Postnatal Maturation of Skin Barrier Function in Premature Infants

Abstract

Background: In preterm infants, skin barrier maturation entails regional variability. Objectives: To characterize postnatal skin barrier development in covered, uncovered and diapered regions in healthy premature infants over a longitudinal observation period. Methods: Transepidermal water loss (TEWL), stratum corneum hydration (SCH), pH and sebum were measured at postnatal ages of 1-7 days and 2-7 weeks on the forehead, abdomen, thigh and buttock of preterm infants (gestational age 30-37 weeks; n = 48) under monitored ambient conditions. A standard minimal skin care regimen was practised. Results: TEWL increased significantly on the buttock (p = 0.007), while remaining stable on the forehead, abdomen and thigh. SCH and sebum remained stable in all studied body regions with increasing age. On the buttock, pH increased (p = 0.049), while other body regions exhibited a significant decrease (p ≤ 0.019). TEWL (p < 0.001) and SCH (p ≤ 0.002) revealed significantly higher values on the buttock, compared to other body regions. Conclusions: Stable TEWL, SCH and sebum values may indicate a lack of skin barrier maturation. Postnatal decrease in skin pH suggests an adaptation process with acid mantle formation. Differences in skin barrier development were observed between anatomical regions. SCH, TEWL and pH values demonstrated a distinct course in the diaper area, indicating an impaired skin barrier function in this region.

Influence of Sunflower Seed Oil on the Skin Barrier Function of Preterm Infants: A Randomized Controlled Trial

“…In preterm infants, TEWL is higher than in full-term neonates at birth and decreases at a slower rate [1,2,4,23,24]. During this study, TEWL remained stable at all investigational sites in group C, indicating a lack of barrier maturation [2].…”

“…Scientific research on the influence of natural oils on preterm infants, considering the unique physiological properties of skin barrier function in this age group, is necessary for the establishment of evidence-based skin care practices [2,4,21]. Indications of beneficial effects of SSO, which is rich in linoleic acid, on skin barrier primarily come from in vitro studies and studies in rat or adult skin [9,11,12,13].…”

“…After cardiorespiratory stability had been ensured, neonates were bathed twice per week with clear water [17,18]. No additional skin care was given, except for areas of skin trauma or diaper dermatitis [2]. No skin care, including SSO application and washing, was performed during the last 3-4 h before measurements.…”

“…TEWL, SCH, skin pH and sebum were measured at inclusion (<48 h after birth) and on postnatal days 5 (D5), 11 (D11) and 21 (D21), using the noninvasive Multi Probe Adapter System MPA® (Courage & Khazaka, Cologne, Germany) connected to a Tewameter® TM300, Corneometer® CM825, Skin-pH-Meter® PH905 and Sebumeter® SM815, according to standardized protocols and guidelines [2,17,18]. Measurements were performed at the neonatal ward; babies were partly undressed for an acclimatization period of 5-10 min.…”

“…Preterm infants have an immature skin barrier function at birth, resulting in an increased risk for high water loss, percutaneous absorption and perinatal infections with high morbidity and mortality [1,2,3]. Emollients and natural oils are being increasingly used for neonatal skin care in developing and developed countries to support skin barrier maturation in preterm infants [4,5,6,7,8].…”