Neonatal Skin-Care and Flammability of Neonate Topical Products
Darlene E. McCord, Ph. D., FAPWCA, Barry E. Newton, B.S.M.E., P.E., Gwenael Chi oleau, Ph.D., Isaiah L. Hankel, B.A.
Abstract Background Continued Figure I. The Acceptability Index is used to
Acceptability Indices Of Selected Materials
rank oxygen compatibility based on the fol-
lowing equation: 1400 1282 1. Patient Madison, K. C. 2003. Barrier function of the skin: "La Raison d'Etre"
Skin care product selection may be essential to tors is used to rank overall oxygen compatibility. catheters to supply oxygen directly into the neonate’s before being ignited. Numerous medical centers have [(oxygen index) x (autogenous ignition of the epidermis. Journal of Investigative Dermatology 121: 231-241.
improving re safety in oxygen-enriched, neona- The heat of combustion value of the industry 1200
nasopharynx. Reservoir systems and high- ow reported res involving oxygen-enriched environ- temperature)] / (heat of combustion) 1023
tal environments. Independent studies were standard, Aquaphor Healing Ointment® from 1000 2. Kalia, Y., L. Nonato, and C. Lund, Guy. 1998. Development of skin barrier
systems employ specialized masks that surround the ments, endotracheal tubing and con ned spaces . Silicone-based skin care products received function in premature infants. Journal of Investigative Dermatology.
conducted comparing the oxygen compatibility Beiersdorf AG, was more than ve times greater infant’s noses and connect to external oxygen supply substantially higher Acceptability Indices 800 111(2): 320-326.
of the industry standard, a petrolatum-based than silicone-based Remedy™ Nutrashield™ and tubing. Enclosure systems, or headbox set-ups, utilize Utilizing advanced silicone creams instead of than petrolatum-based products . In par- 600 3. Klaus, M. H., and A. A. Fanaroff. 1987. Yearbook of Perinatal/Neonatal
product, against newer silicone-based products. Skin Repair Cream™ from Medline Industries, Inc. oxygen hoods designed to surround the head of the petrolatum-based products diminishes risks associ- ticular, petrolatum-based Aquaphor® burns Medicine. Chicago: Year Book Publishers. Pg. 538.
Oxygen compatibility was determined via Aquaphor® had a heat of combustion value of neonate . ated with ammability. Silicones are currently used in with an extremely high energy release, com-
200 4. Mendenhall, A. K., and L. F. Eichenfield. Back to basics: Caring for the
autogenous ignition temperature testing, 10869 calories/gram, ranking near gasoline at numerous transdermal delivery systems, catheters parable with gasoline . 48 newborn's skin. Contemporary Pediatrics. 2000.
oxygen index testing and heat of combustion 10400 cal/g and mineral oil at 10930 cal/g. Sub- Petrolatum-based skin care products are composed of and specialized medical devices . A substantial ad- 0
AQUAPHOR® NUTRASHIELD™ SKIN REPAIR CREAM™ 5. Lund, C., J. Kuller, A. Lane, J. Lott, D. Raines, and K. Thomas. 2001.
testing. Autogenous ignition temperature is a sequently, Skin Repair Cream™ and Nutrashield™ highly ammable hydrocarbons. Petrolatum itself is a vantage of using silicone over petrolatum-based Neonatal skin care: evaluation of the AWHONN/NANN research-
relative indication of a material’s propensity for received an Acceptability Index rating semisolid mixture of hydrocarbons obtained by the products for neonatal skin care is silicone’s oxygen based practice project on knowledge and skin care practices.
ignition, oxygen index is a relative indication of a approximately 20 times and 25 times better than Association of Women's Health, Obstetric and Neonatal
fractional distillation of petroleum . Hydrocarbon- compatibility. Silicone-based products that have un- Figure II. Heat of combustion is an absolute Nurses/National Association of Neonatal Nurses. J. Obstet.
material’s ammability, and heat of combustion Aquaphor®, respectively. The application of oxygen mixtures are extremely explosive, especially in dergone compatibility testing for use in high oxygen Gynecol. Neonatal Nurs. 30(1): 30-40.
value of a material’s energy release upon Heat of Combustion (HoC) of Selected Materials
is the absolute value of a material’s energy ammable, petrolatum-based products in neo- con ned spaces . Furthermore, endotracheal tubing environments have attained promising results . In burning, which is an indication of its 6. Lund, C., and J.W. Osborne. 2004. Validity and reliability of neonatal skin
release. Skin care products with a high natal intensive care environments enriched with is composed of highly combustible materials with addition, the industry standard was found to be ve damage potential. Petrolatum-based condition score. J. Obstet. Gynecol. Neonatal Nurs. 33: 320-327.
autogenous ignition temperature, a high oxygen 23-100% oxygen may impose signi cant risks surprisingly low indices of ammability . This times more combustible than selected silicone-based Aquaphor® was found to have a heat of com-
7. Bowman, E., and S. Fraser. 2005. Neonatal Handbook Editorial Board.
index and a low heat of combustion are recog- associated with ignition and re. Further studies lower index of ammability corresponds to a skin care products . bustion greater than gasoline. Furthermore, Aquaphor Neonatal Handbook.
nized as being more compatible for application are recommended to determine which products decreased intensity of heat a material can absorb Aquaphor® contains mineral oil, which was
also found to release more energy upon 8. Myers, T. R. 2002. AARC clinical practice guideline: selection of an oxygen
in oxygen-enriched environments. Furthermore, can provide proper neonatal skin care while Mineral Oil delivery device for neonatal and pediatric patients.Respiratory Care
an Acceptability Index based on the above fac- maintaining re safety standards. burning than gasoline . 47(6): 707-716.
10000 10200 10400 10600 10800 11000
9. Taber’s Cyclopedic Medical Dictionary. 1993. 17th Edition. Pg. 1483.
Background Table I. Enclosure systems combine oxygen to obtain AIR FLOW OXYGEN FLOW PERCENT OXYGEN IN HoC (calories/gram)
10. Lizhong, Y., F. Weicheng, Z. Xiaodong, and W. Qing'an. 2001. Analysis of
the oxygen saturation required for infant survival. The (L/min) (L/min) ENCLOSURE SYSTEM (%) fire and explosion hazards of some hydrocarbon-air mixtures.
Neonatal skin maturation requires the proper The Evidence-Based Clinical Practice Guideline system provides an enriched oxygen atmosphere J. Hazard Mater. 84(2-3): 123-131.
9 1 30
with an oxygen concentration most commonly be-
development of the dermis, epidermis and the for neonatal skin care recommends 2-4 weeks of
tween 23-90%, although the system is capable of 8 2 40 Discussion Conclusions 11. Wolf, G., and J. Simpson. 1987. Flammability of endotracheal tubes in
outermost, semipermeable barrier provided by skin care product application in order to prevent 6 4 50 oxygen and nitrous oxide enriched atmosphere. Anesthesiology
achieving concentrations of 100% . Application of
the stratum corneum . The stratum corneum excessive transepidermal water loss (e-TEWL) in petrolatum-based products containing highly am- 5 5 60 The application of petrolatum-based products The heat of combustion value of the 67(2): 236-239.
becomes fully keratinized in utero between 32 preterm neonates delivered prior to 32 weeks mable hydrocarbons may endanger infants being 4 6 70 to neonatal skin in oxygen-enriched environ- petrolatum-based product tested was more 12. Wolf, G., G. Sidebotham, and J. Stern. 1994. Intraluminal flame spread in
and 34 weeks gestational age . Premature gestation. The Association of Women’s Health, treated in con ned neonatal enclosure systems. 2.5 7.5 80 ments may impose signi cant re risks However, than ve times greater than the silicone-based tracheal tubes. Laryngoscope 104(7): 874-879.
neonates are frequently delivered with severely Obstetric and Neonatal Nurses (AWHONN) and 1 9 90 introducing highly ignitable and extremely am- products tested. The petrolatum-based product 13. Thompson, J., W. Colin, T. Snowden, A. Hengesteg, R. Stocks, and
underdeveloped stratum corneum and the National Association of Neonatal Nurses mable petrolatum materials into infant care sys- had a heat of combustion value of 10869 S. Watson. 1998. Fire in the operating room during tracheostomy.
South Med. J. 91(3): 243-247.
epidermal skin layers. The delay in tissue matura- (NANN) have validated the Guideline . tems is avoidable. New silicone technologies calories/gram, ranking in between gasoline
tion disallows the numerous protective Currently, the AWHONN and the NANN recom- Table II. Two of the most common endotracheal tube ENDOTRACHEAL TUBE INDEX OF allow for oxygen compatible products that pro- (10400 cal/g) and mineral oil (10930 cal/g). How- 14. Sheffield, P., and D. Desautels. 1997. Hyperbaric and hypobaric chamber
functions provided by fully developed skin . mend a petrolatum-based skin care product to materials are polyvinylchloride and red rubber. Both MATERIAL FLAMMABILITY fires: a 73-year analysis. Undersea Hyperbaric Med. 24(3): 153-164.
vide proper neonatal skin care while diminish- ever, the manufacturer of the chosen
materials have surprisingly low indices of ammability.
treat neonatal skin . POLYVINYLCHLORIDE 0.263 ing risks associated with re safety. petrolatum-based product may indeed o er an 15. Colas, A., and L. Aguadisch. 1997. Silicones in pharmaceutical
The low indices in conjunction with petrolatum-based applications. Chimie Nouvelle. 15(58): 1779.
product application may impose signi cant risks in RED RUBBER 0.176 alternative skin care product that is oxygen
Neonatal incubators pro- neonatal intensive care units. Endotracheal tubes are Each of the following components is considered compatible. The silicone-based products tested 16. Briquet, F., A. Colas, and X. Thomas. 1996. Silicones and medical usage.
vide environments en- Dow Corning Form No. MMV0396-02.
utilized in low- ow, high- ow and reservoir systems . necessary for combustion to occur under stan- were determined to be highly compatible with
riched with 23-100% dard conditions. Reducing or eliminating one or oxygen-enriched environments The chosen 17. Wendell Hull & Associates, Inc., Oxygen Systems Engineering and Test
oxygen while monitoring more of the components may diminish re silicone-based products achieved Acceptability Group. 2006. WHA Test Report on Oxygen Compatibility of Materials for
Medline Industries, Inc. 1020 S. Main St., Las Cruces, NM 88005.
humidity, oxygen satura- Results risks . Index Indices of 1282 and 1023, respectively. Ad-
tion and inspired oxygen • Presence of burnable material ditional studies are recommended to determine 18. Lapin, A. 1973. Oxygen Compatibility of Materials. International
Institute of Refrigeration Conference Presentation. Brighton, England.
concentration . Premature Table III. Autogenous (petrolatum, etc.) which products can provide proper neonatal
MATERIAL AUTOGENOUS OXYGEN HEAT OF COMBUSTION
infants may receive oxygen ignition temperature indi- IGNITION TEMP (˚C) INDEX (%) (CALORIES/GRAM) • Source of ignition skin care while maintaining strict re safety stan- 19. Wendell Hull & Associates, Inc., Oxygen Systems Engineering and Test
Group. 2006. WHA Test Report on Oxygen Compatibility of Materials for
from low- ow, reservoir, cates a substance’s pro- (electrical systems, etc.) dards.
Aquaphor® 186 25 10869 McCord Research, Inc. 1020 S. Main St., Las Cruces, NM 88005.
high- ow and enclosure pensity for ignition; Nutrashield™ 224 55 2111 • Oxygen
20. Lypson, M.L., S. Stephens, and L. Colletti. 2005. Preventing surgical fires:
systems. Low- ow systems oxygen index indicates a Skin Repair Cream™ 179 50 1989 who needs to be educated? Jt. Comm. J. Qua Safety. 31(9): 522-527.
utilize endotracheal tubes substance’s ammability;
Endotracheal tube combustion and nasopharyngeal heat of combustion is an absolute value of a material’s energy release upon burning. Oxygen compatible Nutrashield™ and
Skin Repair Cream™ maintain a high autogenous ignition temperature and oxygen index, and a low heat of combustion . HTR Group, Inc.