This topic is about caring for a 3-week-old baby boy who has undergone surgery due to an imperforate anus, resulting in the creation of two openings: a colostomy stoma for stool and a separate mucous fistula. The challenge is keeping the Hollister Pouchkins 3778 two-piece system in place, as the skin barrier tends to lift after a few hours. Here are some helpful tips and advice for managing this situation:

1. **Routine Adjustments**:
- Consider whether adhesive remover is necessary every time or if gentle peeling might be sufficient.
- Experiment with different cleaning methods: water wipes, saline wipes, or plain water, to see which works best for adhesion.
- Use stoma powder and barrier film only if the skin is irritated, not routinely.
- Explore safer warming methods than a hair-dryer for the wafer.

2. **Professional Support**:
- Seek home-health visits or consult a pediatric WOCN for hands-on guidance.
- Access resources like the Coloplast UK neonatal stoma care PDF for detailed information.

3. **Product and Brand Suggestions**:
- Try a pediatric one-piece pouch, such as the Hollister Pouchkins 3790 series, which may be more flexible for the infant.
- Order free samples from the Hollister website to find the best fit.
- Consider Eakin neonatal/fistula pouches and Eakin Cohesive barrier rings, which can be cut to size.
- For thick output, use Dansac Soft Wire Ties Ostomy Bag Closures and insert cotton balls for absorption.
- Use Cavilon Advanced Skin Protectant on weepy skin; otherwise, skip films and powders.
- Use gentle barrier tapes like Hypafix or silicone NICU tapes.

4. **Skin Cleaning and Preparation**:
- Avoid baby wipes with oils or extracts; use plain warm or sterile water.
- Use alcohol-free adhesive remover to prevent skin damage, and ensure the skin is washed and dried before applying a new wafer.
- Apply stoma powder only on red or weepy areas, sealing it with Cavilon if needed.

5. **Cutting and Fitting the Wafer**:
- Cut the wafer opening slightly larger than the stoma for a better seal, avoiding irritation or exposure.
- Ensure the mucous fistula is not covered by the wafer; trim the barrier ring if necessary.

6. **Securing and Warming**:
- Warm the wafer and barrier ring with a low hair-dryer setting before application.
- Apply gentle hand pressure for a few minutes after application, using a pre-warmed blanket if needed.
- Secure the pouch with a snug diaper or onesie to minimize movement.

7. **Timing of Changes**:
- Change the pouch midway between feedings to reduce the risk of stool output during the procedure.

8. **Wear-Time Expectations**:
- Aim for a 24-hour wear time, which is realistic for neonates, and celebrate any improvements.

9. **Organization Tips**:
- Prepare "change kits" with all necessary supplies in zip bags for quick access, especially at night.
- Use a small storage caddy to keep all supplies organized in one place.

10. **Safety Notes**:
- Be cautious with heat sources, as newborn skin is sensitive and can burn easily.
- Contact the care team immediately if the skin becomes red, broken, or ulcerated.

These insights and adjustments can help improve the wear time and comfort for the baby, making the process smoother for the parents.