The development of a nomogram model for the individualized prediction of diaper dermatitis risk in pediatric hospitalized children aged 1-36 months.

AIMS AND OBJECTIVE: To develop a nomogram model for individualized prediction of diaper dermatitis in pediatric hospitalized infants and toddlers aged 1-36 months. BACKGROUND: Diaper dermatitis is a common skin health problem in pediatrics, which brings pain and discomfort to the child. However, there is a scarcity of risk prediction tools for diaper dermatitis in infants and toddlers hospitalized in pediatrics. DESIGN: A cross-sectional study. METHODS: 210 cases each for caregivers and hospitalized children aged 1-36 months were selected as the research objects. A prediction nomogram model was established based on the risk factors according to the results of univariate analysis and multivariate logistic regression analysis. The predictive performance of the nomogram model was evaluated by discrimination and calibration. The clinical utility of the model was evaluated by decision curve analysis. This study was reported using the TRIPOD checklist. RESULTS: 41 hospitalized children with diaper dermatitis with a prevalence of 19.52%. The risk factors included: age in months, diarrhea, history of diaper dermatitis, without prophylactic application of buttock protection products, frequency of diaper change per day ≤6.6 times, and the level of caregivers' knowledge of infantile diaper dermatitis. The results showed that the C-index of the nomogram model was 0.891(95% CI: 0.832, 0.950), the calibration curve manifested a satisfactory consistency, and the net benefit was satisfactory. CONCLUSIONS: The nomogram has a good predictive ability and satisfactory clinical utility, which is useful for pediatric medical staff screening high-risk patients with diaper dermatitis. RELEVANCE TO CLINICAL PRACTICE: The prediction nomogram model can help pediatric medical staff to calculate the risk probability of diaper dermatitis in pediatrics, formulate interventions timely, and optimize pediatric DD standardized care protocols. NO PATIENT OR PUBLIC CONTRIBUTION: the children's caregivers enrolled in this study only for the data collection.

The factors related to recovery time of diaper dermatitis in infants: A prospective observational study.

AIM: Prolonged diaper dermatitis may increase the risk of atopic dermatitis or infections. This prospective observational study aimed to investigate the prevalence, symptoms, areas, and recovery time of diaper dermatitis in infants aged 1 month and identify the factors related to recovery time. METHODS: Diaper dermatitis was defined as the presence of erythema, papules, dryness, erosion, or ulceration in the diapered area. Recovery time was days between infant's 1-month medical check-up and disappearance of symptoms. Survival analysis was performed using the Kaplan-Meier method, and the log-rank test was used to identify the factors related to recovery time. RESULTS: Among 113 infants, 66 (58.4%) had diaper dermatitis, with erythema at the perianal area being the most common symptom. The median recovery time was 10 days. Four infants (6.1%) had diaper dermatitis for >5 weeks. Severity was not related to recovery time. CONCLUSIONS: A frequency of diaper changing of ≤10 times per day was a risk factor for recovery time. Our data showed recovery in approximately 10 days, regardless of severity at study enrollment. Health care professionals could inform parents of recovery time and recommended diaper changing frequency.

Clinical signs and symptoms of diaper dermatitis in newborns, infants, and young children: A scoping review.

RATIONALE: Diaper dermatitis (DD) is a significant problem in the care of newborns, infants, and young children and good recognition of signs and symptoms optimises timely treatment. There is also a need for a standardised set of related descriptors to enable communication between health care providers about diagnosis and treatment. OBJECTIVE: The study aimed to review the literature for descriptive words to define the clinical signs, symptoms, and characteristics, including anatomical locations and assessment scales or tools, in the newborn, infants and young children population who have been diagnosed with DD. METHODS: A systematic review process utilising PRISMA guidelines [1] was conducted using advanced search techniques to analyse the terms from the database thesauri and keywords. Data bases including Ovid MEDLINE® and Epub Ahead of Print, in-Process & Other Non-Indexed Citations, Daily and Versions® were searched from 1946 to March 18, 2021. Cochrane Handbook Searching for and selecting studies were used as a guide and as best practice to conduct the search. RESULTS: Of the 551 publications originally identified, 55 full text publications were examined and 21 met the inclusion criteria. The wide range of descriptors used in the literature for DD supports the need for a clearer approach to report the signs and symptoms, and the severity, of DD. CONCLUSIONS: These findings point to gaps in the literature, both in recording signs and symptoms of DD and features such as wetness, infection, anatomical location, severity and pain in newborns, infants, and young children. There is a need to develop a robust methodological tool to bridge the gap and link a common terminology on signs and symptoms to support diagnosis of the severity of DD.

Diaper Need Is Associated with Pediatric Care Use: An Analysis of a Nationally Representative Sample of Parents of Young Children.

OBJECTIVE: To examine the possible association between diaper need, difficulty affording an adequate amount of diapers, and pediatric care visits for urinary tract infections and diaper dermatitis. STUDY DESIGN: This cross-sectional analysis using nationally representative survey data collected July-August 2017 using a web-based panel examined 981 parents of children between 0 and 3 years of age in the US (response rate, 94%). Survey weighting for differential probabilities of selection and nonresponse was used to estimate the prevalence of diaper need and to perform multivariable logistic regression of the association between parent reported diaper need and visits to the pediatrician for diaper rash or urinary tract infections within the past 12 months. RESULTS: An estimated 36% of parents endorsed diaper need. Both diaper need (aOR 2.37; 95% CI 1.69-3.31) and visiting organizations to receive diapers (aOR 2.14; 95% CI 1.43-3.21) were associated with diaper dermatitis visits. Similar associations were found for diaper need (aOR 2.63; 95% CI 1.54-4.49) and visiting organizations to receive diapers (aOR 4.50; 95% CI 2.63-7.70) for urinary tract infection visits. CONCLUSIONS: Diaper need is common and associated with increased pediatric care visits. These findings suggest pediatric provider and policy interventions decreasing diaper need could improve child health and reduce associated healthcare use.

Diaper Dermatitis: Prevalence and Associated Factors in 2 University Daycare Centers.

Purpose: Diaper dermatitis is uncommon in children older than 2 years because the majority of these children are diaper independent. However, diaper dermatitis still occurs, especially in children in daycare settings. This study attempted to determine the prevalence of diaper dermatitis and its associated factors among children aged 2 to 4 years attending daycare centers. Cross-sectional analysis and tests for correlation were conducted to determine the factors associated with diaper dermatitis among the study population. Results: The prevalence of diaper dermatitis during the study period was 17.2%. Factors significantly correlated with the occurrence of diaper dermatitis were beginning toilet training later than 2 years of age (odds ratio [OR] = 2.84, 95% CI = 1.17-6.86, P = .02) and the use of oral antibiotics (OR = 15.92, 95%CI = 3.57-70.94, P < .001). Conclusion: Two major adjustable factors for preventing diaper dermatitis in the study population were toilet training before 2 years of age and avoiding the use of unnecessary oral antibiotics. These results may help in devising a preventive protocol for diaper dermatitis among this age group in the future.

Diaper dermatitis prevalence and severity: Global perspective on the impact of caregiver behavior.

OBJECTIVES: To compare prevalence and severity of diaper dermatitis (DD) in infants and toddlers (babies) across three countries (China, USA, and Germany), including diapered skin measures and caregiver practices. METHODS: A cross-sectional study of 1791 babies (~600 from each country) was recruited at each clinical site. Based on regional toilet-training habits, exclusively diaper-wearing infants were recruited between ages 2-8 months in China and 2-18 months in the USA and Germany. DD was measured, as well as skin pH, transepidermal water loss (TEWL), and relative humidity (RH) in the diapered region. Caregiver habits were collected via a questionnaire and included information on hygienic practices. RESULTS: Diaper dermatitis was highest in the perianal area, followed by the intertriginous, genital, and buttock regions. In general, DD was significantly lower in babies in China, highest in Germany, and intermediate in the USA. This rank ordering of DD by geography was also observed in baby age 2-8 months. The lower DD observed in China was associated with lower skin pH and TEWL on diapered skin and decreased RH in the diaper. Chinese caregivers had the highest rate of prophylactic topical product usage, the most robust cleaning of the diapered area, lack of cleansing after urine-only diaper changes, and Chinese infants spent the least time in an overnight diaper. CONCLUSIONS: These data suggest caregiver behaviors including prophylactic use of topical products, thorough cleaning after stooling and reduced time in an overnight diaper are associated with less DD, lower superficial skin pH, and enhanced skin barrier.

Diaper dermatitis: a survey of risk factors in Thai children aged under 24 months.

BACKGROUND: To identify the prevalence and risk factors associated with diaper dermatitis in Thai children aged 1-24 months. METHODS: This was a cross-sectional study of 1153 participants using structural questionnaires, which was conducted at Khon Kaen University Faculty of Medicine Pediatric department in Thailand. Univariate and multivariate logistic regression analyses were used to test the association between diaper dermatitis and its possible risk factors. RESULTS: The prevalence of diaper dermatitis among the study population was 36.1%, a rate which significantly decreased with age. The highest prevalence was found in subjects who were one to six months old. Risk factors that had a statistically significant association with diaper dermatitis in both univariate and multivariate analysis were i) diaper changing fewer than three times/night, ii) previous episodes of diaper rash, iii) using cloth diapers, and iv) topical application of baby talcum powder to the diaper area. CONCLUSIONS: Frequent diaper changings during the daytime do not compensate for fewer changings during the night. Moreover, the use of baby talcum powder on the diaper area significantly increased the risk of diaper dermatitis among the study population. These findings should be applied in future preventive strategies for diaper dermatitis in this age group.

Dermatitis irritativa del pañal: revisión bibliográfica / Irritative diaper dermatitis: literature review

Objetivo: El objetivo de esta revisión es describir la clínica y el diagnóstico diferencial, la prevención y la educación sanitaria en la dermatitis irritativa del pañal (DIP). Método: Se realizó una revisión de las guías de práctica clínica de las diferentes sociedades científicas y grupos de trabajo relevantes, así como una búsqueda en bases de datos bibliográficas. Resultado: Los resultados de la revisión se estructuraron en las siguientes secciones: clínica y diagnóstico, prevención, productos protectores y efecto barrera, y educación sanitaria (papel de la matrona). Conclusión: El abordaje de la DIP debe ir orientado hacia la prevención y el tratamiento sintomático de las lesiones establecidas. La mejor estrategia es actuar sobre la prevención, con un buen asesoramiento a los padres sobre el cuidado de la piel del área del pañal, incidiendo principalmente en la higiene de ésta, la aplicación regular de productos protectores de la piel en cada cambio de pañal y el correcto uso del pañal

Objective: The objective of this review is to describe the clinical and differential diagnosis, prevention and health education in irritative diaper dermatitis. Method: A review of the clinical practice guidelines of the different scientific societies and relevant working groups and search in bibliographic databases were carried out. Result: The results of the review were structured in the following sections: clinical and diagnostic, prevention, protective products and barrier effect, and health education: role of the midwife. Conclusion: The approach should be oriented towards the prevention and symptomatic treatment of established lesions. The best strategy is to act on prevention, with good advice to parents on the skin care of the diaper area, focusing mainly on the hygiene of this, the regular application of skin protection products at each diaper change and the correct use of the diaper

Heridas en pediatría: Úlceras por presión, dermatitis asociada a incontinencia y lesiones por extravasación / Pediatric wounds: pressure ulcers, incontinence associated dermatitis and extravasation injures

En comparación con los adultos, la piel de los pacientes pediátricos presenta importantes diferencias que les hacen susceptibles de padecer determinadas lesiones con mayor facilidad, especialmente los neonatos. Entre ellas destacan las úlceras por presión (UPP), las dermatitis asociadas a incontinencia (DAI) y las lesiones por extravasación periférica. En todas ellas el papel de la enfermera es vital. El presente artículo describe y aporta pautas de actuación basadas en las últimas evidencias científicas para el diagnóstico precoz, la prevención y el tratamiento de estas lesiones que sirvan de ayuda a las enfermeras que atienden población pediátrica que presenta o tiene riesgo de presentar estas lesiones

Comparing to adults, children's skin has important differences that make them liable to suffer some skin lesions easily, specially neonates. Among these lesions stand out pressure ulcers, incontinence associated dermatitis and extravasation injuries. In all of them Nursing rol is vital. This article describes and provide standards of practice based in last scientific evidences for early diagnosis, prevention and treatment that are useful to nurses who cares pediatric patients with or at risk of these lesions

Perianal Dermatitis, Its Incidence, and Patterns of Topical Therapies in a Level IV Neonatal Intensive Care Unit.

OBJECTIVE: To define the incidence of perianal dermatitis (PD) and determine the usage pattern and cost efficacy of diaper products among neonates admitted to a level IV neonatal intensive care unit (NICU) including those with a diagnosis of neonatal abstinence syndrome (NAS). METHODS: A retrospective cohort study to evaluate neonates with PD based on number of orders for Aquaphor, Bagbalm, Desitin, Flanders, or Nystatin. Various demographic and clinical parameters were recorded. Usage patterns of these five products were analyzed, and their costs estimated. Subgroup analysis was performed among infants with NAS. RESULTS: Of 1,241 admissions, 56.2% had at least one diaper product ordered during their NICU stay, while 52.6% had multiple products ordered. Only 23.0% of all neonates had appropriate documentation of PD. The most common product ordered first was Aquaphor (64.3%), followed by Desitin (19.2%). Note that 86% term NAS infants had PD compared with 28% term non-NAS infants. The estimated product cost was $14,139 over 2 years, averaging $20 per patient. CONCLUSION: Over half of NICU neonates were exposed to one or more diaper products, usually without documented PD diagnosis. Term NAS infants had three times higher incidence of PD than term non-NAS infants. The cost of diaper product use was significant, and possibly underestimated due to lack of documentation.

Efeito da pomada de óxido de zinco e da película de barreira não irritante na prevenção da dermatite associada à incontinência em idosos hospitalizados: ensaio clínico randomizado / Effect of zinc oxide ointment and non-irritant barrier film on the prevention of incontinence-associated dermatitis in hospitalized elderly: a randomized clinical trial

Observa-se na prática clínica pacientes internados com Dermatite Associada à Incontinência (DAI), uma inflamação cutânea que ocorre como consequência do contato entre a pele perineal, perigenital, perianal e áreas adjacentes com urina e fezes, além de epiderme com erosão e maceração. O cuidado com a prevenção deve ser estabelecido, mas pouco se sabe sobre esse cuidado. É necessário evitar ou minimizar a exposição a fatores causais e uma combinação de cuidados específicos da pele, como a limpeza da região, aplicação de produtos barreira. Normalmente, são utilizados sabão e água e é aplicado a pomada de óxido de zinco, um creme de barreira. No entanto, desde a década de 1990, uma película de barreira não irritante (PBNI), livre de álcool foi projetado para proteger a pele. O objetivo deste estudo foi comparar o efeito do uso de pomada de óxido de zinco e PBNI na prevenção de DAI em pacientes incontinentes internados em unidades de clínica médica. É um estudo experimental, do tipo ensaio clínico randomizado realizado em um hospital geral, de grande porte, público e de ensino. A população do estudo foi constituída por 114 pacientes idosos, que apresentavam eliminações urinárias e fecais em fralda descartável. Foram definidos três grupos de estudo, com 38 paciente em cada grupo: controle com o uso da higienização com água e sabão, intervenção I com a higienização e aplicação da pomada de óxido de zinco e intervenção II com higienização e aplicação do PBNI spray. Para a análise descritiva, foram utilizadas as distribuições de frequência simples, medidas de tendência central e medidas de variabilidade; para a avaliação do efeito das intervenções, o teste de regressão de Cox. Quanto ao efeito dos tratamentos sobre o risco de adquirir a DAI, identificou-se que os pacientes que receberam a intervenção II apresentaram menor risco (HR=0,54; p= 0,183) quando comparado ao grupo que recebeu intervenção I (HR=1,06; p=0,895) e ao grupo que recebeu somente a higienização. Contudo, não se encontrou diferença estatisticamente significativa entre os dois grupos de intervenção e o controle, não sendo possível afirmar qual a melhor intervenção. As variáveis que tiveram influência no aparecimento da DAI foram: dias de uso de tamanho adequado da fralda, número de dias de fezes pastosas, pacientes em risco nutricional e nível de saturação de oxigênio, sendo, portanto, fatores que devem ser monitorados pela enfermagem para evitar o surgimento do problema.(AU)

It is observed in clinical practice patients hospitalized with Incontinence-Associated Dermatitis (IAD), a cutaneous inflammation that occurs as a consequence of the contact between the perineal, perigenital, perianal skin and adjacent areas with urine and feces, as well as epidermis with erosion and maceration. Care with prevention should be established, but little is known about such care. It is necessary to avoid or minimize exposure to causative factors and a combination of specific skin care, such as cleaning the region, applying barrier products. Usually, soap and water are used and it is applied to zinc oxide ointment, a barrier cream. However, since the 1990s, a non-irritating barrier film (NIBF), alcohol-free was designed to protect the skin. The objective of this study was to compare the effect of the use of zinc oxide ointment and NIBF in the prevention of IAD in incontinent patients hospitalized in medical clinic units. It is an experimental study, of the type randomized clinical trial conducted in a general hospital, large, public and teaching. The study population consisted of 114 elderly patients, who had urinary and fecal eliminations in a disposable diaper. Three study groups were defined, with 38 patients in each group: control with the use of soap and water hygiene, intervention I with the hygiene and application of the zinc oxide ointment and intervention II with hygiene and application of NIBF spray. For the descriptive analysis, we used the simple frequency distributions, measures of central tendency and measures of variability; for the evaluation of the effect of the interventions, the Cox regression test. Regarding the effect of the treatments on the risk of acquiring the IAD, it was identified that the patients who received the intervention II had a lower risk (HR = 0.54; p = 0,183) when compared to the group that received intervention I (HR = 1.06, p = 0.895) and the group that received only the hygiene. However, no statistically significant difference was found between the two intervention groups and the control, and it was not possible to state the best intervention. The variables that influenced the appearance of IAD were: days of adequate diaper size, number of days of pasty stools, patients at nutritional risk and oxygen saturation level, and therefore, factors that should be monitored by nursing to prevent the problem from arising.

Skin pH and Transepidermal Water Loss Values in Children with Diaper Dermatitis in Ibadan, Nigeria.

BACKGROUND/OBJECTIVES: Diaper dermatitis (DD) is one of the most common skin conditions in infants and young children. Among the factors associated with greater frequency of DD are high skin pH and transepidermal water loss (TEWL). This study examined the prevalence of DD in healthy black children in Nigeria and evaluated the association between skin surface pH, TEWL, and DD in this population. METHODS: The study was cross-sectional in design and involved children younger than 2 years attending eight immunization clinics in Ibadan, Nigeria (N = 424). Children were recruited into the study using multistage sampling. Information collected included sociodemographic data, diapering and feeding practices. Physical examination of the diaper area was performed on each child to determine whether dermatitis was present. TEWL and skin pH were measured on the anterior chest wall and gluteal areas of each child. RESULTS: A total of 165 (38.9%) children had clinical evidence of DD. The mean skin pH and TEWL values were higher in the gluteal area than the anterior chest wall in all subjects, with or without dermatitis. The mean skin pH and TEWL were significantly higher on the anterior chest wall and in the gluteal area in children with DD. CONCLUSION: In Nigerian children with DD, skin pH and TEWL are higher in the diaper area and at an unaffected skin site.

Incontinence-associated dermatitis: a cohort study in critically ill patients. / Dermatite associada à incontinência: estudo de coorte em pacientes críticos.

OBJECTIVES: Estimate incidence, determine risk factors and propose a prediction model for the development of incontinence- associated dermatitis critically ill adult patients. METHOD: Concurrent cohort study with 157 critically ill patients. Data collection was daily performed between February and July 2015, at a public teaching hospital of Belo Horizonte, Minas Gerais. Data was entered in a database and subjected to descriptive, survival and multivariate analysis. RESULTS: An overall incidence of 20.4% was obtained. Nineteen (19) risk factors significantly associated with the disorder were found. The variables identified in the risk prediction model were male, trauma, use of hypnotics/sedatives, lactulose, nutritional support, loose stools and complaints of burning. CONCLUSION: The results showed that dermatitis is a common clinical finding in critically ill adult patients and requires special attention from the nursing staff.

Construcción de un instrumento de valoración del riesgo y gravedad de las lesiones del área del pañal en lactantes RDIC-lac / Construction of an instrument of risk assessment and injury severity for the diaper area in infants: RDIC-lac

Objetivo. Diseño de una escala para valorar el deterioro de la integridad cutánea en el área del pañal del lactante y la gravedad de la lesión para la prevención y manejo de la dermatitis irritativa de pañal. Metodología. Estudio en 3 etapas: 1) revisión exhaustiva y lectura crítica de literatura para el diseño preliminar del instrumento; 2) evaluación crítica de propuesta inicial por grupo de expertos (enfermería y medicina pediátrica) con cuestionarios de opinión y guía de preguntas ad hoc; 3) análisis de contenido mediante tabulación de datos para la modificación y diseño final del instrumento. Ámbito. Gerencia de Atención Primaria de Tenerife. Resultados. En la 1.ª fase se diseña una propuesta de instrumento: dos grupos de factores de riesgo (10 moduladores del riesgo y 9 de alto riesgo) y escala de gravedad con 5 aspectos a valorar de 4-5 ítems cada uno (profundidad, localización, extensión, tipo de lesión, signos de infección). En la 2.ª fase participan 19 profesionales. Se realiza una tabulación de los datos agrupados en factores a añadir u omitir. La 3.ª fase finaliza con una versión del instrumento modificada: 10 factores moduladores, 5 de alto riesgo y 4 ítems para cada aspecto a valorar en escala de gravedad. Discusión-Conclusiones. La escasa bibliografía encontrada y la ausencia de herramientas similares justificaron el diseño. La siguiente fase será la validación del instrumento RDIC-lac. Relevancia clínica. Susceptibilidad de prevenir lesiones cutáneas en el área del pañal en la edad pediátrica (AU)

Objective. To design an instrument to measure impairment of skin integrity in the diaper area of infants and severity of injury for the prevention and management of irritative diaper dermatitis. Methodology. Design in 3 phases: 1) comprehensive review and critical appraisal of literature to design the preliminary content of the instrument; 2) critical evaluation of initial proposal by an expert group (nursing and pediatric medicine) with opinion survey and ad hoc questions; 3) content analysis using data tabulation for the modification and final design of the instrument. Setting. Primary Care Management of Tenerife Results. In the 1st phase a proposed instrument is designed: two groups of risk factors (10 modulators risk and 9 high risk); and a severity scale with 5 aspects to assess including 4-5 items each (depth, location, extension, type of injury, signs of infection). The 2nd phase involved 19 professionals. A Tabulation of the data grouped into add or omit factors was used. The 3rd phase ends with a modified version of the instrument: 10 modulating factors, 5 of hig risk and 4 items for each aspect to assess severity. Discussion-Conclusions. The scarce bibliography found and the absence of similar tools explain the design. The next phase will be the validation of RDIC-lac instrument. Clinical relevance. Susceptibility to prevent skin lesions in the diaper area in the pediatric age (AU)

Preventive effects of topical washing with miconazole nitrate-containing soap to diaper candidiasis in hospitalized elderly patients: A prospective, double-blind, placebo-controlled study.

The objective of the present randomized, double-blind trial was to evaluate the efficacy and safety of daily washing with miconazole nitrate-containing soap for candidiasis at diaper-covered sites in elderly subjects under long-term inpatient care. To confirm the onset and disappearance of candidiasis, we microscopically evaluated the existence of the pseudohyphae and/or blastoconidia of Candida spp. We enrolled 75 elderly patients who wore diapers all day in the hospital or nursing home. Patients were randomly assigned to receive treatment with either miconazole soap or miconazole-free placebo soap, and 28 patients in the miconazole group and 27 patients in the placebo group were followed for 4 weeks. Although washing with miconazole soap did not affect the frequency of pseudohyphae/blastoconidia-positive patients, it significantly inhibited the positive conversion of pseudohyphae/blastoconidia compared with the placebo group. As a result, the frequency of patients positive for pseudohyphae/blastoconidia was significantly lower in the miconazole group than in the control group at 4 weeks (17.9% vs 44.4%). Clinically apparent diaper candidiasis did not develop in either group. Washing with miconazole soap was a significant independent factor for reducing the cases positive for pseudohyphae/blastoconidia, while diarrhea and heart failure were significant factors associated with an increase in the positive rate at the end-point. Severe adverse effects were not found in any patients. Thus, washing with miconazole soap is well-tolerated and can inhibit the positive conversion of Candida in patients wearing diapers. Therefore, maintenance of genital hygiene using this soap may prophylactically decrease the overall prevalence of patients with diaper candidiasis.

Diaper Dermatitis: A Review of 63 Children.

BACKGROUND/OBJECTIVE: Diaper dermatitis (DD) is a common infantile dermatosis with a highly variable prevalence and incidence. This study aimed to present the demographic and clinical features of babies with DD. METHODS: Data, including demographic and clinical features, obtained from DD patient forms were retrospectively analyzed. RESULTS: The study included 63 babies with DD (female: n = 35 [55.6%]; male: n = 28 [44.4%]; mean age 11.6 mos). Most of the patients (43.5%) were 0 to 6 months of age. In all, 76.3% were breastfed, of whom 31.7% were exclusively breastfed. The number of previous episodes of DD was significantly lower in breastfed babies. The most common diaper area cleansing method was wet wipes (54.1%). Diaper creams were used in 86.2% of patients. DD was severe in 22.2% of patients, moderate in 57.4%, and mild in 20.4%. Candida infection was noted in 77.4% of patients. The median number of previous episodes of DD was significantly higher in patients with Candida infection than in those without (p = 0.02). Treatment yielded greater than 50% improvement (complete and moderate response) in 59.4% of patients at the first follow-up visit (3-5 days) and 82.6% at the second follow-up visit (10 days). CONCLUSION: Most babies with DD were 0 to 6 months of age. Breastfed babies had fewer previous episodes of DD, so mothers should be encouraged to breastfeed their babies to reduce the incidence of DD. Candida infection was common; clinicians should be aware of its association with DD.

Comparative Study between Talcum and Zinc Oxide Cream for the Prevention of Irritant Contact Diaper Dermatitis in Infants.

Background: Baby powder which consists of talcum powder (magnesium silicate) as an active ingredient has been popularly used for prevention of irritant contact diaper dermatitis for a long time because it has water absorbent and friction-decreased properties. There are some case reports of its side effects of pulmonary complication from massive inhalation and the risk of ovarian tumors in adult. However the clinical research on the effectiveness of talcum powder for the prevention of diaper dermatitis has not been investigated. Objective: To compare the effectiveness between talcum powder with topical zinc oxide cream for the prevention of irritant diaper dermatitis. Materials and Method: Fifty Thai infants at the age of 6-12 months old were randomized. Either topical talcum powder or zinc oxide cream was topically applied to their skin before changing new diapers. The follow-up were conducted at week 0, 2 and 8 to evaluate an occurrence of diaper dermatitis and to collect the median time-to-event data (the duration of disease occurrence). The clinical severity was assessed by using diaper dermatitis severity scoring scale and the side effects were recorded. Results: The average age of the infants was 8.8 months old. The incidence of irritant contact diaper dermatitis from the talcum group was 4 per 1,000 persons-day (95% confidence interval, 95% CI: 2-7) while the incidence of diaper dermatitis from the zinc oxide group was 2 per 1,000 persons-day (95% CI: 1-5). The median time-to-event outcome of diaper dermatitis for the talcum group was 19 days (interquartile range, IQR: 7-29) which was earlier than that of zinc oxide group, which was 39 days (IQR: 30-59). This showed statistically significant difference (p = 0.03, Log rank test). The average of disease duration of the talcum group (mean + SD) was 2.7+0.5 days whereas that of the zinc oxide group was 3.7+3.3 days. There is no significant difference between the two groups (p = 0.34). Most of the severity of the disease found in both groups is mild. The risk evaluation of diaper dermatitis at week 8, determined by using Cox proportional hazard analysis showed that the talcum group had 5.3 times greater risk than the zinc oxide group (hazard ratio, HR; 5.3, 95% confidence interval, CI: 1.4-20.0), with significant group difference (p = 0.01). There was no adverse effect detected on both groups. Conclusion: Topical zinc oxide cream was better than talcum powder for the prevention of irritant contact diaper dermatitis.

Dermatite associada à incontinência: estudo de coorte em pacientes críticos / Dermatitis asociada con incontinencia: estudio de cohorte en pacientes críticos / Incontinence-associated dermatitis: a cohort study in critically ill patients

RESUMO Objetivos Estimar incidência, determinar fatores de risco e propor modelo de predição de risco para desenvolvimento de dermatite associada a incontinência em pacientes adultos críticos. Método Trata-se de um estudo de coorte concorrente realizado com 157 pacientes críticos. A coleta de dados foi conduzida diariamente entre fevereiro e julho de 2015 em hospital público e de ensino de Belo Horizonte, MG. Os dados foram lançados em banco de dados, submetidos a análise descritiva de sobrevida e multivariada. Resultados Obteve-se uma incidência global de 20,4%. Foram encontrados 19 fatores de risco que apresentaram associação significativa com o problema. As variáveis encontradas no modelo de predição de risco foram: sexo masculino, trauma, uso de hipnótico/sedativos, lactulona, suporte nutricional, fezes pastosas e queixa de ardência (local). Conclusão Os resultados mostraram que a dermatite é um achado clínico comum em pacientes adultos críticos e merece atenção especial para maior qualidade da assistência de enfermagem.

RESUMEN Objetivos Estimar incidencia, determinar factores de riesgo y proponer modelo de predicción de riesgo para el desarrollo de la dermatitis asociada a la incontinencia en pacientes adultos críticos. Método Se trata de un estudio de cohorte concurrente de 157 pacientes críticamente enfermos. La recolección de datos se realizó diariamente entre febrero y julio de 2015, en un hospital público y de enseñanza de Belo Horizonte-MG. Los datos se introdujeron en la base de datos, sometidos a análisis descriptivo, de supervivencia y multivariada. Resultados Se obtuvo una incidencia global del 20,4%. Se encontraron 19 factores de riesgo asociados significativamente con el problema. Las variables identificadas en el modelo de predicción de riesgo fueron: sexo masculino, trauma, uso de hipnóticos/sedantes, lactulona, soporte nutricional, heces sueltas y queja de ardor (local). Conclusión Los resultados mostraron que la dermatitis es un hallazgo clínico frecuente en pacientes adultos críticos y merece una atención especial para una mayor calidad de los cuidados de enfermería.

ABSTRACT Objectives Estimate incidence, determine risk factors and propose a prediction model for the development of incontinence- associated dermatitis critically ill adult patients. Method Concurrent cohort study with 157 critically ill patients. Data collection was daily performed between February and July 2015, at a public teaching hospital of Belo Horizonte, Minas Gerais. Data was entered in a database and subjected to descriptive, survival and multivariate analysis. Results An overall incidence of 20.4% was obtained. Nineteen (19) risk factors significantly associated with the disorder were found. The variables identified in the risk prediction model were male, trauma, use of hypnotics/sedatives, lactulose, nutritional support, loose stools and complaints of burning. Conclusion The results showed that dermatitis is a common clinical finding in critically ill adult patients and requires special attention from the nursing staff.

Diaper Dermatitis in Infants Admitted to Social Pediatrics Health Center: Role of Socio-demographic Factors and Infant Care.

OBJECTIVE: To determine infant diaper dermatitis (DD) at pediatrics health center; its relation to socio-demographic factors and infant care. METHODS: The study included 113 infants aged 0-24 mo. Data on infants' age, sex, weight, mothers' education, nutrition, diaper change frequency, cleaning methods and prophylactic cream use were recorded. Infants with minimum one time rash, were accepted to have DD. RESULTS: Seventy six (67.3 %) infants had DD [32 girls (42.1 %), 44 boys (57 %), mean age: 6.5 mo]. Infants with DD had significantly higher age than those without (p 0.001). DD frequency in infants ≥4.5 mo-old was 5.8(2.4-13.7) times more than in infants ≤4.5 mo. Cleaning material types did not affect DD frequency. No significant difference was observed in DD with diaper change of ≤3 times and ≥4 times. Significant difference in DD increase was observed with supplementary food intake vs. without it (p 0.000). DD frequency in infants with supplementary food intake was 6.4 times (2.4-17.1) more than in those without it. Human milk intake was statistically significant in causing less occurrence of DD as shown in univariate model (p < 0.05). Rash incidence was significantly lower with cream use compared to without its use (p < 0.001). DD prevalence was decreased 0.203 (0.087-0.477) times by cream usage. CONCLUSIONS: Age, supplementary food intake and lack of cream use seem to be accountable for DD whereas human milk intake lessened the occurrence of DD. Mothers should be informed on dermatitis care and encouraged for breastfeeding.