Abstract
Background: The stratum corneum is a skin layer made up of a dead cell layer of corneocytes. This structure acts as a barrier which prevents water loss while also preventing entry of infectious organisms, toxins, and allergens. Dysfunction or prematurity of this barrier can lead to increased water loss, dehydration, and therefore, hypotension, electrolyte imbalance, and weight loss. The stratum corneum does not become mature until 32 weeks postconceptional age. Therefore, the earlier the infant is born the higher the transepidermal water loss (TEWL). Adding humidity to the environment of these infants can greatly reduce the amount of transepidermal water loss. Transepidermal water loss has been associated with significant morbidity.|Purpose: The purpose of this practice change was to implement the use of humidity in the isolettes of infants 32 weeks of gestation or less.|Literature Review: Literature shows that by adding humidity to premature infant’s isolettes we may be able to decrease the incidence of morbidity due to dehydration and hypotension, intraventricular hemorrhage, necrotizing enterocolitis, electrolyte imbalances, and increased caloric demands.|Sample and Setting: The intervention of humidifying isolettes was implemented in a Midwest Level 2 NICU. All infants born at 32 weeks of gestation or less were placed in a humidified environment within six hours of birth. Data were collected on these patients and a retrospective review of a comparison group of infants was done prior to implementation of humidity to evaluate whether the added humidity contributed to less weight loss in these premature infants during the first week of life. Daily weights were documented on both groups and a comparison of total percentage of weight loss was evaluated. Also, infection rates in the NICU during this time were evaluated due to the risks of water-borne bacterial infections related to humidity being added to the isolettes as a possible contributing factor to disease in premature infants. Incidence of infection prior to and after implementation was compared. A sample of sixteen infants received humidity since the policy was implemented in July 2017.|Results/Outcomes: The data was evaluated using descriptive statistics to determine whether humidity added to the isolettes of premature infants produced less weight loss during the first week of life in similar infants as compared to infants in the NICU prior to the practice change. Evaluating the pre- and post-implementation infection rates allowed us to compare the infection rates of patients. Sixteen infants received humidity after the practice change and experienced an overall average weight loss of 3.77%. Of these sixteen infants, 2 of them were diagnosed with an infection. The retrospective chart review determined that fifteen infants who did not receive humidity experienced an overall average weight loss of 6.02% and 4 of them were diagnosed with an infection.|Conclusions/Implications: Comparison of data showed that the premature infants in an incubator with humidity experienced less weight loss and had a decrease incidence of infection in the initial days of life. The results also determined that the lower the gestational age, the higher the transepidermal water loss and therefore weight loss.