Diapering for Healthy Skin and Development

Nov 10, 2022 | 5min. Read

Huggies celebrates more than 5 years of a trusted and valued partnership with clinical nurses and neonatal therapists from the NICU. Combining clinical knowledge and insights with the evidence-based research from our skin scientists, we developed diapering products specifically designed to help foster healthy skin and support development of premature infants. This article highlights the multi-faceted skin-health approach to diapering in the NICU.

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Every Change Matters™ in the NICU

Studies have shown that a diaper change can be a stressful event for an infant, simply because they are being disturbed during this process. This can be exacerbated by the presence of skin irritation in the diapered area which can contribute to baby’s discomfort. Checking for signs of irritation at every diaper change, employing good skin care practices and selecting complementary diapers and wipes specifically designed to help maintain healthy diapered skin is essential to help support healthy development and champion sleep. This is especially true when caring for infants in the NICU.

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The Premature Skin Barrier

Although the skin barrier starts to develop during the second trimester, structural integrity at birth is correlated to gestational age and maturation continues throughout the first year of life. Below 34 weeks of gestational age, the skin barrier is considered underdeveloped. Compared to full-term infant skin, preterm infant skin has a thinner dermis with less structural proteins and a thinner epidermis with a compromised skin barrier. Because of this, premature infants are more susceptible to abrasion, penetration of irritants and infection.

Anatomical Model Card

Caring for Premature Infant Skin

When caring for premature infant skin, it is essential to ensure gentle contact and minimize prolonged exposure to excess skin moisture to prevent further damage to the already compromised skin barrier. It is also important to maintain a balanced skin pH to promote healthy skin barrier function and provide protection from skin irritating fecal enzymes. For this reason, it is critically important to select a diapers and wipes combination that is specifically designed to help maintain healthy diapered skin and can help foster the developmental growth of this vulnerable population. Product design for premature infants needs to be comprehensive, from helping to protect against the top two causes of diaper dermatitis (excess moisture and skin irritating fecal enzymes) to also considering the fragility of premature skin to prevent further damage to the skin barrier and delaying its maturation.

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Products Designed for Skin Health, Growth and Development

The Huggies® Little Snugglers® Nano and Micro preemie diapers were specifically designed for low-birth weight infants; materials and design components were carefully selected considering this vulnerable population. They feature a soft, flexible, narrow pad that conforms to baby’s body to help deliver appropriate positioning and keep baby comfortable. They also have a fastening system that allows for fastening tabs to overlap, stretch, and attach anywhere on the diaper’s outer cover, for a truly adjustable, gentle fit. In addition, they are made with a super absorbent material that quickly pulls in fluid and locks it away, helping keep delicate skin clean, dry, and healthy. As a complementary product, Huggies® Natural Care® Extra Sensitive baby wipes were developed for fragile and delicate skin and are made of an absorbent, proprietary plant-based basesheet with a lotion-based cleansing system. They are designed to complement healthy skin pH and to help wipe away fecal enzymes from skin. A low pH is important to help support healthy skin barrier integrity and help against fecal enzymes that are irritating to skin. Huggies® Natural Care® Extra Sensitive baby wipes contain emollients that help reduce friction between the wipe and delicate baby skin and have been clinically proven to be more gentle than cloth and water on compromised skin.

Implementing a Diapers and Wipes System Approach

It is important to keep in mind that not all products are designed with infant skin health in mind. In fact, we have recently demonstrated in a clinical setting that a diapering regimen comprised of Huggies® Little Snugglers® diapers and Natural Care® Sensitive wipes is designed to help maintain clean, dry skin and clinically proven to complement healthy baby skin pH.* (*data on file). On the other hand, a regimen featuring a non-breathable diaper in combination with a baby wipe that is not buffered to complement healthy baby skin pH was found to significantly increase baby’s skin pH over time. A higher skin pH does not support the healthy state of the protective barrier of the skin and, it has been demonstrated to increase the susceptibility to diaper dermatitis.

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Dr. Karien J. Rodriguez currently leads the Life Sciences team in the Corporate Research Organization at Kimberly-Clark Corporation. Dr. Rodriguez has a PhD in Biomedical Engineering specializing in biomaterials, tissue engineering and skin health, she has been conducting skin health research for over 10 years, has authored multiple scientific publications and her accomplishments have been recognized by Great Minds in STEM-Hispanic Engineer National Achievement Awards Corporation and more recently by the College of Engineering at the University of Wisconsin-Madison with an Early Career Achievement Award.

  1. Gregorio J, Rodriguez K. Diaper dermatitis in infant skin: causes and mitigation. Neonatal Intensive Care. 2017;30:38-40.
  2. Comaru T, Miura E. Postural support improves distress and pain during diaper change in preterm infants. J Perinatol. 2009;29:504-507.
  3. Blume-Peytavi U, Lavender T, Jenerowicz D, et al. Recommendations from a European roundtable meeting on best practice healthy infant skin care. Pediatr Dermatol. 2016;33:311-321.
  4. Chon S, Minerath BM. Impact of Urine on Diapered Skin Health. Neonatal Intensive Care. 2017;30(2):26-29.
  5. Akin F, Spraker M, Aly R, Leyden J, Raynor W et al. “Effects of Breathable Disposable Diapers: Reduced Prevalence of Candida and Common Diaper Dermatitis”. Pediatr Dermatol. 2001;18(4):282-290.
  6. Clark-Greuel JN, Helmes CT, Lawrence A, Odio M, White JC. "Setting the record straight on diaper rash and disposable diapers." Clinical Pediatrics. 2014;53(9 suppl):23S-26S.
  7. Helmes CT, O'Connor R, Sawyer L, Young S. "Disposable diaper absorbency improvements via advanced designs." Clinical Pediatrics. 2014;53(9 suppl):14S-16S.
  8. Ngai D, Vongsa R, Rodriguez KJ. Infant skin barrier damage inflicted by fecal enzymes and ways to mitigate: Why water is insufficient. Kimberly-Clark Corporation poster presentation at the 18th Annual National Neonatal Nurses Conference: September 5-8, 2018, New Orleans, LA, USA. Association of Neonatal Nurses, New Orleans LA, 2018.
  9. Rodriguez KJ, Cunningham C, Foxenberg R, Hoffman D, Vongsa R. The science behind wet wipes for infant skin: Ingredient review, safety, and efficacy. Pediatr Dermatol. 2020 May;37(3):447-454. doi: 10.1111/pde.14112. Epub 2020 Feb 17. PMID: 32065466; PMCID: PMC7383888. 
  10. Vongsa R, Rodriguez K, Koenig D and Cunningham C. “Benefits of Using an Appropriately Formulated Baby Wipe to Clean Diapered Skin of Preterm Infants”. Global Pediatric Health. 2019;6:1-6.

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