Visscher MO, Taylor T, Narendran V, et al.
Journal of the European Academy of Dermatology and Venereology : JEADV. Date of publication 2013 Apr 1;volume 27(4):486-93.
1. J Eur Acad Dermatol Venereol. 2013 Apr;27(4):486-93. doi:
10.1111/j.1468-3083.2012.04470.x. Epub 2012 Feb 20.
Neonatal intensive care practices and the influence on skin condition.
Visscher MO(1), Taylor T, Narendran V.
Author information:
(1)Skin Sciences Program, Cincinnati Children's Hospital Medical Center,
University of Cincinnati, Cincinnati, OH, USA. marty.visscher@cchmc.org
BACKGROUND: Premature skin has a thinner epidermis with a poorly formed stratum
corneum (SC) barrier compared to full term skin. Poor skin integrity increases
the risk of exposure to irritants and infectious agents. Interventions that
facilitate skin maturation are essential.
OBJECTIVE: The objective was to examine the effects of prematurity and time from
birth on SC maturation and to identify factors that impact skin condition.
METHODS: A retrospective review was conducted among 130 NICU patients. Skin
regions were evaluated for erythema, rash, integrity and function. The effects
of gestational age, time from birth, stool exposure, nutrition and diagnosis
were examined.
RESULTS: Three groups emerged: (i) premature and <38 weeks adjusted age; (ii)
premature and >38 weeks adjusted age; and (iii) full term. Surprisingly, the
premature infants exhibited lower perineal irritation and greater SC integrity
(lower transepidermal water loss) than full terms (P < 0.05). Group 2 had a
longer time before the first skin-stool contact. Chest skin pH showed
maturational changes for Group 1 (P < 0.05) but did not change for premature
Group 2 who was older at enrollment. Erythema was lower for infants using
elemental formulas or total parenteral nutrition.
CONCLUSIONS: Premature infants with early stool contact and high exposure, full
term infants, and patients with congenital diaphragmatic hernia or trisomy 21
are at high risk for skin compromise and may benefit from prophylactic
interventions to minimize compromise. Low stool exposure and greater time before
the first stool contact appear to be protective against skin compromise.
© 2012 The Authors. Journal of the European Academy of Dermatology and
Venereology © 2012 European Academy of Dermatology and Venereology.
DOI: 10.1111/j.1468-3083.2012.04470.x
PMID: 22340077 [Indexed for MEDLINE]
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