FIELD OF THE INVENTION
[001] The present invention relates to the field of medical science, and more particularly, the present invention relates to the care of skin in neonates (neonatal skin care guidelines).

BACKGROUND FOR THE INVENTION:
[002] The following discussion of the background to the invention is intended to facilitate an understanding of the present invention. However, it should be appreciated that the discussion is not an acknowledgment or admission that any of the material referred to was published, known, or part of the common general knowledge in any jurisdiction as of the priority date of the application. The details provided herein the background if belongs to any publication is taken only as a reference for describing the problems, in general terminologies or principles or both of science and technology in the associated prior art.
[003] Neonatal skin experiences a progressive adaptation to the extrauterine environment during which special care is needed. The immaturity of the epidermal barrier in the neonatal period may cause dry skin, vulnerability to trauma, rapid onset of microbial colonization, and percutaneous drug toxicity. Neonatal skin suffers a progressive adaptation to the extrauterine environment and special care is needed during this period. This skin is very sensitive, thin, and fragile. Immaturity of the epidermal barrier reduces the defense against the excessive proliferation of microbes and makes the skin more vulnerable to trauma and percutaneous drug toxicity. Because of the peculiar characteristics of newborn, infant, and children's skin, the use of cosmetic products designed for hygiene and protection requires caution. In order to preserve the integrity of neonatal and child skin, this article reviewed basic preventive care practices in relation to hygiene, bathing, cleansing agents, topical products, and their percutaneous toxicity. The purpose of skin care is the maintenance of skin integrity promotes the following: provides a barrier against substances such as microbial organism and chemicals; regulation of fluid and electrolyte balance and body temperature; provide tactile stimulation, and facilitate parental bonding.
[004] In light of the foregoing, there is a need for the care of skin in neonates (neonatal skin care guidelines)that overcomes problems prevalent in the prior art.

OBJECTS OF THE INVENTION:
[005] Some of the objects of the present disclosure, which at least one embodiment herein satisfies, are as follows.
[006] The principal object of the present invention is to overcome the disadvantages of the prior art by providing the care of skin in neonates (neonatal skin care guidelines).
[007] An object of the present invention is to provide the care of skin in neonates (neonatal skin care guidelines), wherein guidelines facilitate the assessment of neonatal skin conditions.
[008] Another object of the present invention is to provide the care of skin in neonates (neonatal skin care guidelines), wherein the guidelines are very easy to use and should be a part of daily skin assessment documentation.
[009] Yet another object of the present invention is to provide the care of skin in neonates (neonatal skin care guidelines), wherein it helps to identify a Neonatal Skin Condition Score (NSCS), choose the description that best fits the neonate's skin related to dryness, erythema, and break down/excoriation and assign the number most appropriate per description.
[010] Yet another object of the present invention is to provide the care of skin in neonates (neonatal skin care guidelines), wherein the purpose of skin care is the maintenance of skin integrity promotes the following: provides a barrier against substances such as microbial organisms and chemicals; regulation of fluid and electrolyte balance and body temperature; provide tactile stimulation and facilitate parental bonding.
[011] Other objects and advantages of the present disclosure will be more apparent from the following description, which is not intended to limit the scope of the present disclosure.

SUMMARY OF THE INVENTION:
[012] The present invention provides care of skin in neonates (neonatal skin care guidelines).
[013] Neonatal skin is fragile, and the premature infant's skin is also underdeveloped. The skin may be highly susceptible to skin breakdown. Increased skin permeability is a major concern that allows the infant to absorb topical medication, chemical preparations, and lotions through their skin, thus placing the infant at risk for toxicity and infections. This increase in skin permeability places the infant at risk for insensible water loss and temperature instability. The neonate’s skin does not mature for approximately 2 weeks. The premature infant’s skin does not mature for 2-3 weeks.
[014] The functional capacity of the skin to form an acid mantle (i.e. surface pH<5). results in a protective barrier to the environment as long as the skin stays intact. An acid skin surface is credited with bactericidal qualities against some pathogens and helps in the defense against infection. In the newborn the skin pH immediately after birth is 6.34 with a decline to 4.95 within 4 days; whereas in the low-birth-weight infants, the mean skin pH is 6.7 at birth and 5.0 by the eighth day of life. Immediately following birth colonization with microbial organisms also begins. These organisms grow in a state of equilibrium providing protection against invading pathogenic organisms. A rise in pH towards neutral (7.0) causes an increase in the total number of bacteria and changes in the flora present. Washing infants with soap can change the pH of the skin, destroying the skin mantle. After bathing the infant with soap and water it takes at least one hour for the acid mantle to be replaced putting the infant at risk for infections during this time period. Lotion and cream can also destroy the composition of the acid mantle and bacterial flora.

DETAILED DESCRIPTION OF DRAWINGS:
[015] While the present invention is described herein by way of example using embodiments and illustrative drawings, those skilled in the art will recognize that the invention is not limited to the embodiments of drawing or drawings described and are not intended to represent the scale of the various components. Further, some components that may form a part of the invention may not be illustrated in certain figures, for ease of illustration, and such omissions do not limit the embodiments outlined in any way. It should be understood that the drawings and the detailed description thereto are not intended to limit the invention to the particular form disclosed, but on the contrary, the invention is to cover all modifications, equivalents, and alternatives falling within the scope of the present invention as defined by the appended claim.
[016] As used throughout this description, the word "may" is used in a permissive sense (i.e. meaning having the potential to), rather than the mandatory sense, (i.e. meaning must). Further, the words "a" or "an" mean "at least one” and the word “plurality” means “one or more” unless otherwise mentioned. Furthermore, the terminology and phraseology used herein are solely used for descriptive purposes and should not be construed as limiting in scope. Language such as "including," "comprising," "having," "containing," or "involving," and variations thereof, is intended to be broad and encompass the subject matter listed thereafter, equivalents, and additional subject matter not recited, and is not intended to exclude other additives, components, integers, or steps. Likewise, the term "comprising" is considered synonymous with the terms "including" or "containing" for applicable legal purposes. Any discussion of documents, acts, materials, devices, articles, and the like are included in the specification solely for the purpose of providing a context for the present invention. It is not suggested or represented that any or all these matters form part of the prior art base or were common general knowledge in the field relevant to the present invention.
[017] In this disclosure, whenever a composition or an element or a group of elements is preceded with the transitional phrase “comprising”, it is understood that we also contemplate the same composition, element, or group of elements with transitional phrases “consisting of”, “consisting”, “selected from the group of consisting of, “including”, or “is” preceding the recitation of the composition, element or group of elements and vice versa.
[018] The present invention is described hereinafter by various embodiments with reference to the accompanying drawing, wherein reference numerals used in the accompanying drawing correspond to the like elements throughout the description. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiment set forth herein. Rather, the embodiment is provided so that this disclosure will be thorough and complete and will fully convey the scope of the invention to those skilled in the art. In the following detailed description, numeric values and ranges are provided for various aspects of the implementations described. These values and ranges are to be treated as examples only and are not intended to limit the scope of the claims. In addition, several materials are identified as suitable for various facets of the implementations. These materials are to be treated as exemplary and are not intended to limit the scope of the invention.
[019] The present invention provides care of skin in neonates (neonatal skin care guidelines).
[020] The present invention provides care of skin in neonates (neonatal skin care guidelines).
[021] Neonatal skin is fragile, and the premature infant's skin is also underdeveloped. The skin may be highly susceptible to skin breakdown. Increased skin permeability is a major concern that allows the infant to absorb topical medication, chemical preparations, and lotions through their skin, thus placing the infant at risk for toxicity and infections. This increase in skin permeability places the infant at risk for insensible water loss and temperature instability. The neonate’s skin does not mature for approximately 2 weeks. The premature infant’s skin does not mature for 2-3 weeks.
[022] The functional capacity of the skin to form an acid mantle (i.e. surface pH<5). results in a protective barrier to the environment as long as the skin stays intact. An acid skin surface is credited with bactericidal qualities against some pathogens and helps in the defense against infection. In the newborn the skin pH immediately after birth is 6.34 with a decline to 4.95 within 4 days; whereas in the low birth weight infants, the mean skin pH is 6.7 at birth and 5.0 by the eighth day of life. Immediately following birth colonization with microbial organisms also begins. These organisms grow in a state of equilibrium providing protection against invading pathogenic organisms. A rise in pH towards neutral (7.0) causes an increase in the total number of bacteria and changes in the flora present. Washing infants with soap can change the pH of the skin, destroying the skin mantle. After bathing the infant with soap and water it takes at least one hour for the acid mantle to be replaced putting the infant at risk for infections during this time period. Lotion and cream can also destroy the composition of the acid mantle and bacterial flora.
[023] Patient Outcome Goals:
- Prevent Injury.
- Maintain skin integrity: Normal healthy premature /neonatal skin should be dry, intact, and may appear flaky. The skin should be free from cracking, fissures and other signs of skin breakdown.
[024] These neonatal skin care guidelines are based on the National Association of Neonatal Nurses' guidelines for neonatal skin care.
[025] The Neonatal Skin Condition Score (NSCS) is reliable when used by single and multiple raters to assess neonatal skin condition, even across weight groups and racial groups. Validity of the NSCS could be demonstrated by confirmation of the relationship of the skin condition scores with birth weight, number of observations, and prevalence of infection [3]. It can facilitate assessment of neonatal skin condition. It is very easy to use, and should be a part of daily skin assessment documentation.
Neonatal Skin Condition Score (NSCS)
Dryness
1= Normal, no sign of dry skin.
2= Dry skin, visible scaling.
3= Very dry skin, cracking/ fissures.
Erythema
1= No evidence of erythema.
2= Visible erythema, < 50% body surface.
3= Visible erythema, > 50% body surface.
Break down/Excoriation
1= None evident.
2= Small, localized areas.
3= Extensive
[026] Newborns lose four times more heat per unit body weight than adults [4]. Many of the thermal care practices were suboptimal. Of particular note was the near universal early bathing of babies in both Nigerian sites, the length of time babies are left undressed during bathing in Ethiopia, and a common belief that bathing with warm water keeps the baby warm. The link between delayed bathing and body odour later in life has been found in other West African countries Bathing includes care of perianal area, cord, eye and oral care. Purpose to provide reduced antimicrobial colonization of the new-borns skin, while at the same time utilizing principles related to neonatal skin physiology, in order to maintain skin integrity. Initial Bath every new born is to get a bath with a mild, low-alkaline soap once the infant's temperature and physiologic condition are stable. Avoid contact with eyes, If needle stick must be performed prior to the initial bath, cleanse the area well with an antimicrobial prep (such us alcohol) to remove blood and other contaminants. Initial bath may be delayed for 48-72 hours if baby is not stable and not unusually soiled. Selective cleaning of soiled parts is then carried out. Special Considerations are Bath infants as soon as possible after the infant's temperature and physiologic condition have stabilized. Alkaline soaps affect The skin pH and disrupt the protective acid mantle of the skin. Soaps and shampoos containing perfumes and dyes are not recommended for newborns during the first 2-4 weeks of life. Rinse skin surface well after bathing. Rubbings skin surfaces should be avoided to prevent chafing and irritation. Immersion bath (tub baths) may be given for stable full-term infants and clinically stable preterm infants after umbilical cord and circumcision sites healed. Extremely low birth weight and unstable infants should receive a gentle sponge hath in incubator or under warmer bed. Bathing may be delayed as long as 48 hours unless baby is soiled. Remove blood from face, head and meconium from the perineal area using water-soaked sponges. Vernix need not be removed till dry, when it will fall off by belt.
[027] Bathing after the Initial Bath • Premature Infants - First 2 weeks of life: Bath 3 times per week with warm water only. - Use warm sterile water if the skin is excoriated or if the skin is extremely thin (usually found in very premature infants), - After 2 weeks of life: Bath 3 times per week with a lowalkaline soap (such as Dove, Pears) or any available baby soap. On alternative days warm water or sterile water may be used if needed. • Term infants or premature infants greater than 1 month of age: Bathe 3 times a week with a mild baby soap. Bath should be given more frequently as needed.
[028] Perianal Care given Using water-soaked cotton to buttocks and perianal region when soiled. Use sterile water if excoriation is present or the skin is extremely thin. A mild, low-alkaline soap or baby soap and water can be used to remove heavily soiled areas. As soon as the babyis wet, change the diaper and dry the area after cleaning with warm water-soaked cotton wool before replacing a new diaper consisting of soft linen or gauze and cotton. Oral care is given by Moisten mucous membranes and lips with water-soaked gauze or soft cotton wipes. Oral care may be required for infants taking regular oral feedings. Cord care given with the umbilical cord is a frequent site for colonization with bacteria. It is a port of entry for harmful bacteria and a common site for local infection. This can predispose to systemic sepsis. Cut the cord with a sterile blade about 2 cm away from the skin after clamping/tying the cord with a clamp or a sterile tie. Inspect the cord 2-4 hours after birth. Bleeding may occur due to shrinkage of the cord and loosening of the ligature. Check clamp is in the lock. One application of triple dye should be placed on the cord after birth if the need for a UAC/UVC it, not anticipated (avoid applying triple dye to the skin) Utilize alcohol in cleansing around the base of the cord after each diaper change avtooid contact with skin). Cord normally separates after 5-10 days (early in summers) but may take longer if it has been kept moistened or when it gets infected. Separation of the cord may be accompanied by slight serosanguinous discharge. This is not an indication of Infection. Clean the base with alcohol swab after cord falls off. To prevent infection the cord should be kept clean and dry.
[029] The disclosure has been described withreference to the accompanying embodiments herein and the various features and advantageous details thereof are explained with reference to the non-limiting embodiments in the following description. Descriptions of well-known components and processing techniques are omitted so as to not unnecessarily obscure the embodiments herein.
[030] The foregoing description of the specific embodiments so fully revealed the general nature of the embodiments herein that others can, by applying current knowledge, readily modify and/or adapt for various applications such specific embodiments without departing from the generic concept, and, therefore, such adaptations and modifications should and are intended to be comprehended within the meaning and range of equivalents of the disclosed embodiments. It is to be understood that the phraseology or terminology employed herein is for the purpose of description and not of limitation. Therefore, while the embodiments herein have been described in terms of preferred embodiments, those skilled in the art will recognize that the embodiments herein can be practiced with modification within the scope of the embodiments as described herein.

We Claim:

1) A care of skin in neonates (neonatal skin care guidelines), the guidelines comprise an initial bath delay of 48-72 hours if the baby is not stable and not unusually soiled; and selective cleaning of soiled parts is carried out;
wherein consideration is to bath infants as soon as possible after the infant's temperature and physiologic condition have stabilized.

2) The guidelines as claimed in claim 1, wherein the Alkaline soaps affect the skin pH and disrupt the protective acid mantle of the skin.
3) The guidelines as claimed in claim 1, wherein the Soaps and shampoos containing perfumes and dyes are not recommended for newborns during the first 2-4 weeks of life.
4) The guidelines as claimed in claim 1, wherein the rinse skin surface well after bathing. The guidelines as claimed in claim 1, wherein rubbing skin surfaces is avoided to prevent chafing and irritation.
5) The guidelines as claimed in claim 1, wherein immersion baths (tub baths) are given for stable full-term infants and clinically stable preterm infants after umbilical cord and circumcision sites healed.
6) The guidelines as claimed in claim 1, wherein extremely low birth weight and unstable infants receive a gentle sponge hath in an incubator or under a warmer bed.
7) The guidelines as claimed in claim 1, wherein bathing is delayed as long as 48 hours unless baby is soiled.
8) The guidelines as claimed in claim 1, wherein the remove blood from face, head and meconium from the perineal area using water-soaked sponges.
9) The guidelines as claimed in claim 1, wherein the vernix is removed till dry, when it will fall off by belt.