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Matching Emollient Neonatal selection skincare changes the level of care
Author: href = "http://www.articlesbase.com/authors/darlene-mccord/58998.htm"> Darlene McCord
Evidence-based clinical practice guideline the neonatal skin care, including skin disease Neonatal Scale (NSCs) has been validated by the Association for Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the National Association of Neonatal Nurses (Nann). In the guidelines, the use of emollients is recommended for infants less than 32 weeks during the first 2-4 weeks. For infants less than 30 weeks gestational age is recommended to use emollients to reduce excessive water loss Transepidermal (e-TEWL).
Over a period of three decades, treatment of newborns has dramatically changed and new guidelines stress that the growth and development. However, this area of skin care has been delayed. The concern that remains is the effect of the toxic ingredients found in water-based products as preservatives and perfumes. If it is possible that these toxic in May, this paper presents evidence that existing products for skin care that contain lanolin and petroleum jelly can be toxic and potentially dangerous. Also, using a product that is not preserved, but occlusive, may, in fact, to allow microorganisms in colony forming units to multiply, resulting in systemic effects. The aim of this paper is clarify these issues and to facilitate greater understanding and discussion.
The skin is the largest organ of the body and provides protection between the body and its environment. In terms of babies, while May is the issues of skin breakdown and infection, the stratum corneum is fully developed and protects newborns. However, the barrier of the skin and skin of a premature newborn is not fully developed.
The skin of a premature infant approximately thirteen (13) percent of their body weight. This compares with three (3) percent by weight of the skin of adults. The weight of the skin is four (4) times higher in newborns compared with adults. Specifically related to skin care, these characteristics in the skin of newborn born in use:
• Fluid imbalance
• Percutaneous absorption of toxins
• tissue damage
• Infection
The structure of the skin of adults is included, while the skin of embryos and newborns is not fully appreciated. Development the skin in the uterus is complex and still under investigation. In utero, the skin undergoes a two-dimensional growth to cover the surface of the embryo and fetus. Newborn premature skin has not gone completely epidermal and dermal epidermal development.
In the neonatal intensive care units (NICU) the selection of skin care is carefully examined. With the risks described above, great care must be taken to ensure the welfare of the newborn first hours and days of life. Skin care is one of the most important areas of care for these children at risk. Currently, Nann and recommended AWHONN Aquaphor?, A petroleum-based product as a newborn baby skin care emollient.
In previous work, Stanford University, found to the conclusion that the emollient cream moisturizer therapy of premature infants reduces dermatitis, without altering the microbial flora. An agent is an emollient which softens and calms the skin. This definition is important because the standard of care in NICUs has changed in the past three decades, the selection of emollients in the industry has changed pharmaceuticals.
High-tech silicone excipients are displaced from the oil companies have sought ways to improve the traceability of the processing of related to the poor aesthetic formulations based on petroleum. Silicones are not new to the pharmaceutical industry. Used in transdermal delivery systems, catheters and specialized medical devices, including pacemakers.
In a test of the aesthetic benefits of silicone-based formulas formulas oil, 18 volunteers were not impaneled. They were asked to assess whether two products are the differences in sensory properties. The evaluation was conducted in the forearms of the experts. Each expert was asked to assess the moisture content, dispersion, speed absorbance (no biological sense only), brightness, film waste fat, silky and slide seen after absorption.
Figure I shows that the formulation contains silicon is perceived as easier propagation and significantly less sticky, before and after absorption. A film was visible on the skin for two, but the wording of silicon containing less fat, silkier and more slippery (better lubrication) and Vaseline. He's perception of greater moisture in the silicone-containing formulation was attributed to the reduction its creaminess.
In a study conducted in a 48-bed private hospital NICU in Houston, Texas, to assess the incidence of systemic candidiasis (SC) by 1000 NICU patient days increased 5.1% in 1996 to17.4% in 1997 (three times), it was determined that the increase in SC has been the impact on the use of petroleum topical ointment (TPO). This well-designed study, researchers went to the hypothesis that TPO enhances the adhesion of C albicans to mucosal surfaces. Also known the study was the conclusion by the Law S, et al, which, unlike the petroleum jelly, skin surface lipids inhibit adherence of Candida albicans to stratum corneum.
As a further consideration, to study more closely these two hypotheses. As noted in the Houston study, Vaseline improve compliance C albicans to mucosal surfaces. Petroleum jelly is known as an occlusive barrier. Occlusion is a problem because all the blocks TEWL, but also blocks the breathing cell to repair the barrier. Furthermore, occlusion of the pitfalls of micro-organisms under the vaseline where you can generate in the moisture content is caught. Moreover, the natural skin lipids such as fatty acids, omega 3-6, inhibit the adhesion of microorganisms in the stratum corneum.
Vaselina studies linking the increased incidence infections in preterm infants is ongoing and shows mixed results. However, the long-term studies reflect a concerns about the protocols used in the Occupied Palestinian Territory NICUs. Petroleum ointment such as Aquaphor? twenty-five years, the formula is the choice of emollients in NICUs. If we consider changes in standards of care in NICUs in the last three decades, perhaps it is time to focus on new technologies that emollients help to achieve the objectives of the skin care cosmetics, skin makes the skin vulnerable to the challenges of chemical products and infection, and prevents gland secretions that normal TEWL, inhibits barrier repair, recovery, skin barriers and reduces the proliferative response of microbial hazards and disadvantages of petroleum.
To demonstrate the effectiveness of the produced high molecular silicones against high Vaseline, Nutrashield TM was tested in an anti-money laundering Aquaphor? and to identify barriers to the skin of each product, the ability to maintain the protection of the skin after cleansing. As Figure II Nutrashield Aquaphor well against? And this, while breathing a hindrance rather than occlusive barrier associated with Aquaphor? (a lanolin and petroleum jelly products made of). Nutrashield in clinical trials has proved effective in the treatment of skin breakdown and discomfort in the skin found in the setting of wound care, compared to products already available.
Based on previous results, Medline Nutrashield yield of products containing such high Petrolatum as 49% vaseline and 15% in combination with zinc oxide. Moreover, Sensi-Care 2 and also contains Dimethicone SWEEN 24 as an active ingredient (SWEEN 6% to 1% in Nutrashield). Extending the performance of the Nutrashield is probably due to the addition of Divinyldimethicone / Dimethicone Copolymer, which has a internal phase is greater than 100,000,000 cst viscosity to the viscosity. Since it is delivered in an emulsion is capable of setting a small, but consistent, solid film.
An in vitro study in an independent laboratory was conducted to determine the effectiveness Nutrashield repair skin 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 is applied by rubbing a finger on the collagen material to simulate actual usage a period of 20 seconds. The product is left to dry for five minutes. Each square was placed in Fisher Payne Permeability Cups with 3 grams of water. The samples were placed in an oven controlled at 37 degrees and every four (4) hours. After 24 hours, cups were removed and a final weight was recorded.
Figure III shows that both REMEDY APPEAL Nutrashield Cream and Skin Repair have been effective in reducing and non-occlusion TEWL. Nutrashield a reduction of four-and TEWL in control, while the repair cream for skin showed an improvement of two orders. The aim of the present skin care does not end all TEWL, TEWL just excessive.
Skin care of newborns is an emerging field. However, since the reduction of child mortality is important, emollient deserve better treatment reflection. Skin care of newborns at high risk requires knowledge of the unique aspects and physiology of the skin. During the neonatal period, many newborns develop preventable, clinically apparent, and many more skin problems, especially preterm infants, morbidity caused by the experience compromise the integrity of the skin barrier. Differences anatomy and physiology of the skin of the premature infant and, ultimately, put at greater risk of injury Skin and distribution. All children Hospital, St. Petersburg, FL, sent a questionnaire to 482 NICU nurses how to describe and measure the degradation of the skin. 45% who responded, it was reported that in the very low birth weight (ELBW) children, 21% suffered skin breakdown during the first weeks of life.
The reduction of microbial contamination and protection against skin breakdown is discussed. Another factor associated with TEWL immature barrier in the newborn is the rate of TEWL. A Swedish study calculated TEWL in children aged 24 and 25 weeks of gestation environment maintained at a pace relative humidity (RH) of 50%. The study found that TEWL on the first day after birth (58.4 + /-14.8gm (-2) h (-1) and remained unchanged during the second day. Then, it decreased significantly to 48.3 + / -9.5 in three days postnatal age. Using a semi-product, such as skin care is Nutrashield excessive TEWL reduction of more than four.
Semi dressing is a proven method to reduce TEWL in neonates due to deterioration of the skin and fluid requirements common in ELBW children. Studies have shown that semifinals (breathable) barrier can be safely used in preterm infants.
The use of ingredients considered "toxic" to newborns has limited the choice NICUs. A large part of the literature points to the Conservatives and perfumes that fall into the "no use" category. Both are in the productive resources. Consideration of the potential toxicity of ingredients found in the "recommended" products in May has not been clarified. This is interesting if one considers that lanolin and petroleum jelly, forming an occlusive barrier, is recommended. Let's look more closely at what is recommended:
Lanolin comes from sheep secretion of the sebaceous glands. Is removed from the wool washing at high speed and centrifugal separators. A lanolin alcohol were 33 and 36 fatty acids identified as constituents, including aliphatics, steroids and alcohol triterpinoid; nonhydroxylated saturated nonhydroxylated and unsaturated acid hydroxhlated. Lanolin is allowed to have commercial up to 40 parts per million (ppm) of pesticide residues. However, it is unclear which monitors compliance.
Veterinary medicines, including those for sheep control of lice and other parasites in sheep holes are covered by the Environmental Protection Agency (EPA). One of the common ingredients of sheep dip organochlorine (OC). This pesticide is based on the benzene ring by one or more chlorine atoms and together, DDT, lindane, aldrin, dieldrin. Other sheep bath Pesticides are synthetic pyrethroids, growth regulators insects spinosyns, ivermectin and magnesium fluorosilicates. In 1994 at Wagga, New South Wales, a team of woolgrowers shearers successfully prosecuted for allegedly endangering their health through the use of chemicals. Shearers are increasingly aware of potential risks associated with exposure to chemicals (sheep dip), especially the group of organophosphate that can cause a serious nervous disorder.
There are nearly 26 pesticide residues found in lanolin. The combined effects of pesticides by a common mechanism may be greater than the individual effect of one pesticide. Given that children are subjected to food sources (such as lanolin) exposure to pesticides is important to take into account the total exposure to pesticides from all sources. Nine hundred and ninety eight (989) references with lanolin and DDT were found in a Google search in April 2005.
La Liga of the International Milk is a major advocate of breastfeeding and maternal commitment has enabled thousands of children are the main nutrients in the colostrum and milk. If the organization recognizes that environmental toxins, including pesticides, appear in breast milk, the benefits outweigh the risks. However, the organization is not recommended for use lanolin current commercial pesticides, due to its content.
It is a petroleum crude oil / fraction. Oil is a complex mixture of chemicals, thought to have formed from the decomposition of ancient marine animals, there are millions of years. Most voters are hydrocarbon molecules oil oxygen, nitrogen and sulfur atoms. Hydrocarbons, mainly in four different forms of atoms, paraffins, olefins, aromatics and cycloparaffins. These voters give us gasoline, kerosene, diesel, lubricating oils (like mineral oil), petroleum jelly, asphalt and tar, to name a few.
During the manufacturing process more unbranched paraffin molecules are capable of binding to form crystalline solids. These are called paraffin wax. Over time, waxes and oils are usually removed resolve. A low temperature, the unbranched paraffin molecules court set the lubricating oil. The semi-solid material that forms the lubricating oil is cold or Vaseline petroleum jelly.
The processing of oil in varying amounts Petrolatum eliminates toxins. The yellow oil residue than the white petrolatum. Two methods of refining sulfuric acid and filtering of the earth. The acid treatment and filtration is an old process still used to remove impurities from the cake (+ technique vaseline oil). Another method of purifying hydrogen pressure of hydrogen from hydrocarbons with a catalyst.
Once you understand the source of petroleum and why it is a risk of toxins, we must move to a question on most biologically. Vaseline is occlusive. In Fore one article, it was found that the degree of occlusion of the skin affect the barrier recovery. Removing occlusive products recovery and reduce the barrier epidermal proliferation due to an abnormality of the stratum corneum barrier. An occlusive products, such as Vaseline, TEWL will prevent and delay the ripening and repair of the epidermal barrier. Occlusion of the skin increases the infectious organisms and potentially increase the pH of the skin. Occlusion also directly increase the pH of the skin. Occlusive products also interfere with cellular respiration and can lead to cell death.
This information presents a powerful message that we want May consider the use of lanolin and petroleum jelly on the skin of the newborn. The use of emollients such as silicone, along with omega 3-6, the construction of the barrier amino acids and natural antioxidants and vitamins in May worth another look. Water-based products for skin care are required by the Food and Drug Administration (FDA) to be retained. This allows the release of bacteria and protects products from contamination during the micro-sources (such as unclean hands) contaminate the product in the container during use.
The requirement for storage and use is not well understood. Conservatives are not optional, according to the Food and Drug Administration (FDA) monograph on the production of safe and effective "or cosmetics. The manufacturer is obliged to do twenty-eight (28) days of the challenge of conservation effective for our products and keep a record of these tests for inspections by the FDA. In addition, each requires proof that the letter of microbial challenge requirements. The batches are tested in the tank before filling, and then again at the beginning, middle and end of the filling process. This test is done to ensure that each product is delivered free of microbial contamination.
Since the use and safety of preservatives, especially parabens is under consideration in this article, three reviews regulatory agencies are presented for consideration.
• The FDA recognizes parabens as a class of preservatives that have been used in a wide variety of foods, medicines, cosmetics and kept free of microbial contamination. The Food, Drug and Cosmetic Act requires that cosmetics and drugs without prescription and its ingredients must be safe and that labeling 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 conservation.
• The European Food Safety Authority (EFSA) reviewed the use of parabens in food and other products. The European Union (EU) Scientific Committee for Food (SCF) evaluated the parabens in 1994 and established an acceptable daily intake temporal (IDA) 0-10mg/kg of body weight as the sum of methyl, ethyl and propyl parabens. Other studies have also shown that the activity was carried out in nooestrogenic vivo, and that there was no effect on the cells of the rat forestomach. Teratogenicity in a study of 300 rabbits orally at doses Methyl Paraben not 550 mg / kg, there was no evidence of toxicity was found. The group recognized that this dose is much higher than any dose oral schedule.
• cosmetics, toiletries, Fragrance Association (CTFA) is the United States and through its board of scientific review, see all new cosmetic ingredients and assigns the INCI nomenclature (the language available with the packaging of all ingredients). CTFA The first studied the safety of parabens in 1984 and concluded that they were safe as used cosmetics. On November 14, 2004, in the normal course of a review by the Committee of Experts decided that he wanted to discuss CIR through literature from the report above 1984. The safety of parabens has been confirmed once again.
Why, then, there may be a product that is not maintained? It is preferable that all products have some kind of protection. However, certain products that contain no water can pass the challenge because microorganisms breed in water. Proof is done without the introduction of water. Consider this: a) an unpreserved product is placed on the skin, b) occlusive products, such as Vaseline, c) of the skin and moisture due to TEWL contains microorganisms that multiply and are trapped between the barrier and occlusive skin, d) products skin care of the skin is not preserved, and today, e) is added to a microorganism-rich moisture. What are the consequences? Is there a systematic link and what is the potential sequel?
Toxins are present in the environment of the newborn. Come from the mother milk, underwear, clothing, human contact and a myriad of other sources. Careful attention should be given to the source of toxins and of multiple sources will have an impact on the newborn. Product are the preservatives and perfumes, but Two of these sources. Protection against e-TEWL and reduced risk of systemic infections should be considered during the selection of newborn skin care.
Nutrashield Medline Industries, Inc. is a semi-emollient cream that:
• has excellent washing
• May reduce the incidence colony-forming microorganism population in the newborn associated with vaseline
• offers excellent benefits, including the expansion of aesthetics.
Other creams and lotions for the repair of providing the range of products and semi-barrier skin37 food. Further research is needed to confirm the suitability of the product for NICUs.
Article by Darlene McCord, Ph.D.
About the author:
Dr. Darlene E McCord is one of the two founders of McCord Search. As a researcher, it provides a unique mix of scientists in the position of power. Through his leadership, the company has achieved worldwide recognition in the OTC drug and device level. His area of specialty is corneotherapy, focusing on the transport of small molecules through the stratum corneum of skin disorders associated with skin lesions and relief. Dr. Darlene E McCord is widely published on topics related to immunodermatology and corneotherapy.
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