Stratum Corneum Maturation

Abstract

The importance of the stratum corneum and its barrier function for infants, especially for newborns, is clinically evident. Research regarding the maturation of the stratum corneum in neonates, i.e. when full barrier function is obtained, has produced varying results. Based on transepidermal water loss and percutaneous absorption studies, term infants seem to possess stratum corneum with adult barrier properties. Additionally, postnatal life is thought to accelerate stratum corneum maturation, so that even preterm infants have barrier function similar to term infants at 2–3 weeks of gestational age. However, a look at other parameters, such as skin thickness, skin pH and stratum corneum hydration, shows that neonatal skin is always adjusting to the extrauterine environment in contrast to the steady state of adult skin. This suggests that barrier stabilization may be dependent on achieving a balance between different parameters. However, it is still in question, which parameters, what balance and what timing. This paper provides an up-to-date overview on the neonatal skin barrier based on the review of current literature.

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].…”

“…One study in very preterm infants showed that topical ointment decreased TEWL, without documenting other skin functional parameters [14]. Yet, the neonatal skin barrier depends on a balance between functional parameters, such as TEWL, SCH, skin pH and sebum, and entails anatomical variability [1,16,17,18,21]. To our knowledge, this is the first prospective study objectively assessing postnatal skin barrier properties at different anatomical sites in otherwise healthy preterm infants under adequate neonatal therapy and monitored ambient conditions not only during, but also after the stop of SSO application.…”

“…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].…”

“…Scientific evidence of the effect of oils on preterm infants primarily comes from studies concentrating on the incidence of nosocomial infections, morbidity and mortality, thermoregulation and growth of newborns or skin condition [5,6,7,8,10,14,15]. To understand the direct effects of SSO on the skin barrier, functional parameters have to be objectively assessed to fully characterize skin barrier function [1,16,17,18]. Given this background, we aimed to investigate the effect of SSO application on postnatal barrier development in healthy low-birth-weight premature infants (without any major disease requiring invasive ventilation or intravenous administration of vasoactive drugs) at different anatomical sites during the first weeks of life, under monitored conditions and using a standardized skin care.…”

Skin of the very premature newborn – physiology and care

“…In premature newborns of <32 weeks of gestational age, stratum corneum is very thin. Such immature stratum corneum does not suffi ciently prevent transepidermal water loss, absorption of external agents and invasion of microbes (1)(2)(3)(4)(5)(6)(7)(8)(9). Birth with exposure to external environment stimulates and accelerates maturation of epidermal barrier in prematures.…”