Human Milk as Diaper Dermatitis Prevention in the NICU: A Quasi-Experimental Study.

Background: Infants in the Neonatal Intensive Care Unit (NICU) face significant skin integrity challenges due to immature epidermis and weakened immune defenses. Despite the prevalence of diaper dermatitis among NICU infants, exacerbated by overhydration and skin barrier disruption, standardized preventive measures remain inconsistent with a lack of focus on natural solutions. Human milk, with its immunoprotective and anti-inflammatory properties, holds promise as a topical preventive agent for diaper dermatitis (DD), yet remains under-researched.

Purpose: This study evaluated the prevalence of DD following the prophylactic application of human milk to the diaper area, referred to as "breast milk on babies' bottoms" (BoBB).

Methods: A pre-post quasi-experimental design was used in a Level III NICU from September 2017 to March 2018 to evaluate BoBB. Infants >34 weeks gestation, with NICU stays >7 days, receiving >160 mL of maternal human milk by Day 7, and without prior DD or barrier product use were included.

Results: A total of 56 infants were analyzed, with 32 in the control group and 24 in the BoBB group. The prevalence of DD was 25% (n = 6) in the BoBB group, compared to 53% (n = 17) in the control group. The sample had mean gestational age and birth weights of 36.2 weeks (SD 1.9) and 2602.5 g (SD 712), respectively. Infants in the BoBB group had lower birthweights, lower gestational ages, and longer NICU stays.

Implications for practice and research: This first U.S. study on human milk for DD prevention in the NICU suggests that it may serve as a safe, effective alternative to barrier creams for infants >34 weeks.