New research has found that a brand of baby wipes is just as safe and hydrating as using water alone on newborn skin, suggesting official guidance may need updating.
The University of Manchester study, published in BioMed Central’s open-access journal BMC Paediatrics, compared Johnson’s Baby Extra Sensitive Wipes against cotton wool and water on 280 newborn babies split into two groups over a three-year period.
Despite advice from the UK’s National Institute for Clinical Excellence (NICE) that mums should use water alone on newborns, the study found that the Johnson’s wipes were as effective and as safe as water and hydrated babies’ skin just as well.
Tina Lavender, Professor of Midwifery at the University’s School of Nursing, Midwifery and Social Work and study lead, said: “Baby wipes can be much more convenient for parents, especially when on the go, but current NICE guidelines recommend using cotton wool and water.
“Our research, looking at one high street baby wipe, wanted to test whether the product was as safe and effective on newborn babies’ skins as water alone to see if midwives could help give parents more options than current guidelines provide.”
The study, funded by Johnson & Johnson, the makers of Johnson’s Baby but carried out under strict, independent scientific protocols, including blind testing and peer review, showed the company’s product was as safe and effective as using water. There was a slight, though not statistically significant, reduction in the occurrence of nappy rash using the Johnson’s wipe.
Professor Lavender added: “Parents can now be confident that using this specific baby wipe, proven in the largest randomised clinical trial conducted in newborn cleansing, is equivalent to water alone. Our trial provides us with the strongest evidence available so far that we shouldn’t base our practice on tradition alone and that NICE needs to look at its current guidelines.
“For the first time, we now have a robust, adequately-powered study that can be used in practice, the results of which should be adopted by our national guidelines. These results should provide healthcare professionals with much needed evidence-based information, giving them the option to support the skin-care cleansing regime best suited to individual parents and their newborn babies.”
The findings of the wipes study showed that Johnson’s Baby Extra Sensitive Wipes were equivalent to water and cotton wool in terms of skin hydration. No significant differences were found in the secondary outcomes, except for maternal-reported napkin dermatitis (nappy rash), which was higher in the water and cotton wool group.
Newborn skin is different to adult skin. Trans epidermal water loss (TEWL), which indicates the amount of water that escapes from the skin, is higher in newborns than in older baby skin. Consequently, the newborn skin barrier is less mature and likely to be more vulnerable to environmental threats. TEWL does not decrease to ‘mature’ levels until at least the first year of life.
The randomised, assessor-blinded controlled wipes trial, was conducted with 280 newborn babies at Central Manchester NHS Foundation Trust, randomised into two groups: cleansing the nappy area with cotton wool and water, and cleansing the nappy area with Johnson’s Baby Extra Sensitive Wipes. Throughout this trial, mums were advised to bathe their newborns in water alone and not to use any other product on their baby’s skin except in the event of nappy rash, in which case they could use a cream provided.
The primary endpoint of the trial was the change in hydration between baseline and at four weeks. Hydration is a measure that shows how much water is contained in the skin, one of the characteristics of skin barrier integrity. Secondary endpoints were TEWL, skin pH, erythema, nappy rash, microbial contamination, clinical observations and maternal views (diaries and structured questionnaires).
Current guidelines vary in their advice and are challenged by the personal beliefs of many health-care professionals. The 2006 National Institute for Health and Clinical Excellence (NICE) guideline, Routine postnatal care for women and their babies, recommends that the use of baby wipes should be avoided in the first six to eight weeks after birth. However, this guidance is not based on robust evidence, rather it is based on the collective experience of the expert guidelines group.
A copy of the paper, ‘Effect on skin hydration of using baby wipes to clean the napkin area of newborn babies: assessor-blinded randomised controlled equivalence trial,’ is available on request. The paper is published in BioMed Central’s open-access journal BMC Paediatrics.
The trial was conducted fully independently by a group of health-care professionals and was approved by the ethics committee and monitored by and external Data Monitoring Committee (DMC).
University of Manchester