Nappy Change Research Articles

Diaper dermatitis--an overview.

Diaper dermatitis, also know as nappy rash, is an inflammation of the skin covered by nappy. It probably results due to an interaction of multiple factors like increased wetness, elevated pH due to urine, fecal enzymes and microorganisms under the nappy. It manifests as an erythematous rash occurring on the convex surfaces of skin under the nappy. Rashes resembling nappy dermatitis can also be caused by some diseases which may have serious systemic manifestations. Therefore it is essential to differentiate and treat them. The principle of treatment of diaper dermatitis is to keep the skin in the nappy area as dry as possible with frequent nappy change. The superabsorbent disposable diapers are known to reduce the incidence of diaper dermatitis. Barrier creams to protect the infant's skin and mild topical corticosteroids to reduce the inflammation are mainstays of therapy. The incidence and severity can be reduced by keeping the skin dry under the nappy and protected from irritants and infections.

Excessively crying infant in the family: mother-infant, father-infant and mother-father interaction.

We studied mother-infant, father-infant and mother-father interaction in 32 families with an excessively crying infant and in 30 control families. The group with excessive criers was divided further into subgroups of severe colic (n=13) and moderate colic (n=19). The three dyads of the family were video-recorded when the infants were an average of 5 weeks old. The assessment was carried out during the infant's feeding, nappy change and discussion between the parents. During the assessment, only four infants were crying. The Parent Child Early Relational Assessment Scale and the Beavers Scale were used. The main findings suggest that both parents of colicky infants had less optimal parent-child interaction compared with the control parents. The problems in the interaction were most pronounced between the fathers and infants in the severe colic group. The father-infant interaction was less optimal in 13 items of 65 (20%) in the severe colic group, in one item of 65 (2%) in the moderate colic group and in none of the items in the control group. The mother-infant interaction was less optimal in six items out of 65 (9%) in the severe colic group, in three items out of 65 (5%) in the moderate colic, and in none of the items in the control group. Severely colicky infants were also less competent in interacting with their parents. In addition, interaction between the parents was more often dysfunctional in the severe colic group. The problems in early family interaction may threaten the well-being of families with excessively crying infants and they therefore deserve special attention from the health care professionals.

Central and peripheral temperature change in normal infants.

The purpose was to explore the relationship between the fall in rectal temperature seen in normal infants after being put down to sleep and the concomitant rise in peripheral shin temperature. In this observational study 21 normal infants had continuous overnight peripheral shin and central rectal temperature recorded, for three nights at 2 weeks, 6 weeks, 3 months and 5 months of age. Parents documented the start and end of feed/nappy changing episodes during the night. All recordings were made in the infants' own home. A strong inverse linear correlation (median r2 = 0.95, lower quartile 0.92, upper quartile 0.97) was seen between rectal temperature and shin temperature on falling to sleep when put down on 106 (65%) of 161 nights. On many other nights a significant nonlinear association was present. It was not possible to exclude the process of being put down to sleep as a confounding variable in this strong association. However, a similar inverse relationship between shin and rectal temperature was seen overnight during 111 of 121 (92%) feed/nappy changing episodes. If causal, the development in early infancy of an inverse relationship between shin and rectal temperature may be important for cardiovascular homeostasis. Further sleep laboratory work including video recording is required to separate the peripheral and central temperature changes that take place on falling to sleep from those associated with removal of clothing during a nappy change.

A comparison of soap, alcohol and glove use during the nappy-changing procedure in a special care baby unit

This study was conducted in a special care baby unit (SCBU) in a district general hospital and concentrated on hand decontamination and glove-wearing during the nappy-changing procedure. The aims were to determine whether or not nurses were adhering to existing infection control policies and guidelines, and to determine the most appropriate product to be used for hand decontamination. Nurses were observed carrying out nappy changes to determine their existing hand-washing and glove-wearing practices. A microbiological analysis of nurses' hands during the nappy change was performed in order to compare the effectiveness of soap, alcohol, and glove use in eliminating bacteria from the hands. The observation study demonstrated that not all nurses were adhering to existing infection control policies and guidelines. The microbiological analysis found that on the majority of occasions, alcohol was better than soap at removing bacteria from the hands but that gloves provided the best protection overall for both babies and nurses by preventing the acquisition of bacteria. Together these findings suggest that nurses' hands may be providing a route for the transmission of hospital-acquired infection in the SCBU. Ideally, nurses should be wearing gloves during the nappy-changing process and using alcohol to decontaminate their hands.

Working cultures matter in care

Some weeks ago my wife gave birth to twins at 25 weeks' gestation. Tragically one of the boys was stillborn, while the other is soldiering on bravely in the special care baby unit at our local hospital. Throughout these traumatic proceedings the hospital staff have been superb - from accompanying us through that first awful night in a room especially designed for grieving parents of stillborn children through to their current daily dealings with us when we visit the unit for the morning ward round and the nappy change and mouth care in the afternoon or evening. But we encountered a different culture when, after four weeks, our baby was transferred for a week to the larger, regional unit for an operation to close his patent ductus arteriosus. I work in industry, which has seen the publication of many dull volumes about corporate culture. I have always been sceptical about dissecting a concept as nebulous as this, and it has taken my current, unsought exposure to hospital life to bring home the reality of how much working culture can matter. Please do not misinterpret this as any criticism of the standard of care in the larger unit. The professionalism …

48. GASTRO-OESOPHAGEAL REFLUX IN THE PRE-TERM INFANT

As the incidence, severity, and natural history of gastro-oesophageal reflux (GOR) in preterm infants is unknown we have studied GOR in this population. Continuous intraoesophageal pH was monitored over 24 hours using a novel 1mm antimony pH electrode (Synectics Medical). Electrode position was determined following identification of the lower oesophageal sphincter (LOS) by maronetry and the LOS pressure (LOSP) measured. 51 measurements were made on 29 patients (post-conceptional age (PCA): median 31, range 26-39 weeks). Mean (± SEM) indices of GOR were as follows: 12.1±2 episodes of GOR per 24 h; pH was < 4 for 4% ±0.9% of the total time; the longest episode during each recording was 17 ±4.6 min. The effect of various events upon GOR was assessed by analysing the amount of QOR occurring during a 30 min period including and following that event. This was compared with GOR during periods of rest. GOR was most likely to occur at the time of physiotherapy, orcpharyngeal suction, and nappy change (each p<0.001), and was increased after feeds (0.05<p<0.1). Reflux was slightly increased in the left lateral position compared with right lateral and prone positions, but this was not significant. There was no correlation between GOR end PCA, gestation, or LOSP. Infants receiving xanthine for apnoea had a twofold increase in GOR (p<0.05). A subgroup of six infants with recurrent apnoea unresponsive to xanthine had markedly higher mean GOR indices than all other infante studied (p<0.001). A rapid reduction in the frequency of apnoea followed abolition of GOR with thickened feeds.