Skin is a complex structure with unusual functional diversity. It forms a critical physical barrier that not only protects the body but also maintains fluid homeostasis. In addition, it regulates temperature as well as sensation1. The skin of preterm infants is immature and ineffective as an epidermal barrier. Poor epidermal barrier function leads to significant disturbances in temperature regulation, water balance and increased propensity for infections. The preterm skin with its inherent poor microbial defense and its denudation during care multiply the possibilities of microbial invasion and sepsis in this vulnerable population.
Topical agents are more rapidly absorbed into infant skin due to deficient intercellular bridges as well as greater body surface area to weight ratio. These inadequacies in its overall functioning need to be kept in mind while managing small neonates in the high-tech neonatal intensive care units.
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References
1.
LawnJE, CousensS, BhuttaZA, DarmstadtGL, MartinesJ, PaulV, . Why are 4 million newborn babies dying each year?Lancet2004;364:399–401.
2.
DarmstadtGL, LawnJE, CostelloA.Advancing the state of the world's newborns. Bull World Health Organ2003;81:224–5.
3.
DarmstadtGL, SahaSK, AhmedAS, ChowdhuryMA, LawPA, AhmedS, . Effect of topical treatment with skin barrier-enhancing emollient on nosocomial infections in preterm infants in Bangladesh: a randomized controlled trial. Lancet2005;365:1039–45.
4.
GalloRL, MurakamiM, OhtakeT, ZaiouM.Biology and clinical relevance of naturally occurring antimicrobial peptides. J Allergy Clin Immunol2002;110:823–31.
5.
BowdishDM, DavidsonDJ, HancockRE.A re-evaluation of the role of host defense peptides in mammalian immunity. Curr Protein Pept Sci2005;6:35–51.
6.
HackettCJ.Innate immune activation as a broad-spectrum biodefense strategy: prospects and research challenges. J Allergy Clin Immunol2003;112:686–94.
7.
StevenB.Hoath and Vivek Narendran. Development of epidermal barrier. NeoReviews2001; 2;269 DOI: 10.1542/neo.2-12-e269
8.
HoathS, NarendranV.Adhesives and emollients in the preterm infant. Semin Neonatol.2000;5:112–119.
9.
RowanJL, AtkinsJT, LevyML, BaerSC, BakerC.Invasive fungal dermatitis in the < or = 1000 gram neonate. Pediatrics. 1995;95:682–687.
10.
EdwardsW, ConnerJ, GerdesJ, . The effect of Aquaphor ointment on nosocomial sepsis rates and skin integrity in infants of birthweights 501-1000g. Program and abstracts of Hot Topics Neonatology Conference; December 3-5, 2000; Washington, DC.
11.
SeigfriedEC, StoneMS, MadisonKC.Ultraviolet light burn: a cutaneous complication of visible light phototherapy for neonatal jaundice. Pediatr dermatology1992;9: 278–282.
12.
DickisonL.GarlandL.Nursing management of NCPAP in preterm neonates:evidence based reduction of skin breakdown. Program and abstracts of the National Association of Neonatal Nurses 19th Annual Conference; October 8-11, 2003; Palm Springs, California.
13.
DarmstadtG, DinulosJ.Neonatal skin care. Pediatr Clin North Am.2000;47:757–782.
14.
ChoudhuriJ, McQueenR, InoueS, GordonRC.Efficacy of skin sterilization for a venipuncture with the use of commercially available alcohol or iodine pads. Am J Infect Control.1990;18:82–85.
15.
LinderN, DavidovitchN, ReichmanB, . Topical iodine-containing antiseptics and subclinical hypothyroidism in preterm infants. J Pediatr.1997;131:434–439.
16.
MakiD, RingerM, AlvaradoC.Prospective randomized trial povidone-iodine, alcohol and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet.1991;338:339–343.
17.
GarlandJS, BuckRK, MaloneyP, . Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: a prospective trial. Pediatr Infect Dis J.1995;14:510–516.
18.
SedinG, HammarlundK, NilssonGE, StrombergB, ObergPA,. Measurement of transepidermal water loss in newborn infants. Clin Perinatol1985; 12:79–99.
19.
ChiouYB, Blume-PeytaviU.Stratum corneum maturation. A review of neonatal skin function. Skin Pharmacol Physiol.2004;17:57–66.
20.
RutterN, HullD.Water loss from skin of term and preterm infants. Arch Dis Child1979;54: 858–868.
21.
RutterN.The immature skin. Br. Med Bull1988;44:957–70.
22.
MarksKH, FriedmanZ, MaiselsMJ.A simple device for reducing insensible water loss in low-birth-weight infants. Pediatrics.1977;60:223–6.
23.
VohraS, FrentG, CampbellV, AbbottM, WhyteR.Effect of polyethylene occlusive skin wrapping on heat loss in very low birth weight infants at delivery: a randomized trial. J Pediatr.1999;134:547–51.
24.
KaushalM, AgarwalR, AggarwalR, SingalA, UpadhyayM, SrinivasV, PaulVK, DeorariAK.Cling wrap, an innovative intervention for temperature maintenance and reduction of insensible water loss in very low-birthweight babies nursed under radiantwarmers: a randomized controlled trial. Ann Trop Paediatr.2005;25:111–8.
EdwardsWH, ConnerJM, SollRF. The effect of Aquaphor Original Emollient Ointment on nosocomial sepsis rates and skin integrity in infants of birth weight 501 to 1000 grams. Pediatr Res2001; 49:2330. (suppl)
30.
RutterN, HullD.Reduction of skin water loss in the newborn. I. Effect of applying topical agents. Arch Dis Child.1981;56:669–72.
31.
DarmstadtGL, Mao-QiangM, ChiE, SahaSK, ZibohVA, BlackRE, SantoshamM, EliasPM.Impact of topical oils on the skin barrier: possible implications for neonatal health in developing countries. Acta Paediatr.2002;91:546–54.
32.
NangiaS, PaulVK, ChawlaD, DeorariA.Topical coconut oil application reduces transepidermal water loss in preterm very low birth weight neonates: A randomized controlled trial. Pediatrics2008;121: S139.
