Aquaphor ointment should be applied topically in a clean manner to all newborns <1000g birthweight for the first 4 days (96 hours) of life.

Aquaphor may also be applied by physician order to local areas of skin breakdown.

Background:

Prophylactic Aquaphor has been shown to:

• improve skin integrity in ELBW infants, and

• decrease transcutaneous insensible water losses, thereby reducing early hypernatremic dehydration in this vulnerable population.

However, prophylactic Aquaphor applied q 12 hours for 14 days has been associated with an increased incidence of Staph epi sepsis in a large multicenter trial.

Therefore, we have reduced the duration of Aquaphor application to only the highest risk period for excessive transcutaneous water loss and skin breakdown.

Resolved at NICU Policy & Procedure Meeting 2/21/01.

References:

Edwards WH. The effects on Aquaphor emollient ointment on nosocomial sepsis rates and skin integrity in infants of birth weight 501 to 1000g, A Vermont Oxford Network Trial. Presented at Hot Topics in Neonatology, Washington DC, 2000. (manuscript in press)

Nopper AJ, Horii KA, Sookdeo-Drost S, Wand TH, Mancini AJ, and Lane AT. Topical ointment therapy benefits premature infants. J Pediatr 1996; 128:660-9.

Pabst RC, Starr KP, Qaiyumi SD, Schwalbe RS, and Gewolb IH. The effect of application of Aquaphor on skin condition, fluid requirements, and bacterial colonization in very low birth weight infants. J Perinatol 1999; 19:278-83.

Soll RF and Edwards WH. Emollient ointment for preventing infection in preterm infants. Cochrane Neonatal Collaborative Reviews, 2000. http://www.nichd.nih.gov/cochrane/SOLL7/SOLL.HTM