Sterile technique may be maintained in the hospital, but it is not the standard at home. Covering affected areas with soothing bandages will make the baby more comfortable and will make it possible for parents to hold their child.
Vaseline gauze is available in every hospital nursery and should immediately be wrapped around affected areas. This will provide comfort and help prevent damage while the doctors, nurses and parents determine the next course of action.
No tape or adhesives
Place a large sign over the baby bed to alert all hospital staff that tape and adhesives are not permitted.
This is the single most effective way to minimize the spread of infection.
Set out supplies
Depending on the child's condition and what products are available, these will vary, but the essentials are:
- Sterile needles or lancets for draining blisters
- Antibiotic ointment (such as Polysporin)
- Vaseline or Aquaphor
- Contact layer such as Mepitel, Restore, Vaseline Gauze
- Soft, conforming, stretch-rolled gauze (2-inch)
- Tubular dressing retainer
EB blisters should be drained if they are tense or if they are a half-inch in diameter or larger. This is because the fluid inside the blister puts pressure on the surrounding skin, causing the blister to grow. A larger blister takes longer to heal and is at greater risk for infection. It also is more painful than a smaller one. The side of the blister should be punctured using a sterile needle, lancet or manicure scissors. If using a needle, be sure the opening in the blister is large enough that it will not seal and refill. Every effort should be made to leave the blister roof in place, as this improves comfort and healing.
Handle one limb at a time. Skin damage will be minimized if all dressings are not removed at once. The baby naturally will kick and rub the hands or feet, causing bleeding and injury. Also, the wounds are more painful when they dry out and when they are exposed to air. Remove the dressings from one limb at a time, provide the care, and then apply the dressing to that limb before proceeding to the next. Do not pull off dressings that are stuck to a wound. Clothing or bandages that have adhered to a wound must be soaked off. Pulling off a bandage that is adhering to a wound will exacerbate the wound and cause bleeding and pain. Often, soaking with water or applying a wet compress will be enough to remove a bandage that is stuck. If this is not effective, apply an ointment such as Vaseline or Aquaphor, then allow it to absorb; the area will soften, and the material will release.
The skin and wounds can be cleansed with a mild, non-perfumed product, such as Cetaphil or Dove. Areas with blisters, sores or missing skin can be rinsed or irrigated with a soapy solution (Cetaphil or Dove and water) and then with clear water. If necessary, the areas can be patted gently, but not rubbed or scrubbed.
An over-the-counter antibiotic ointment (Polysporin or Bacitracin) may be applied to affected areas. Some parents prefer to use non-medicated ointments, such as Vaseline or Aquaphor.
Next, a non-adherent contact layer should be applied. Examples include Mepitel, Restore, Vaseline Gauze and Telfa pads. (See section about bandaging for more information.) Then, the conforming rolled gauze is wrapped around the contact layer and secured with the tubular dressing retainer.
Every small blister does not require a dressing. Simply applying ointment may be enough for small, isolated lesions. A blister, erosion or wound should be bandaged in any of these circumstances:
- The wound requires protection from further trauma or contact/friction with clothes.
- The wound is draining or bleeding.
- The wound requires topical treatment for infection.
- The wound is painful, and a dressing will improve comfort.
Until it is determined how delicate the newborn’s skin is, daily dressing changes are recommended. New blisters may develop under the dressings, and, therefore, the skin must be inspected and the blisters drained daily. Some products may dry out in about 24 hours, further necessitating the need for daily dressing changes (Vaseline Gauze).
Unless there is an obvious problem, such as the bandages becoming soiled from a bowel movement or bleeding under the bandages, more frequent dressing changes are not recommended. The wound bed must be left undisturbed to facilitate healing.