Current skin care practices in very low birth weight infants in German Neonatal Intensive Care Units – results from a cross-sectional survey

Abstract Background The skin is the largest epithelial organ and a critical barrier. However, in preterm infants, particularly very low birth weight infants (VLBWI, < 1500 g), it is immature and highly susceptible to injury and infection. Despite growing awareness of neonatal skin care, evidence-based guidelines for this vulnerable population are lacking. This study aimed to provide an overview of current skin care practices in German Neonatal Intensive Care units (NICUs) and compare them with other European centers. Methods A cross-sectional, web-based survey was distributed to German level III NICUs (n = 70) and selected European centers (n = 10) in May 2025. The questionnaire comprised 20 items covering skin risk assessment and skin care routines, bathing, skin antisepsis, and perceived challenges. Responses were analyzed descriptively. Results The overall response rate was 73.8% (n = 59). Responses were analyzed from 48 German NICUs and eight European centers. Among German centers, only 14.6% (n = 7) reported applying skin risk assessment tools, and 16.7% (n = 8) reported standardized skin care protocols. A dexpanthenol-containing cream was the most commonly used skin care product. Use of other products varied greatly, while 39.6% of German centers (n = 19) reported using no skin care products at all. Bathing was practiced in 77.1% of NICUs (n = 37), with frequency and use of additives varying. Octenidine 0.1% and its combinations were the main products for skin antisepsis. Major challenges perceived by neonatologists included high skin vulnerability (87.5%), issues with adhesives (72.9%), risk of infection (64.5%), and limited or unclear evidence in skin care of VLBWI (54.2%). Criteria for product selection included clinical evidence (60.4%), practical experience (60.4%), and hygiene regulations (54.2%). Comparison with reports from the other European countries revealed both notable similarities and considerable variations in practices across the international context. Conclusion Skin care practices for VLBWI in German and European NICUs vary widely, with limited use of standardized protocols or risk assessment tools. High skin vulnerability, issues with adhesives and infection risk remain the main challenges. These findings underscore the urgent need for evidence-based guidelines to optimize skin care in this high-risk population.