Chapter 42 ■ Neonatal Ostomy and Gastrostomy Care 295

Fig. 42.5. One-piece ostomy appliance on small newborn

dwarfs this infant but provides longer wear time and holds larger

volume of output than the preemie pouches previously used.

skin and obtain acceptable wear time. In the rare

instance when a pouch cannot be maintained, it

may be necessary to leave the pouch off and protect

the peristomal skin with a protective barrier ointment that will adhere to denuded skin to allow the

skin to heal. The barrier ointment can be covered

with petrolatum-impregnated gauze; fluff gauze can

then be placed on top to absorb the effluent and

changed as needed. In some cases of severe skin

damage, some neonatal centers stop enteral feedings briefly to limit stool production and allow the

skin to heal (2). The more damaged the skin, the

more difficult it is to maintain a seal. It is best to

heal the skin, get a good seal, and then resume the

feeding.

d. Protect stoma from trauma. Measures include accurate sizing of the pouch opening to clear the stoma

as the size changes. If the infant’s movements cause

the inner edge of the barrier to rub against the

stoma, a moldable barrier between the stoma and

the wafer can be used to protect the stoma.

E. Equipment

A variety of pouches and ostomy care supplies are available

(Tables 42.2). One-piece pouches come with a barrier and

pouch attached as a single unit. Two-piece appliances have

a barrier and pouch separate, with a mechanism for attaching the pouch to the wafer. The type of pouch used for a

Table 42.2 Ostomy Accessory Products

Product Indications and Precautions

Barrier powder This product is used to dry moist and/or weepy skin. It can add extra adhesiveness to the

skin. It must be sealed by padding with a moistened finger and allowed to dry. In cases of

severely moist weeping skin, it may be necessary to apply powder and seal two or three

times to attain a dry peristomal skin surface. It adds an additional barrier over the skin to

protect from drainage. Apply in limited amounts and wipe off excess. Protect infant from

inhalation of aerosolized powder by using minimal amounts and wiping away gently; do

not blow powder away.

Paste Barrier product that is semiliquid because of addition of alcohol. Best if applied to barrier

and allowed to air for 1 to 2 minutes to allow the alcohol to evaporate (Fig. 42.6). Not

recommended for use on premature infants or term infants <2 weeks old.

Skin sealants Sealants use plasticizing agents to form a barrier on the skin that can protect from effluent

and also improve adherence of some adhesives. Most skin sealants contain alcohol and

are, therefore, contraindicated for use in preemies or term neonates <2 weeks old. One

skin sealant that does not contain alcohol is Cavilon No Sting Barrier Film (3M, St. Paul,

Minnesota).