New Mother Tips

Stages of Baby?s Development – A Newborn?s Simple Instincts

Newborns also exhibit several reflex responses to external stimulation and these patterns and reflexes help the baby to manage their power resources as well as their responses to what is around them.

 Just right after birth, there is often a short spell where the baby is attentive, searching at and responding to people.

 Sleep patterns of a newborn differ. Investigation has identified six diverse states of infant awareness:

Quiet or deep sleep: Baby will have eyes closed with no eye movements and no activity apart from occasional jerky movements standard breathing.
Active or light sleep: Baby’s eyes are closed but rapid eye movements can be observed breathing may possibly be irregular, activity level is low.
Drowsiness: Baby’s eyes might open and close but appear dull when open there is delayed response to stimulation and activity level varies.
Alert inactivity: Baby’s eyes are open and bright his/her attention will concentrate on outside stimuli such as a ceiling light or something bright.
Alert activity: Baby’s eyes are open activity level is high. Baby will react to stimulation and show increased startles and motor activity.
Crying: Intense crying that is challenging to quit high levels of motor activity.

A newborn will exhibit many reflexive responses. Some will last for life. The presence or absence of reflexes and their developmental course will give data about the baby’s neural responses. For instance when the physician runs a thumb along the left side of baby’s spinal column, the baby really should reflexively bent to the left. If this reflex occurs on 1 side but not the other it is doable the nerves are damaged on the side that shows no reflexive reaction.

Other reflexes a newborn will show include:

 Rooting Reflex: Stroke a newborn’s cheek subsequent to the side of his mouth and baby will turn his head to that side and search with his mouth.
Moro Reflex: Baby will thrust arms outward, open hands, arch back and stretch legs outward just before clenching fists across chest in reaction to a sudden sound or the loss of head support.
Palmar or hand grasp: Baby will grasp a finger or rod with his finger.
Stepping Reflex: Support baby in upright position with bare feet on flat surface and baby will make rhythmic stepping movements. This reflex disappears in two to 3 months.
Swimming Reflex: Hold baby horizontally on stomach in water and baby will alternate arm and leg movements, exhaling through mouth. This reflex disappears at six months.
Plantar or toe grasp: Press finger against ball of baby’s foot and he will curl all toes under. This reflex disappears in between eight and twelve months.

Although reflexes are typically automatic, it has been found that environmental aspects do have an effect on their appearance for instance a satiated baby may not show a rooting response.

Development in Baby’s First Month – ilestones in Infant’s Development

All babies will develop differently however investigation helps give a general indication of the various stages of development in infants and roughly when these stages might be seen.

As well as the distinct stages of development, research also assists suggest when these stages could be seen.

Just right after birth baby’s birth weight will drop and this is regained when baby is approximately ten days old.

Newborns will sleep and eat whenever they need to have it. Some babies sleep as much as twenty hours a day, waking randomly, other people might require much less sleep and may spend time crying instead.

During the initial month the baby will start to recognise mother’s voice and smell.

Sight and Hearing in the course of the Very first Few Months of Life

A newborn will turn his head from side to side when lying on his stomach he will exhibit poor head manage when lifted and display alternating movements of his legs when on stomach as if attempting to crawl. At this stage too, baby will automatically grasp and hold onto a finger.

Familiar sounds might elicit some response in baby for instance he might respond to music or a Tv program his mother watched often even though he was in her womb. He will be comforted by familiar voices and really should be left to sleep with a background of common household sounds.  Baby will turn head towards voices, from birth.

Baby can see from birth but a newborn has difficulty focusing beyond nine inches (22 cm). Adults need to make regular eye contact with baby. More than the very first few weeks baby’s sight will sharpen until at about six to eight months, he will see the world virtually as properly as an adult does.

Baby’s hearing is fully mature at the end of the 1st month. By two months baby will be able to focus both eyes and track a moving object. (Some do this earlier). Also at two months baby will see colour differences far more clearly.

How Adults Can Support Baby’s Development

Studies have shown babies prefer human faces to patterns maintain your face close to the newborn so he or she can study your features. When baby is 1 month old, almost anything passed in front of his face will transfix him. Hold shiny, colourful objects in front of baby and move them up and down. This ought to attract his attention and encourage his interest in colours. Hang eye-catching mobiles exactly where baby can see them.

Always be sure to support baby’s neck when he is being lifted. Speak to baby continuously while he is awake during the very first weeks and months. He will adore the distinct tones in voices. For the duration of his initial month baby may also try to mimic the faces you make and lip movements. Vocal interactions are essential in the development of baby so even if you really feel silly talking to him in public, just do it.

Sources:

Bee, Helen L. The Creating Child. 7th ed. New York: HarperCollins College Publishers, 1995.

Gemelli, Ralph J. Regular Child and Adolescent Development. Washington, DC: American Psychiatric Press, 1996.

Kagan, Jerome. The Nature of the Child. New York: Basic Books, 1994.

Piaget J. The Psychology of the Child. New York Basic Books 1972.

Neisser U. Cognitive Psychology. New York: Appleton-Century Crofts 1977.

What is Infant Constipation?

Infant constipation is the difficulty in passing bowels.  Usually the bowels are hard and dry.  It is actually a very common occurrence, especially in children and babies who have just been weaned off breast milk and have started formula milk or when he or she is given table food instead of strained foods.

Normal infant stool looks differently at every stage.  Breast-fed babies have stools that are soft, often yellow to orange with white flecks and varying in frequency.  Bottle-fed babies pass stools that look like soft paste, greenish gray, yellow or brown in color. 

Breast fed babies often pass bowel movements once a day or once in two days.  Babies eating solid food have stools that are formed, but still pasty and contain undigested food.  Color and frequency can vary according to the food eaten but often times, when babies start eating solid food, the frequency of bowel movement decreases.

Infant diarrhea, however, is characterized by firm, hard and dry feces.  Often, they look like pebbles.  Another sign of infant diarrhea is that your baby might cry while defecating, while bleeding from the anus might be present. Also check if your baby is eating less often or having abdominal pain.

There are many causes of infant diarrhea, including the lack of fluids, the introduction of new food, having low fiber in their diet, medications and the type of formula he or she is drinking.  Check whether your baby is of the right weight, uses more than five diapers daily, getting enough water.  If not, you might have a problem with infant diarrhea.

Bottle fed babies drinking formula milk are also more prone to infant diarrhea.  On top of that, there are some types of baby formula that can cause constipation, like those containing casein, lactose-free formulas, and anti-regurgitation formulas.  Switching formulas can also cause constipation.

Common medications and supplements like pain killers, antibiotics, iron supplements and aluminum-containing antacids can also cause infant diarrhea.

Contrary to popular opinion, infant constipation is not the absence of regular or daily bowel movement.  Parents are advised not to worry too much. 

Newborns often enter a period of transition during the first two to six weeks of age where there is a marked decrease in bowel movements and an increase in their irritability.  It is also around this time that babies begin to strain due to passing gas and bowel movement.  Straining, per se, is not a sign that your baby has infant diarrhea.  In fact, straining is normal for babies.  Straining is often brought about by gastro-colic and the defecation reflexes.  Think of it as your baby’s way of learning which muscles to use in the effort of eliminating feces.

Therefore, it is not infant diarrhea unless all three conditions are present: hard, firm and pebbly stools, crying and straining while passing feces, and no bowel movement for a certain period of time.

If your baby has infant diarrhea, you must give him lots of water, sugar, fruits, vegetables, juices and probiotics.  Probiotics have been found to have beneficial health benefits including improving the balance of microflora in the intestines.  In fact, infant formula with probiotics are said to change the constitution of intestinal microflora so that it is almost the same as those of breast-fed babies.  One of the most common probiotics in baby formula is bifidobacteria.

For severe cases, or when all these failed, then it might be good to consult your pediatrician to get a good laxative for your baby.  Do this only as a last resort.

Why Your Newborn Cries? What Helps?

When your newborn cries often and for extended periods without any apparent reason, the cause may be colic. It is a fairly common problem. Baby colic affects around one third of all newborns.

Infant colic is repeated excessive crying episodes, in a baby between three weeks and three months, for no apparent reason.

Your newborn cries because he/she suffers sharp intermittent abdominal pains. Often the baby will extend its legs, arch its back, its face will become very red, fist will be clenched, gas will be passed but the baby will have a hard time passing stools.

What causes baby colic:

Since doctors don’t know the cause of colic in infants, defining the actually syndrome makes it difficult. As you may have guessed however, there are a lot of theories floating around out there.

1. The digestive system for some reason does not allow the release of gas. This build-up of gas would cause the baby severe stomach pain.

2. Adverse environmental condition, inherent sensitivity and possibly the baby’s premature nervous system. These factors make for uncontrollable crying babies.

3. Half the babies suffering from colic had some form of gastro-esophageal reflux and lactose intolerance. Baby colic is greatly influenced by gut flora which simply put is bacteria that live in our digestive tract that perform many useful functions such as helping in the digestion of our food. Some researchers refer to gut flora as the forgotten organ. Lack of gut flora in a baby causes problems with the digestive system and the result is a fussy baby.

Although colic in newborns happens worldwide it is not considered a serious disorder since it will eventually disappear without any particular treatment. It seems to be at its worst between the ages of six to eight weeks.

Breastfeeding

Mothers who are breastfeeding should avoid foods that cause gas as this can be passed on to the baby. Also it should be noted that probiotics (which are helpful with digestion) occur naturally in breast milk so therefore the gut flora of a breast fed baby is quite different than a formula fed baby. Mothers who are breastfeeding and who change their diets have found their babies to be less colicky.

There are studies being done now to see if pre-natal stress, birth mother smoking during pregnancy and trauma at the actual birth can be contributing factors to colic.

There are many theories floating around about colic in newborns so thank goodness it is something that infants seem to grow out of.

Colic is one of many other reasons why your newborn cries

Why newborn cry?

Read what may be the other most often reasons why your newborn cries: Why newborn cry

How to help your newborn sleep?

Matching Emollient Neonatal Skin Care Product Selection With Changes in the Standard of Care

The Evidence-Based Clinical Practice Guideline for neonatal skin care, including a Neonatal Skin Condition Scale (NSCS), has been validated by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the National Association of Neonatal Nurses (NANN). Within the Guidelines, the use of emollients is recommended for infants less than 32 weeks during the first 2-4 weeks. For infants younger than 30 weeks, gestational age emollient use is recommended to reduce excessive transepidermal water loss (e-TEWL).

Over a period spanning three decades, the handling of neonates has radically changed and the new guidelines highlight this growth and development. However, this area of skin care has lagged behind. One concern that remains is the issue of the toxic effects of ingredients found in water-based products like preservatives and fragrances. While it is possible that these may be toxic, this article will present evidence that the current skin care products that contain petrolatum and lanolin may be more toxic and potentially harmful. Further, using a product that is not preserved, yet occlusive, may in fact allow for microorganisms in colony forming units to multiply, thereby yielding systemic implications. The purpose of this article is to further illuminate these issues and to allow for greater understanding and discussion.

Skin is the largest organ of the body and provides protection between the body and its environment. In term babies, while there may be issues related to skin breakdown and infection, the stratum corneum is fully developed and protects the newborn. In contrast, the skin and skin barrier of a preterm neonate is not fully developed.

The skin of a premature neonate accounts for approximately thirteen (13) percent of its body weight. This compares to three (3) percent of body weight for adult skin. The body weight to skin ratio is four (4) times greater in the neonate when compared to an adult. As related specifically to skin care, these characteristics in neonate skin call into account:

• Fluid imbalances

• Percutaneous absorption of toxins

• Tissue injury

• Infection

The structure of adult skin is understood, while embryonic and neonate skin is not fully appreciated. Development of the skin within the uterus is complex and still under investigation. In utero, the skin undergoes two-dimensional growth to cover the surface area of the developing embryo and fetus. Premature neonate’s skin has not gone through full epidermal and dermal epidermal development.

In neonatal intensive care units (NICU) skin care product selection is carefully reviewed. With the risks outlined above, great care must be taken to ensure the wellbeing of the neonate within the first hours and days of life. Care of the skin is one of the most important areas of care for these at risk infants. Currently, NANN and AWHONN recommended a Aquaphor?, a petrolatum-based product as neonate skin care emollient.

In earlier work done at Stanford University, it was concluded that emollient cream moisturizer therapy of premature neonates decreases dermatitis without changing the microbiological flora. An emollient is an agent that softens or soothes skin. This definition is important because just as the standard-of-care has changed in NICUs over the past three decades, the selection of emollients has changed in the pharmaceutical industry.

High-tech silicone excipients have displaced petrolatum as companies have sought ways to improve treatment compliance traced to poor aesthetics associated with petrolatum-based formulations. Silicones are not new to the pharmaceutical industry. They are used in transdermal delivery systems, catheters and specialized medical devices, including pacemakers.

In a test to determine aesthetic benefits of silicone formulas over petrolatum-based formulas, 18 untrained volunteers were impaneled. They were asked to evaluate whether two products present any differences on individual sensory properties. The evaluation was conducted on the panelist’s forearms. Each panelist was asked to evaluate wetness, spreadability, speed of absorbance (not biologically, just feel), gloss, film residue, greasiness, silkiness and slip after perceived absorbance.

Figure I shows the silicone-containing formulation was perceived to be easier to spread and was clearly less tacky before and after absorption. A perceptible film was present on the skin for both formulations but the silicone-containing formulation was less greasy, silkier and more slippery (better lubrication) than petrolatum. The panelist’ perception of higher wetness for the silicone-containing formulation was attributed to its lower oiliness.

In a study conducted at a 48-bed NICU private hospital in Houston, Texas, to evaluate why the rate of systemic candidiasis (SC) per 1000 NICU patient-days increased from 5.1% in 1996 to17.4% in 1997 (a three-fold increase), it was determined that the increase in SC incidences was linked to the use of topical petrolatum ointment (TPO). In this well designed study, the investigators went on to hypothesize that TPO enhanced the adherence of C albicans to mucocutaneous surfaces. Also referenced in the study was a finding by Law S, et al, that unlike petrolatum, skin surface lipids inhibit adherence of candida albicans to stratum corneum.

By way of further examination, let’s more closely examine these two hypotheses. As observed in the Houston study, petrolatum enhanced adherence of C albicans to mucocutaneous surfaces. Petrolatum is known as an occlusive barrier. Occlusion is problematic because while it blocks TEWL, it also blocks cellular respiration necessary for barrier repair. Further, occlusion traps microorganisms under the petrolatum where they can breed in the moisture trapped therein. On the other hand, natural skin lipids, like omega 3-6 fatty acids, inhibit adherence of microorganisms to the stratum corneum.

Studies linking petrolatum to increased incidences of infections in preterm infants is ongoing and demonstrates mixed results. However, long term studies reflect a concern over the use of TPO protocols in NICUs. Petrolatum based ointments, like Aquaphor’s? twenty five year old formula, are the emollients of choice in NICUs. When one considers the changes in the standards of care in NICUs over the past three decades, perhaps now is the time to focus on new technologies in emollients that achieve skin care objectives without the aesthetic, epidermal challenges renders skin vulnerable to chemicals & infection, prevents normal TEWL & gland secretions, inhibits barrier repair, suppresses barrier recovery and reduces the epidermal proliferative response and microbial risk disadvantages of petrolatum.

To demonstrate the effectiveness of high products using molecular height silicones against petrolatum, Nutrashield TM was tested in a wash-off study against Aquaphor? and other leading skin barriers to determine each product’s ability to maintain skin protection after cleansing. As shown in Figure II, Nutrashield performed well against Aquaphor?, and did so while providing a breathable barrier instead of the occlusive barrier associated with Aquaphor? (a lanolin and petrolatum-based product). In clinical trials Nutrashield has proven effective in the treatment of skin breakdown in disordered and damaged skin, encountered in the wound care setting, as compared to previously available products.

Based on the above results, Medline Nutrashield outperforms products containing petrolatum levels as high as 49%, and petrolatum combined with 15% Zinc Oxide. Additionally, both Sensi-Care 2 and Sween 24 also contain Dimethicone as an active ingredient (Sween at 6% versus 1% in the Nutrashield). The extended performance of the Nutrashield is most likely due to the addition of Divinyldimethicone/ Dimethicone Copolymer, which has an internal phase viscosity that is greater than 100,000,000 cst in viscosity. As it is delivered in an emulsion form, it is capable of laying down a thin, but consistent and robust film.

An in-vitro study at an independent laboratory was conducted, to determine the effectiveness of Nutrashield and Skin Repair Cream in reducing e-TEWL. Collagen samples were cut into 4×4 inch squares. Each square was pre-coated with 0.1 g of product. The product was applied by rubbing a finger over the collagen material to simulate actual use for a 20 second period. The product was then allowed to dry for five minutes. Each square was placed over Fisher Payne Permeability Cups, containing 3g of water. The samples were placed in a 37 degree oven and checked every four (4) hours. After 24 hours the cups were removed and a final weight was recorded.

Figure III shows that both REMEDY Nutrashield and REMEDY Skin Repair Cream were effective at reducing e-TEWL without occlusion. Nutrashield provided a fourfold reduction in e-TEWL over the control, while Skin Repair Cream showed a twofold improvement. The objective of topical skin care intervention is not to stop all TEWL, just excessive TEWL.

Skin care for neonates is an emerging science. But, since the reduced risk of infant mortality is paramount, improved emollient treatments deserve thoughtful consideration. Skin care for the high-risk neonate requires knowledge of the unique aspects and physiology of their skin. During the neonatal period many newborns develop preventable, clinically apparent skin problems and many more, especially preterm neonates, experience morbidity caused by compromised skin barrier integrity. Anatomical and physiological differences in the skin of premature and term infants place them at increased risk of skin injury and breakdown. All Children’s Hospital, St. Petersburg, FL, sent out a questionnaire to 482 NICU’s to learn how nurses describe and measure skin breakdown. Of the 45% that responded, it was reported that in extremely low birth weight (ELBW) infants, 21% suffered skin breakdown during the first week of life.

The reduction of microbial contamination and the protection against skin breakdown has been discussed. Another critical factor is TEWL associated with immature barrier in neonates is the rate of TEWL. A Swedish study calculated TEWL in infants 24 and 25 weeks of gestation maintained at an ambient relative humidity (RH) of 50%. The study found that TEWL on the first day after birth (58.4 +/-14.8g m(-2) h(-1) and remained at the same level during the second day. It then decreased significantly to 48.3+/-9.5 at postnatal age of day three. The use of a semipermeable skin care product like Nutrashield will reduce excessive TEWL by as much as fourfold.

Semipermeable dressings have been tested as a method to reduce TEWL in neonates to address skin breakdown and high fluid requirements common in ELBW infants. The studies revealed that semipermeable (breathable) barriers can be used safely on premature infants.

The use of ingredients perceived as “toxic” to neonates has limited the choices within the NICUs. Much of the literature points to preservatives and fragrances as falling into the “do-not-use” category. Both are found in the REMEDY products. Consideration of the potential toxicity of ingredients found in the “recommended” products may not have been fully clarified. This is interesting when one considers that lanolin and petrolatum, forming an occlusive barrier, are recommended. Let’s take a closer look at what is being recommended:

Lanolin originates as a secretion from the sebaceous glands in sheepskin. It is removed from the wool by scouring and high-speed centrifugal separators. Lanolin has had 33 alcohols and 36 fatty acids identified as constituents including aliphatic, steroid and triterpinoid alcohols; saturated nonhydroxylated, unsaturated nonhydroxylated and hydroxhlated acid. Commercial lanolin is allowed to have up to 40 parts per million (ppm) pesticide residues. However, it is not clear who monitors for this compliance.

Animal medicines, which include sheep dips for controlling lice and other parasites on sheep, are regulated by the Environmental Protection Agency (EPA). One of the common sheep dip ingredients is organochlorine (OC). This pesticide is based on the benzene ring with one or more chloride atoms attached and includes; DDT, lindane, dieldrin and aldrin. Other sheep dip pesticides include; synthetic pyrethroids, insect growth regulators, spinosyns, ivermectins and magnesium fluorosilicate. In 1994 in Wagga, NSW, a team of shearers successfully sued woolgrowers for allegedly endangering their health by improperly using chemicals. Shearers are becoming more aware of the potential risks associated with exposure to chemicals (sheep dip), particularly organophosphate group which can cause a serious nervous disorder.

There are about 26 pesticide residues found in commercial lanolin. The combined effect of pesticides acting by a common mechanism can be greater than the individual effect of any single pesticide. Since children are subject to non-dietary sources (like lanolin) of exposure pesticides, it is important to consider total exposure to pesticides from all sources combined. Nine hundred and ninety eight (989) references to lanolin and DDT were found in a Google search, April 2005.

La Leche League International is an important advocate for breastfeeding and their commitment has assured thousands of infants receive the vital nutrients found in colostrum and mother’s milk. While the organization acknowledges that toxins from the environment, including pesticides, show up in breast milk, the benefits outweigh the risks. However, the organization does recommend against topical use of commercial lanolin because of its pesticide content.

Petrolatum is a crude oil/petroleum fraction. Petroleum is a complicated mixture of chemicals, thought to have formed from the decay of ancient marine animals millions of years ago. Most of the constituents of petroleum are hydrocarbon molecules, oxygen, nitrogen, and sulfur atoms. The hydrocarbon atoms take principally four different forms; paraffins, olefins, cycloparaffins and aromatics. These constituents give us gasoline, kerosene, diesel fuel, lubricating oils (like mineral oil), petrolatum, asphalt and tar, to name a few.

During the manufacturing process, longer unbranched paraffin molecules are able to join together to form crystalline solids. These solids are called paraffin waxes. With time, paraffin waxes settle out of the lubricating oils and are usually removed. At lower temperatures, shorter unbranched paraffin molecules also settle out of lubrication oil. The semi-solid material that forms in cold lubricating oil is petrolatum or petroleum jelly.

The processing of petroleum into petrolatum removes varying amounts of toxins. The yellowish petrolatum has more residue than that of the white petrolatum. Two of the refining methods include sulphuric acid and earth filtering. The acid treatment and filtering is an old process still used to remove the impurities of the “cake” (petrolatum + technical oils). Another purification method is hydrogenation which pressurizes hydrogen through the hydrocarbons with the help of a specific catalyst.

Once one understands the source of petrolatum and why there is a risk of toxins, one must move on to a biologically more concerning issue. Petrolatum is occlusive. In an article by Fore, it was found that the degree of skin occlusion has an effect on barrier recovery. Occlusive products suppress barrier recovery and reduce the epidermal proliferative response to an abnormal stratum corneum barrier. An occlusive product, like petrolatum, will prevent TEWL and will slow the epidermal maturation and barrier repair. Occlusion of the skin increases the infectious organisms, potentially raising the skin’s pH. Occlusion will also directly increase the pH of the skin. Occlusive products also interfere with cellular respiration and may lead to cell death.

This information presents a powerful message that one may want to rethink the use of lanolin and petrolatum on neonate skin. The use of modern emollients like silicone, combined with natural omega 3-6 fatty acids, barrier-building amino acids and natural antioxidants and vitamins may deserve another look. Water-based skin care products are required by the Food and Drug Administration (FDA) to be preserved. This keeps them free of bacteria and protects the products from contamination when microorganisms from sources (like unclean hands) contaminate the product in the container as well as during use.

The requirement of preservatives and their use is not well understood. Preservatives are not optional in accordance with Food and Drug Administration (FDA) monographs covering the manufacturing of “Safe and Effective Drugs” or cosmetics. A manufacturer is required to perform a twenty eight (28) day preservative effectiveness challenge on its products and maintain a record of such testing for FDA inspections. Further, each batch requires proof that the batch meets microbial challenge requirements. Batches are tested in the tank, prior to filling, and then again at the beginning, middle and end of the filling process. This testing is done to ensure each product shipped is free of microbial contamination.

Since the use and safety of preservatives, especially parabens is under consideration in this article, comments from three regulating bodies are brought forward for consideration.

• The FDA recognizes parabens as a class of preservatives that have been used in a wide variety of foods, drugs, and cosmetics and that they keep products safe from microbial contamination. The Food, Drug, and Cosmetic Act require that cosmetics and non-prescription drugs and their individual ingredients must be safe and that labeling must be truthful and not misleading. The FDA can take immediate action to stop the sale of any product that does not meet its high standards. This includes the use of an effective preservative system.

• The European Food Safety Authority (EFSA) has reviewed the use of parabens in food and other products. The European Union (EU) Scientific Committee for Food (SCF) evaluated parabens in 1994 and established a temporary Acceptable Daily Intake (ADI) of 0-10mg/kg bw, as the sum of methyl, ethyl and propyl parabens. Further study also demonstrated that nooestrogenic activity took place in-vivo, and that there was no effect on forestomach cells in rats. In a teratogenicity study on 300 rabbits with oral does of methyl paraben, at doses of 550 mg/kg, no evidence of toxicity was found. The panel recognized that this dose far exceeded any anticipated oral dose.

• The Cosmetic, Toiletries, Fragrance Association (CTFA) is the body in the United States and through its Scientific Review Board, reviews all new cosmetic ingredients and assigns their INCI nomenclature (the required language found on packaging for all ingredients). The CTFA first studied the safety of parabens in 1984 and concluded they were safe as used in cosmetics. On November 14, 2004, as part of the normal re-review process, the CIR Expert Panel determined that it wanted to conduct a through review of the literature since the previous report in 1984. The safety of parabens has been once again reconfirmed.

Why then can there be a product that is not preserved? It is best that all products have some protection. However, some products that do not contain water can pass the challenge because microorganisms breed in water. Testing is done without the introduction of water. Consider this: a) an unpreserved product is placed on the skin, b) the product is occlusive, like petrolatum, c) the skin and its moisture, due to TEWL, contains microorganisms that are multiplying and trapped between the occlusive barrier and the skin, d) the skin care product on the skin is not preserved and now, e) a microorganism-rich moisture is being added. What are the consequences? Is there a systemic link and what is the potential sequela?

Toxins will be introduced to the neonate’s environment. They will come from mother’s milk, linens, clothing, human contact and a myriad of other sources. Careful consideration must always be given to the source of toxins and how multiple sources of them will impact the neonate. Product preservatives and fragrance are but two of these sources. The protection against e-TEWL and reducing the risks of systemic infections are worth considering when making neonate skin care choices.

Nutrashield from Medline Industries, Inc. is a semipermeable emollient barrier cream that:

• has excellent wash-off characteristics

• may reduce the incidence of colony forming microorganisms in the neonate population associated with petrolatum

• offers excellent aesthetic benefits including spreadability.

Additional creams and lotions in the REMEDY product line provide semipermeable barriers and nourish the skin37. Further research is necessary to confirm the product’s suitability in NICUs.

Article by Darlene McCord, Ph.D.