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Nappy Rash

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Prevention

  • Change nappies frequently 
  • Wash bottom with warm water and dry thoroughly. 
  • If faeces are present use baby soap 
  • Apply petroleum jelly -especially if infants are on preterm infant formula or fortified breast milk. Petroleum jelly does not need to be prescribed on the drug chart. 

For High Risk Infants

For example, Short Bowel Syndrome, malabsorption, opiate withdrawal, infectious diarrhoea, or Cystic Fibrosis  - apply a thick layer of 10% w/w zinc oxide ointment

Treatment of an Excoriated Bottom

  • Apply 10% zinc oxide ointment (Karicare ointment) each nappy change when Candidiasis is not present. 10% Zinc oxide ointment does not need to be prescribed on the drug chart. 

If bowel motions are frequent

  • Change nappies and apply 10% zinc oxide ointment more often. 
  • Exposing buttocks to air may not be effective. 

Severe Nappy Rash

If there is no improvement after 2 days of treatment:

  • Consider sending a skin swab for Candida (Candida may not always display a typical appearance). 
  • Apply SECURA extra protective / triple cream for worsening nappy dermatitis. 
  • Triple cream should be prescribed for the patient and needs to be ordered from pharmacy 

Treatment of Candidiasis

  • Take a skin swab 
  • It is a clinical decision as to whether you await the result or commence treatment immediately. 
  • Apply nystatin (Mycostatin, Nilstat ) cream four times a day (prescribed on drug chart). 
  • Apply 10% zinc ointment (after Nystatin application) to treat excoriation.
  • Treatment should extend for at least 3 days after rash has healed. 
  • Infant should also be treated with Oral Nystatin 0.5ml-1.0ml QID. 


References

  1. Atherton, D. J. (2004). A review of the pathophysiology, prevention and treatment of irritant diaper dermatitis.
  2. Baer,E., Davies, M., & Easterbrook, K. (2006). Disposable nappies for preventing napkin dermatitis in infants. Cochrane Database of Systematic Reviews. (4).
  3. Kuller, J., Raines, D.A., Ecklund, S., Folsom, M.S., Lund, C., & Rothwell, D. M. (2001). Neonatal Skin Care: Evidence-based clinical practice guideline. Washington: Association of Women's Health, Obstetric and Neonatal Nurses.
  4. Lund C, Kuller J, Lane A, Lott JW, Raines DA. Neonatal skin care: the scientific basis for practice. J Obstet Gynecol Neonatal Nurs 1999; 28(3):241-54.
  5. Lund CH, Osborne JW, Kuller J, Lane AT, Lott JW, Raines DA. Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. J Obstet Gynecol Neonatal Nurs 2001; 30(1):41-51.
  6. Ralf, A., (2008). Skin care of the diaper area. Pediatric Dermatology, 25(4), 427-433.
  7. Rowe, J., McCall., & Kent, B. (2008). The clinical effectiveness of barrier preparations in the prevention and treatment of nappy dermatitis in infants and preschool children of nappy age: A systematic review. International Journal of evidenced-Based Healthcare

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Document Control

  • Date last published: 31 August 2009
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years