Nappy change

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Authors

Camba F, Oude-Reimer M, Frauenfelder O, Ceccatelli M, Jørgensen E, Hankes-Drielsma I, Silva E

Click on the image to read the standard in brief.

Target group

Infants, parents, and families

User group

Healthcare professionals, neonatal units, hospitals, and health services

Statement of standard

Nappy change is performed with a technique that minimises skin damage, discomfort, and physiologic instability.

Rationale

Nappy change is an everyday care routine and necessary for infant’s comfort, to keep the perineum area clean and the skin protected. Inadequate hygiene or aggressive cleansing may trigger dermatitis in the perineal area. The procedure can be stressful, especially for extremely preterm and ill infants. (1) They are at greater risk of short-term consequences of stress (e.g. fluctuations in intracranial blood pressure with an increasing risk for intraventricular haemorrhage, increased heart rate, and decreased oxygen saturation), as well as long-term consequences of stress (e.g. allostatic load and an inability to respond appropriately to a stressor). (2) The manner in which nappy change is performed makes a difference for the infant’s comfort and physiologic and behavioural stability, and should be carried out in a developmentally sensitive manner. (3–6)

Benefits

Short-term benefits

Improved comfort (2–4)
Improved physiological stability during the procedure (3,4)
Reduced perineal skin damage (6)
Protected sleep (5)
Supported parents’ role and bonding (7,8)
Improved parental awareness of their infant’s behavioural cues, and participation in the care of their infant (7,9,10)

Long-term benefits

Reduced complications associated with prematurity (2)
Improved parental awareness of their infant’s behavioural cues, and participation in their’s infant´s care (consensus)

Components of the standard

Component

Grading of evidence

Indicator of meeting the standard

For parents and family

Parents and family are informed by healthcare professionals about nappy change, skin care, behavioural signs of discomfort in the infant during nappy change, and how to react accordingly. (9,10) (see Care procedures)

A (Moderate quality)
B (High quality)

Parent feedback, patient information sheet¹

Parents are offered the opportunity to carry out nappy change (cleaning the skin, offering postural support or holding the infant in skin-to-skin contact). (9,10)

A (Moderate quality)
B (High quality)

Parent feedback

For healthcare professionals

A unit guideline on nappy change is adhered to by all healthcare professionals.

B (High quality)

Guideline

Training on nappy change, infant behaviour during nappy change, strategies to optimise comfort, minimise disturbance, and skin care is attended by all responsible healthcare professionals.

B (High quality)

Training documentation

For neonatal unit

A unit guideline on nappy change is available and regularly updated.

B (High quality)

Guideline

For hospital

Training on nappy change, infant behaviour during nappy change, strategies to optimise comfort, minimise disturbance, and skin care is ensured.

B (High quality)

Training documentation

Disposable absorbent nappies of different sizes suitable for infants of various weights are available. (8,11)

A (Low quality)

Guideline

Specific skin cleaning agents and skin protection products according to different ages are available. (see Care procedures)

A (Low quality)
B (High quality)

Guideline

For health service

N/A

¹The indicator “patient information sheet” is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.

Where to go

Further development

Grading of evidence

For parents and family

N/A

For healthcare professionals

N/A

For neonatal unit

N/A

For hospital

N/A

For health service

N/A

Getting started

Initial steps

For parents and family

Parents and family are encouraged to actively participate in care procedures.
Parents and family are verbally informed by healthcare professionals about nappy change, skin care, behavioural signs of discomfort in the infant during nappy change, and how to react accordingly.

For healthcare professionals

Attend training on nappy change, infant behavior during nappy change, strategies to optimise comfort, minimise disturbance, and skin care.

For neonatal unit

Develop and implement a unit guideline on nappy change.

For hospital

Support healthcare professionals to participate in training on nappy change, infant behavior during nappy change, strategies to optimise comfort, minimise disturbance, and skin care.

For health service

N/A

Mörelius E, Hellström-Westas L, Carlén C, Norman E, Nelson N. Is a nappy change stressful to neonates? Early Hum Dev. 2006 Oct;82(10):669–76.
Anand KJ. Clinical importance of pain and stress in preterm neonates. Biol Neonate. 1998;73(1):1–9.
Comaru T, Miura E. Postural support improves distress and pain during diaper change in preterm infants. J Perinatol Off J Calif Perinat Assoc. 2009 Jul;29(7):504–7.
Lyngstad LT, Tandberg BS, Storm H, Ekeberg BL, Moen A. Does skin-to-skin contact reduce stress during diaper change in preterm infants? Early Hum Dev. 2014 Apr;90(4):169–72.
Levy J, Hassan F, Plegue MA, Sokoloff MD, Kushwaha JS, Chervin RD, et al. Impact of hands-on care on infant sleep in the neonatal intensive care unit. Pediatr Pulmonol. 2017;52(1):84–90.
Visscher MO, Taylor T, Narendran V. Neonatal intensive care practices and the influence on skin condition. J Eur Acad Dermatol Venereol JEADV. 2013 Apr;27(4):486–93.
Craig JW, Glick C, Phillips R, Hall SL, Smith J, Browne J. Recommendations for involving the family in developmental care of the NICU baby. J Perinatol. 2015 Dec;35(Suppl 1):S5–8.
Ortenstrand A, Westrup B, Broström EB, Sarman I, Akerström S, Brune T, et al. The Stockholm Neonatal Family Centered Care Study: effects on length of stay and infant morbidity. Pediatrics. 2010 Feb;125(2):e278-285.
Gooding JS, Cooper LG, Blaine AI, Franck LS, Howse JL, Berns SD. Family Support and Family-Centered Care in the Neonatal Intensive Care Unit: Origins, Advances, Impact. Semin Perinatol. 2011 Feb;35(1):20–8.
Patel N, Ballantyne A, Bowker G, Weightman J, Weightman S, Helping Us Grow Group (HUGG). Family Integrated Care: changing the culture in the neonatal unit. Arch Dis Child. 2018 May;103(5):415–9.
Ohlsson A, Jacobs SE. NIDCAP: a systematic review and meta-analyses of randomized controlled trials. Pediatrics. 2013 Mar;131(3):e881-893.