Diaper rash is a common occurrence during infancy, with Safe and effective colonization of B. infantis in the infant gut has an estimated 50% of all infants in a pediatrician’s practice now been demonstrated through feeding the probiotic strain B. experiencing this condition at some point in their diaper-wearing infantis EVC001 to term, breastfed infants.11,12,13 Furthermore, years.1 Although diaper rash itself is not usually harmful, infants in this study who received B. infantis EVC001 had a emerging data now suggest that diaper rash may be an early significant reduction in the number of loose, watery stools per indicator of gut dysbiosis, or an overgrowth of pathogenic day compared to controls, along with a reduction in average bacteria in the infant gut. Gut dysbiosis has been linked to many fecal pH from 5.9 to 5.1.12 A recent survey of consumers giving autoimmune and allergic disorders later in life and recognizing B. infantis EVC001 to their infants, marketed under the brand diaper rash as symptom of this condition may allow for early name Evivo®, showed that 70% of parents observed a reduction and effective intervention during the window of immune or resolution of diaper rash within one week of product use. development during the first few months of life.2,3,4 In addition to the reduction in pH and improvement in stool consistency, infants who received B. infantis EVC001 also Current recommendations for preventing diaper rash usually showed an 80% reduction in gut pathogens associated with include keeping skin dry and limiting prolonged exposure of autoimmune and allergic conditions later in life. Together, these skin to urine and feces.5 However, a common misconception results indicate that restoration of the infant gut microbiome with around the development of diaper rash includes the role of pH. B. infantis, and subsequent reduction in both frequency and pH Diaper rash is caused in large part by an elevation in skin pH, of the stool, may be an effective way to address the underlying rather than a more acidic pH as commonly believed. In 1955, gut dysbiosis as well as manage the biochemical factors that the average pH of the perianal skin in breastfed infants was precede the onset of diaper rash, rather than waiting to treat the reported to be between 5.3-5.5.6 However, prolonged exposure skin topically once diaper rash has occurred. of the perianal region to urine and feces leads to a more alkaline pH, increasing the risk for diaper rash.7 Fecal pH also plays a References significant role in the development of diaper rash, in that fecal 1. Shin, Helen T. “Diaper dermatitis that does not quit.” Dermatologic therapy 18.2 (2005): 124-135. enzymes, which are activated by elevated pH, have a direct 2. Vatanen, Tommi, et al. “Variation in microbiome LPS immunogenicity contributes to autoimmunity in humans.” Cell 165.4 (2016): 842-853. irritant effect on the skin.8 3. Walker, W. Allan. “The importance of appropriate initial bacterial colonization of the intestine in newborn, child, and adult health.” Pediatric research 82.3 (2017): 387. Historically, breastfed infants were found to have an average 4. Insel, Richard, and Mikael Knip. “Prospects for primary prevention of type 1 diabetes by fecal pH of ~5.0, and this was thought to explain the lower restoring a disappearing microbe.” Pediatric diabetes 19.8 (2018): 1400-1406. incidence of diaper rash in breastfed infants previously 5. Berg, R. W. “Etiology and pathophysiology of diaper dermatitis.” Advances in dermatology 3 observed.9 Indeed, human breastmilk contains specific (1988): 75-98. 6. Pratt, Arthur G., and W. T. Read Jr. “Influence of type of feeding on pH of stool, pH of skin, and carbohydrates, called human milk oligosaccharides (HMO), incidence of perianal dermatitis in the newborn infant.” Journal of Pediatrics 46 (1955): 539- which promote the growth of lactic acid producing bacteria 543. in the infant gut. Specifically, Bifidobacterium longum subsp. 7. Kazaks, Emily L., and Alfred T. Lane. “Diaper dermatitis.” Pediatric Clinics 47.4 (2000): 909-919. infantis (B. infantis) is an infant-adapted gut bacterium 8. Buckingham, Kent W., and Ronald W. Berg. “Etiologic factors in diaper dermatitis: the role of that efficiently converts HMO from human milk into acidic feces.” Pediatric Dermatology3.2 (1986): 107-112. 9. Jordan, W. E., et al. “Diaper dermatitis: frequency and severity among a general infant byproducts, lactate and acetate, creating a fecal pH of ~5.0.10 population.” Pediatric dermatology 3.3 (1986): 198-207. In the absence of B. infantis, the production of these acidic 10. Sela, D. A., et al. “The genome sequence of Bifidobacterium longum subsp. infantis reveals byproducts is limited, causing fecal pH to rise to ~6.0 or higher. adaptations for milk utilization within the infant microbiome.” Proceedings of the National Unfortunately, due to modern medical practices in the US over Academy of Sciences 105.48 (2008): 18964-18969. the past century, most infants no longer maintain appreciable 11. Henrick, Bethany M., et al. “Elevated fecal pH indicates a profound change in the breastfed levels of B. infantis in their gut microbiome during infancy, and infant gut microbiome due to reduction of Bifidobacterium over the past century.” mSphere3.2 (2018): e00041-18. recent studies show that most infants in the US today have an 12. Smilowitz, Jennifer T., et al. “Safety and tolerability of Bifidobacterium longum subspecies elevated stool pH.11 infantis EVC001 supplementation in healthy term breastfed infants: a phase I clinical trial.” BMC pediatrics 17.1 (2017): 133. 13. Frese, Steven A., et al. “Persistence of Supplemented Bifidobacterium longum subsp. infantis Dr Tracy Shafizadeh is the Director of Scientific Communications at Evolve EVC001 in Breastfed Infants.” MSphere 2.6 (2017): e00501-17. BioSystems, Davis, California.
22 neonatal INTENSIVE CARE Vol. 32 No. 4 Fall 2019 n
Get to the Bottom of Diaper Ad Rash Page 23 Diaper rash is more than just a skin irritation, it is an early indicator of gut dysbiosis (pathogen overgrowth).
Over the last century, stool pH
has increased by 1 log unit.1 Higher stool pH activates stool enzymes, which leads to the breakdown of the skin barrier and diaper rash. Breastfed infants fed Evivo® (activated B. infantis EVC001, ActiBif®) had a lower stool pH of ~1.0 log unit.2
Evivo lowers the stool pH to a range
that is known to be skin protective 2
Protect your patients
Learn more at and reduce incidence of diaper rash with Evivo. Evivo.com
Evivo is in use in NICUs across the country!
References: 1. Tisdall FF et al. Am J Dis Child. 1924;27(4):312-331.
Effect of Health Teaching On Knowledge and Practice of Postnatal Mother Admitted in Selected Hospital Regarding Using Diaper in Children To Prevent Systemic Bacterial Infection
