The Delicate Skin of Preterm Infants: Barrier Function, Immune-Microbiome Interaction, and Clinical Implications

Abstract

The skin of preterm infants is a delicate organ with critical structural and functional differences as compared to term born infants. Unique features contribute to an increased susceptibility to injury, infection, thermal instability, and water loss. During rapid, often accelerated adaption of the physical barrier function of preterm skin, a parallel and mutual development of host skin immunity and skin microbiome seem to be crucial for skin homeostasis. Recent advances in molecular biology have enabled researchers to gain a deeper understanding of the microbial community composition of preterm skin and the important relationship with microbiome composition of other body sites. Nevertheless, several questions remain to be answered, including niche factors and environmental influences on skin maturation. In line with that, evidence-based guidelines on skin care practice in preterm infants are missing. This review articles aims to provide an overview of the current knowledge of preterm infant skin development including immune and barrier function, host-microbial interactions, and potential clinical implications.

Exploring the Microbial Landscape of Neonatal Skin Flora: A Comprehensive Review

“…Influence of preterm birth on skin microbiota: The gestational age of preterm infants significantly shapes the development of their skin microbiota. Numerous studies have underscored the correlation between gestational age and skin structure and function maturation, consequently influencing the cutaneous microbiome of preterm infants [ 12 , 27 , 13 ]. Notably, the skin microbiota in preterm infants exhibits considerable variation across individuals and by body site, reflecting disparities in environmental exposures and infant developmental stages [ 13 ].…”

“…Factors such as mode of delivery, environmental exposures, and maternal transmission further contribute to the diversity of the skin microbiota in preterm infants [ 28 ]. A comprehensive understanding of the dynamics of the skin microbiota in this vulnerable population is essential for identifying potential clinical implications and developing targeted therapeutic strategies to support the delicate skin microbiome of preterm infants [ 15 , 27 ].…”

Antimicrobial Peptides (AMPs) and the Microbiome in Preterm Infants: Consequences and Opportunities for Future Therapeutics

“…Regarding the skin microbiome in infants, there is a limited number of studies available [ 88 ]. The initial skin microbiome is primarily influenced by the mode of delivery [ 81 , 83 ].…”

Linoleate-Containing Acylglucosylceramide, Acylceramide, and Events Associated with Formation of the Epidermal Permeability Barrier

“…It takes five to six years before TEWL drops to match adult levels [74,75]. Preterm infants have even poorer barrier function and require special care to avoid dehydration [76,77].…”