A Unique Transforming Powder Technology for Managing Skin Breakdown in Extremely Low Birthweight Babies

Vera Berry:

Hi, my name is Vera Berry. I work at AdventHealth Orlando. I am a certified pediatric nurse. I'm certified in extremely low birth weight babies, certified in wound care and ostomy care. I've been a nurse since 1980. Most of my career has been dedicated to NICU and pediatrics, and I have just transitioned to wound care in order to make a difference.

We had been called out to see a 22, 23 week baby. These are kids that are born very immature. In the past, they did not survive. So this is a brand new field, that is what my credentialing is for extremely low birth weight babies, these are these babies. They are born with very little stratum corneum, two cells thick, if that, you can see all kinds of things because it's so transparent, veins. They look almost ominous when they're first born. I actually brought a doll to kind of give you a visual of just how tiny these babies are. Okay, this is about the size of a micro preemie. So we went out to see this baby and one of the things that happens quite frequently is that the little tapes for the EKG monitor when they come off, they pull a lot of skin with them. And this baby already had a lot of skin breakdown and you have to understand that when those layers of skin are gone, you are already down to the dermal layer. So these areas begin to bleed and they're very difficult to heal in the past.

By transitioning to wound care, I started seeing some of the products in the formulary for adults and I saw this product, it's a polymer powder. We put that on the baby's skin and you sprinkle it on like dust and then you need to moisturize it. So what I did was I took one of the little bullets for the saline for suctioning, and I put that in the bottle warmer to warm it up for a few minutes so that it wasn't cold, 'cause these babies are very sensitive to cold stress. And I dripped it over top of it. And then we placed a piece of Mepilex Transfer on top of that just to protect their skin. And it was pretty remarkable, the baby healed in less than 2 weeks, as you can see.

There are very few products and research being done on micro preemies, premature babies and their skin issues, and coming over to this area I now see how lacking this area is in terms of having wound care nurses that are specifically for the pediatric NICU population, that are aware of their particular needs and cautions that you would have to take in treating those kids. For example, their skin is so thin that anything that you put on it will be absorbed into their bodies, just about. So you have to be very careful about the products that you put on these babies because it can become toxic very quickly.

So it was very encouraging to see a product that met all those qualifications, that did not have a toxic effect, create such a positive outcome in such a short period of time. Once these babies get that hard crusty surface on their skin, it's very hard for their body to epithelialize. And what happens, they can help the migration of the keratinocytes into the wound bed by making the body believe that there's already a layer of epithelial cells there that they can begin regenerating. It is very neat and I was very excited to be a part of that.

I think the whole thing was very surprising to me. You just sit back and you go, "Okay, how's this baby going to react to something like this? It's brand new. We've never tried it before. How's this going to work?" And one of the biggest things was that the mother was on board. That is a huge thing because when you're dealing with these types of babies and they're so vulnerable and so tiny, the mothers are often very anxious and they don't understand all the technology and the terminology that you're trying to do for their baby. "What are you trying to do?" And this mother just happened to know this product because she had worked in a different field where they had used it. So we didn't even have to explain to her what the product was and what we expected it to do, she was on board from the day 1, and that was very exciting. That was very unexpected.

That's a hard question to answer because that's part of the problem with pediatrics and NICU is actually doing research because you would literally have to withhold the polymer on one child and give it to another and see what the difference was. Yeah, well you would have to have a control group. So, I mean, we can go by past experience of what we've seen, that's something. But to actually do a trial, it's very difficult because you have to have everybody on board.

One of the things that I personally believe is that skin is the largest organ of the body, even for a baby, and when babies have their skin break down there's several things that are going on. First of all, that's the first line of defense, and these babies have already got a lot of things on their plate. Their lungs are not developed. Their brain is not developed at all, it's just a central matrix in the middle of the brain area that is going to grow out into that area. And all that is going to happen inside that isolette where, if the baby had stayed in the womb, he or she would've grown in the womb and matured in that way. But instead, all of that has to happen inside that isolette. So you have skin breakdown. You have also the fact that the baby's immune system is immature, so any kind of germ or something like that that can get in there, can alter that baby's state.

And I believe that the baby is, actually, the body of the baby is trying to allocate resources towards that skin because even though for us it looks like, well, that's kind of superficial, it's really a lot of skin that got taken off and the baby is trying to allocate resources to heal that. At the same time they're trying to breathe and the brain is trying to grow and all of those they necessitate protein to function. So if you can just take that one thing off their plate, then they can allocate their resources towards things like growing new lung tissue or that brain developing.

Plus, in the research, one of the biggest things that they have found in studies is that when these kids reach around 6 years old, their executive function is way off, and they have backtracked that to how are we dealing with them when they were just tiny and so vulnerable. And so we have done all kinds of things to try and minimize that stress that they're going through. One of the things is the first 72 hours we are just very particular about touching them. They only get touched every 6 hours, unless there was absolute necessary reason to get into that isolette to do something, we leave them alone, and we just try to produce the most stress-free environment we possibly can for these kids.