Development of Skin Barrier Function in Premature Infants

Abstract

Histologic analysis suggests that epidermal development is complete in utero at approximately 34 wk gestational age. Infants born more prematurely have elevated rates of both transepidermal water loss and transcutaneous heat loss, and have difficulty maintaining homeostasis. The underdeveloped integument is also a portal of entry for infection and the percutaneous uptake of toxins. Previous measurements of transepidermal water loss have suggested that, regardless of gestational age, competent barrier function is attained within 2-4 wk postnatal age. In this study we have utilized another noninvasive biophysical technique, low frequency impedance spectroscopy, to complement transepidermal water loss measurements. We present longitudinal data from infants ranging from 23 to 32 wk gestational age. The results suggest that, for ultra-low birth weight infants (23-25 wk gestational age), the complete development of a fully functional stratum corneum can require significantly longer than 4 wk. In contrast, the data from the older infants suggest that a postnatal existence period of 2-4 wk may not be necessary to attain functional maturity, because infants born at 30 and 32 wk gestational age were found to have barrier function comparable with that of adults.

Effective use of transdermal drug delivery in children

“…The rapid changes in TEWL and chemical absorption observed post-natally in pre-term infants are consistent with the histological changes previously reported [11]. For example, the skin of infants born at [24][25][26][27][28][29][30] wk GA shows a significant increase in the number of epidermal cell layers and develops a well-formed SC over a 16 week post-natal period; however, little development of dermoepidermal undulations was observed.…”

“…The periderm acts as the interface between the amniotic fluid with the developing epidermis prior to SC formation; later the periderm sheds to become part of the vernix caseosa at 15-20 wk GA. The effects of GA and PNA on the histological development of the epidermis were reported in 169 (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) infants aged from a few hours to 1 year old [11]. The thickness and number of epidermal cell layers, the degree of undulation of the dermo-epidermal junction, and the SC thickness increased clearly with GA in children who had died within 7 days of birth; both the SC and the dermo-epidermal undulations were barely perceptible until 34 wk GA.…”

“…The use of radiant warmers approximately doubles IWL (measured as weight loss) of infants [18]; the use of heat shields reduces this effect [25]. Administration of prenatal steroids (to the pregnant mother) does not affect foetal barrier maturation; in contrast post-natal parenteral steroid administration inhibits this process [26].…”

“…Skin barrier development was assessed in 23-32 wk GA children using TEWL and impedance spectroscopy [26]. Low-frequency skin impedance increased significantly with barrier development and was inversely correlated with TEWL; i.e., TEWL was highest (60-70 g.h -1 .m -2 ) and low frequency impedance smallest for infants born with the shortest GA and PNA.…”

Safety of chlorhexidine gluconate used for skin antisepsis in the preterm infant

“…The stratum corneum, the outermost layer of the skin, is only 2 to 3 cell layers thick at 23 weeks gestation and is not well developed until around 34 weeks of gestation. 30 It is essential for creating an effective epidermal barrier. Without this effective barrier, preterm infants are at risk for increased absorption of potentially poisonous substances, as well as increased susceptibility to skin damage, infection and water loss.…”