Early adaptation of human skin following birth: a biophysical assessment

Abstract

Background/aims: Successful adaptation to postnatal life requires rapid physiological transitions in multiple organ systems. Mechanisms regulating stratum corneum water interactions and evaporative heat loss, for example, are pivotal in making the transition from the warm, aqueous prenatal state to a cold, dry postnatal environment. Understanding these mechanisms is important in formulating skin care guidelines in early infancy.Methods: One hundred and one full term infants were enrolled prospectively and evaluated in three maternity hospitals over the first few hours after birth. Skin surface electrical capacitance and optical imaging were performed over selected body sites after placement under a radiant warming device. A selected group of infants were occluded with a plastic wrap following towel drying in the delivery room. Specific measurements included baseline skin hydration, continuous capacitive reactance, peak water sorption, rate of water desorption, skin pH, and grading of optical images for abnormal skin desquamation.Results: Occlusion of the skin surface following birth delays the normal fall in surface hydration and transepidermal water movement (TEWM). Sites exposed to the radiant warmer (chest) exhibited decreased hydration and increased pH compared to non‐exposed sites (back). Desquamation was increased over the chest compared to the back as judged by optical image grades. Significant inverse correlations were noted between baseline skin hydration and the ability to desorb surface water. Unexpectedly, females exhibited significantly increased desorption of exogenously applied water with a near significant increase in maternal‐infant bonding time.Conclusions: Newborn infant stratum corneum undergoes a slow (minutes to hours) diminution in surface hydration following birth; this is a function of body site, position, and exposure to the radiant warmer. Practices such as occlusion of the skin surface at birth delay the normal drying process. The data support potential gender specific differences in skin surface water handling and/or delivery room practices. Focus on the complex process of newborn skin adaptation provides a physiological framework for skin care protocols extending into infancy, childhood, and later life.