What is occurring with liquid fortifier and diaper rash?

[Devinenursem13]

I work in a smaller community Level II+ NICU (we keep 30wks and above, short term vents, lots of CPAP, etc). Us nurses have seen an unbelievable amount of bad, bad diaper rashes in the past 2 years and it only seems to be getting worse no matter what we do. After trying many different changes with no improvement a few of us feel that it may be attributed to our liquid HMF.

We use Similac products and we currently use their hydrolyzed protein liquid HMF packets for fortification of EBM. A few years ago, we had only the powdered packets, then Similac changed to a liquid and we were thrilled since we felt it mixed up way better than the powder. Then a year or two ago (can't remember exactly when) they changed to a different liquid (the hydrolyzed protein) and we have seen horrible bleeding butts. Related? Not positive but sure does seem that way.

We see babes with no rash at all, we begin fortifying with HMF and within 2-3 days have horrible rashes - then switch to powdered formula (neosure, etc) to fortify when close to going home and rash goes away! So frustrating!

Anyone else having these issues? I'd love to know, we're desperate!

Thanks in advance!

[KRVRN, BSN, RN]

My unit is very large and we also changde to the same liquid in the last few years. I have not noticed an increase it sore butts, and or any change with switching to neosure

[aerorunner80, ADN, BSN, MSN, APRN]

I've noticed s difference as well. We use Enfamil products. I've always wondered if the pH in these liquid fortifiers is lower which would contribute to the problem. What's interesting is that we have had Similac fortifier and seen less diaper rash than with Enfamil.

[TiffyRN, BSN, PhD]

The liquid Enfamil HMF uses acidification as a preservative process. It burns the poor kids butts horribly. We used to beg to change kids to home fortification routine (adding Neosure to EBM). We finally changed to Similac HMF and saw DRAMATIC improvement. Some kids still react to it (liquid stools, sore bottom), but so much less.

[Devinenursem13]

Thanks to everyone for your input! What's puzzling to us is that Similac 'supposedly' does not use the acidification process, only heat to sterilize but I think you are right with the pH being low. I'd love to get some test strips to see! It's got to be something, we have seen a huge change and not for the better We have very very frequent diaper rash and some get so bad they are bleeding! Just wish we could figure this out, it's awful!

[KRVRN, BSN, RN]

We used Enfamil HMF for awhile but switched back to Similac HMF because we were seeing kids with metabolic acidosis

[amoLucia]

Have any of you contacted the manufacturer re your concerns? I don't know how forthcoming they would be if this has turned out to be a common concern (one that they would rather not have occurring). It would make a good topic for some research to be published.

Wonder if anything has been reported to the FDA?

[Devinenursem13]

Good idea. I have reached out to our local Similac rep to see what she might have to say. FDA...that is interesting. We actually have started a research project in regards to diaper rash in our NICU. We are currently enrolling a prospective randomized trial comparing virgin coconut oil to our current standard of care for diaper rash :) We are listed on clinicaltrials.gov as well. So far it hasn't seemed to make a huge difference in our rashes but we are very young, just started enrollment 2 months ago.

Thanks again for your input everyone.