Skin Integrity and Care
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Evidence
Janina Marissen, Mercedes Gomez de Agüero, Parul Chandorkar, Lilith Reichert, Kirsten Glaser, Christian P. Speer, Christoph Härtel
Abstract: The skin of preterm infants is a delicate organ with critical structural and functional differences as compared to term born infants. Unique features contribute to an increased susceptibility to injury, infection, thermal instability, and water loss.
Deanne August, Sabrina de Souza, Vita Boyar, Amy Curran, Amy A. Hobson, Miki Konishi, Gillion Noreiks, Kylie Pussell, Hannah Skelton, Matthew A. Rysavy, Karen Walker, Marty Visscher & Pranav R. Jani
Abstract: Increased survival of preterm infants born <28 weeks’ gestation brings new challenges for healthcare teams and families, particularly in the absence of high-quality, population-specific evidence to guide optimal skin care. Skin integrity is critical for preventing infection, reducing pain, and minimising fluid loss. However, variations in care, delivery models, geographic settings, and clinician expertise continue to influence outcomes—impacting both immediate survival, long-term morbidity and mortality.
Education
Your baby’s skin is very soft and delicate. This is especially true if they were born early such as less than 28 weeks gestation. Premature babies have skin that is not fully developed. It can be up to two times thinner than the skin of a full-term baby. Because of this, their skin needs extra care to keep it safe and comfortable.
Common Types of Skin Injuries
Healthcare teams use special words to describe changes to a baby’s skin:
- Medical Adhesive Related Skin Injury (MARSI) – This means the skin was hurt by medical tape or adhesives.
- Skin stripping or redness – When tape pulls the top layer of skin or makes it red.
- Pressure injury – Redness from lying on the same spot for too long or from a medical device pressing on the skin.
- Intra-Venous (IV) injury or “tissuing” – Sometimes fluids or medicines can leak out of the cannula and cause swelling or redness.
How long do skin injuries last
Most skin injuries get better while your baby is still in hospital. The healthcare team may use dressings or make management plans to help the skin heal and keep your baby comfortable.
Skin Problems Often Seen in Hospital
- Dry or peeling skin can be normal, especially for babies born after 40 weeks. It usually goes away on its own.
- Nappy rash (nappy dermatitis) is common in hospital and at home. It can happen when the skin stays wet, rubs on the nappy, or because of some medicines or treatments. The skin can look red, sore, or broken.
- Some babies may have tiny white spots on their face. These are called milia and will disappear over time.
- Pressure marks may appear if your baby has tubes or monitors attached. These marks usually fade with time.
Empowerment
How You Can Help Your Baby’s Skin
You know your baby best. You can help by telling the healthcare team if you notice changes such as:
- Skin colour changes
- Skin that feels or looks dry, moist, shiny, flaky, or swollen
- Any blisters or broken skin
Your local hospital and unit will have regular practices and products for use while your baby is in hospital. Working with them to achieve what is best can maximise the benefits of the following recommendations.
Helping With Tape Removal
- If you would like to learn how to support your baby during tape removal this video can help–Adhesive Removal Tutorials 3 - YouTube
Nappy Care
- Keep your baby’s bottom clean and dry. Use soft cotton pads and warm water. Pat gently—don’t rub.
- Ask the nurses to show you how to clean your baby’s skin safely.
- Make a plan together with your healthcare team. This may include how often to change nappies, what barrier creams to use, and whether nappy-free time is helpful.
- Change nappies often to help prevent nappy rash. A cream with zinc oxide can also help protect the skin.
Bathing and Moisturising
- Overall, newborns are most often bathed with water for washing. They do not need a bath every day unless they are dirty, because too much washing can make their skin dry.
- Use gentle lotions only if needed. Ask the nurses which ones are safe for your baby.
Special thanks to the Australian College of Neonatal Nurses (ACNN) Neo-Skin Special Interest Group (SIG) partnership in development of this item.
Useful Links
ACNN Neo-Skin SIG
https://www.acnn.org.au/branches-and-sigs/neo-skin-sig/
SIGNET Collaborative - The Skin InteGrity in extreme preterms research NETwork actively encourages and provides a forum for families to discuss care.
https://signetcollaborative.org/
Raising Children Australia
The Royal Children's Hospital, Melbourne
https://www.rch.org.au/kidsinfo/fact_sheets/Skincare_for_babies_and_young_children/.
Other Evidence links
Boyar V, Visscher M, Lund C, Narendran V, 14 TBCSCRMKABEKSYNAJBAVKBC. Seeing beyond the obvious: pragmatic skin care guidance for infants 22–24 weeks gestational age. Journal of Perinatology. 2025:1-11. https://pubmed.ncbi.nlm.nih.gov/40954186/
August D, Chapple L, Flint A, Macey J, Ng L, New K. Facilitating neonatal MARSI evidence into practice: Investigating multimedia resources with Australian Neonatal Nurses – A participatory action research project. Journal of Neonatal Nursing. 2020;27(4).
This document is endorsed by the Australian College of Neonatal Nurses (ACNN) Inc. (#1300211) on the understanding that statements and opinions expressed are those of the authors and not those of ACNN. Endorsement by ACNN does not imply endorsement of any commercial products.
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Disclaimer: This publication by Miracle Babies Foundation is intended solely for general education and assistance and it is it is not medical advice or a healthcare recommendation. It should not be used for the purpose of medical diagnosis or treatment for any individual condition. This publication has been developed by our Parent Advisory Team (all who are parents of premature and sick babies) and has been reviewed and approved by a Clinical Advisory Team. This publication is not a substitute for professional medical advice. Miracle Babies Foundation recommends that professional medical advice and services be sought out from a qualified healthcare provider familiar with your personal circumstances.To the extent permitted by law, Miracle Babies Foundation excludes and disclaims any liability of any kind (directly or indirectly arising) to any reader of this publication who acts or does not act in reliance wholly or partly on the content of this general publication. If you would like to provide any feedback on the information please email [email protected].
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