Conflicts of interest The authors declare no conflict of interest.
Neonatal intensive care practices and the influence on skin condition
Article first published online: 20 FEB 2012
© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology
Journal of the European Academy of Dermatology and Venereology
Volume 27, Issue 4, pages 486–493, April 2013
How to Cite
Visscher, M.O., Taylor, T. and Narendran, V. (2013), Neonatal intensive care practices and the influence on skin condition. Journal of the European Academy of Dermatology and Venereology, 27: 486–493. doi: 10.1111/j.1468-3083.2012.04470.x
Funding sources This study was supported by the Skin Sciences Program of Cincinnati Children’s Hospital Medical Center.
- Issue published online: 18 MAR 2013
- Article first published online: 20 FEB 2012
- Received: 23 October 2011; Accepted: 24 January 2012
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.