Abstract
Objective To define the incidence of perianal dermatitis (PD) and determine the usage pattern
and cost efficacy of diaper products among neonates admitted to a level IV neonatal
intensive care unit (NICU) including those with a diagnosis of neonatal abstinence
syndrome (NAS).
Methods A retrospective cohort study to evaluate neonates with PD based on number of orders
for Aquaphor, Bagbalm, Desitin, Flanders, or Nystatin. Various demographic and clinical
parameters were recorded. Usage patterns of these five products were analyzed, and
their costs estimated. Subgroup analysis was performed among infants with NAS.
Results Of 1,241 admissions, 56.2% had at least one diaper product ordered during their NICU
stay, while 52.6% had multiple products ordered. Only 23.0% of all neonates had appropriate
documentation of PD. The most common product ordered first was Aquaphor (64.3%), followed
by Desitin (19.2%). Note that 86% term NAS infants had PD compared with 28% term non-NAS
infants. The estimated product cost was $14,139 over 2 years, averaging $20 per patient.
Conclusion Over half of NICU neonates were exposed to one or more diaper products, usually without
documented PD diagnosis. Term NAS infants had three times higher incidence of PD than
term non-NAS infants. The cost of diaper product use was significant, and possibly
underestimated due to lack of documentation.
Keywords
perianal dermatitis - diaper dermatitis - neonatal intensive care unit - neonatal
abstinence syndrome - diaper product
