned prone, the best method I've found is:

1. Always cleanse extremely gently with water wipes (don't disrupt the few depositing skin cells that are trying to rebuild)

2. Apply a few puffs of stoma powder, we stock this now in our pyxis and this is this most common use for it, not ostomies.

3. Apply a thick layer of Calazime skin protectant paste with zinc oxide.

4. Apply another few puffs of stoma powder.

5. Handy tip, if this is a boy, lay a gauze over the member while this is going on because they are GOING to pee all over you. This process takes several seconds and boys are that way.

Now, of course, our unit stop stocking Calazime a couple of years ago so now I order it and keep a stash in my locker to be dispensed to the kids with the worst butts.

Another thing, our butt rash rate has improved dramatically since we switched from Enfamil liquid HMF to Similar liquid HMF. The Enfamil is acidified to prevent bacterial growth and that stuff is horrible for those delicate butts. We saw a huge immediate improvement the week we changed products. The Similac product stinks and looks horrible in the milk, but it just doesn't give them the runny horrible green diarrhea and give them bleeding rashes.