Step 2 comprised the development of the neonates and infants’ skincare algorithm. To that end, the panel comprised of four pediatric dermatologists, one dermatologist, two pediatricians, and one basic scientist from the US convened a virtual meeting on February 5, 2021. The virtual discussion was followed by an online follow-up replacing the use of a questionnaire.17 During this meeting, the systematic literature review results addressing OTC skincare for neonates and infants with healthy skin were discussed and adopted using evidence coupled with the expert opinion and experience of the panel. During the meeting in three small groups using virtual breakout rooms, the panel discussed and adapted the draft algorithm that was prepared by LS and AA based on the results of the literature searches. The breakout session was followed by presenting the three adapted versions of the algorithm to the group. An online process was then used to fine-tune the algorithm, reach consensus, and prepare and review a manuscript for publication.
The Algorithm
Figure 2A shows the algorithm which uses the Neonatal Skin Condition Score (NSCS), a validated scale to assess skin condition.20 The NSCS includes three clinical signs: 1) Xerosis, 2) Erythema, and 3) Skin breakdown.20 A 3-point scale is used to score the skin condition per sign [1 = normal, no signs, 2 = visible signs, 3 = extensive signs] (Table 3).20 After scoring per sign, the total score for all three signs is calculated. A perfect score equals three, and the worst score equals nine. If a neonate or infant scores a single score of three of one sign area or a combined score of six and above, a physician must be notified. A dermatology referral may be appropriate in this case.20-23
According to the panel, the NSCS scoring system initially developed to assess the skin condition of neonates is also applicable for infants. However, the cause of xerosis, erythema, and skin breakdown may be different.
