Applied physiology: the newborn skin

Abstract 

The most important function of the skin is to provide a protective barrier between the body and the environment. It limits loss of body water, prevents absorption of noxious agents and protects against physical trauma. The epidermal barrier begins to develop in mid-gestation and is fully formed by about 32 weeks gestation. In the extremely preterm infant, it is poorly formed and functionally weak. Exposure to air after birth accelerates epidermal development.

Transepidermal water loss is high in the immature infant, causing difficulties in fluid balance and temperature control. The percutaneous absorption of topically applied agents may lead to accidental poisoning. Adhesive trauma strips the epidermis, predisposing to infection. These problems can be minimized by limiting the use of skin probes and adhesive tape, nursing the infant in a high ambient humidity and sparing use of aqueous chlorhexidine as an antiseptic. The routine use of emollients or skin coverings is not recommended.

Keywords:  epidermis, transepidermal water loss, percutaneous absorption, prematurity, adhesive, emollient