Skin Of Newborn Infants Research Articles

Antimicrobial skin peptides in premature infants: Comparison with term infants and impact of perinatal factors.

Preterm infants have an immature epidermis barrier function that may lead to an increased permeability to pathogens. On the surface of the human skin, antimicrobial peptides (AMPs) are important molecules of the innate immune system, have broad antimicrobial properties, and provide an essential role in integrity of the microbiome. Given the marked susceptibility of preterm infants to infection, we hypothesize a decreased expression of AMPs on the skin of preterm infants. In a prospective single-center study with 35 preterm and 20 term infants, we analyzed skin rinsing probes for the presence of the AMPs psoriasin (S100A7) and ribonuclease 7 (RNase 7) via enzyme-linked immunosorbent assay. Samples were taken from preterm infants < 34 0/7 weeks gestational age (mean ± SD gestational age, 28.8 ± 2.4 weeks) on days 0, 7, 14, and 28 after birth. Term infants (> 36 6/7 weeks) (controls) were washed on days 0 and 28. Psoriasin and RNase 7 were both expressed on skin of preterm and term infants and increased in concentration significantly over time. RNase 7 was more expressed in term infants on day 0 [preterm = 1.1 (0.7-2.9) vs. term = 2.0 (1.1-3.4) ng/ml, p = 0.017]. On day 28, premature infants showed higher values of psoriasin [preterm = 10.9 (5.6-14.2) vs. term = 6.3 (3.4-9.0) ng/ml, p < 0.001]. Notably, preterm infants with infectious or inflammatory context driven by histological proof of chorioamnionitis and early-onset or late-onset sepsis had higher concentrations of psoriasin as compared with non-affected preterm infants. After exclusion of infants with inflammatory hit, median concentrations of RNase 7 and psoriasin did not differ between preterm and full-term infants on days 0 and 28. Psoriasin and RNase 7 concentrations increase over time on the skin of newborn infants and seem to play a role in the first defense against infection. This is of particularly interest as the role of AMPs on a maturing skin microbiome and its possible new prevention strategies is unclear and needs to be determined.

Improving newborn skin health: Effects of diaper care regimens on skin pH and erythema.

Background/ObjectiveNewborn infant skin is functional but immature, and diapering products can play a significant role in infant diapered skin health. Previous work demonstrated a regimen consisting of a diaper with an emollient and apertures on the inner liner (topsheet) with an acidic, pH‐buffered wipe (Regimen A) lowered newborn skin pH and reduced the enzymatic activity on skin post‐stool cleaning versus a regimen without these features (Regimen B). This study extends these findings to determine the impact of Regimen A on diaper area erythema severity over a 2‐week use period.MethodsThis IRB‐approved, blinded, randomized, crossover study enrolled newborn infants >7 days and ≤8 weeks. Participants exclusively used two unique diaper and wipe combinations, Regimen A and Regimen B (non‐emollient, non‐aperture containing topsheet and wipe with limited buffering capacity), each for 14 days and preceded by a 3‐day washout regimen.ResultsDiapered skin pH was reduced during Regimen A use to values similar to that of a non‐diapered control site (chest), while use of Regimen B was associated with a more alkaline skin pH. Regimen A resulted in significantly fewer severe erythema episodes. At the site of highest erythema, the perianal space, the average erythema score was significantly lower and more newborns were free of erythema while using Regimen A vs. Regimen B (P < .05).ConclusionsThese findings demonstrate that diapering products can have a significant impact on newborn skin. They reinforce the need to support the physiological normalization of skin pH and protection from skin irritation and damage.

Physiological changes in newborn skin after natural oil massage in rural Nepal

# Background Natural oils are applied daily to newborn infant skin during massage in certain cultures. In hospitalized premature infants, topical oils reduced infection and improved skin condition. A community study among neonates in rural Nepal compared sunflower and mustard oils for effects on skin integrity. Particularly notable was the rapid increase in skin rash that peaked at day 14 and lessened by day 28 for both oils, a finding not previously reported. # Methods To investigate the rash physiology, high-resolution digital images were collected for a subset of 216 premature and full-term infants. Image features were characterized for type and severity, quantified for color and surface texture and compared to measures of skin barrier integrity. # Results Skin features were observed in 403 of 811 images, including localized erythema, discrete papules and an occasional pustule. Miliaria crystallina was noted in 32.2%. A second texture, with raised, “pebble” features, characterized 26%. Of 216 subjects, 61% had “pebble” on at least one visit. Miliaria severity increased and day 14 was higher than 1 and 7 (P<0.05). Pebble texture severity increased. Day 28 was higher than 1, 3 and 7 (P<0.05). Skin pH was lower and erythema, rash and massage numbers were higher for miliaria than without it (P<0.05). Subjects with and without pebble texture did not differ for skin integrity measures. # Conclusions An understanding of the maturational changes in qualitative and quantitative skin color and texture with routine neonatal oil massage provides the basis for leveraging this commonly practiced ritual to optimize skin care.

Newborn infant skin: Physiology, development, and care

Infant skin is critical to the newborn child’s transition from the womb environment to the journey to self-sufficiency. This review provides an integrative perspective on the skin development in full term and premature infants. There is a particular focus on the role of vernix caseosa and on the implications of skin development for epidermal penetration of exogenous compounds. Healthy full-term newborn skin is well-developed and functional at birth, with a thick epidermis and well-formed stratum corneum (SC) layers. Transepidermal water loss is very low at birth, equal to, or lower than adults, indicating a highly effective skin barrier. Vernix facilitates SC development in full-term infants through a variety of mechanisms including physical protection from amniotic fluid and enzymes, antimicrobial effects, skin surface pH lowering, provision of lipids, and hydration. Premature infants, particularly those of very low birth weight, have a poor skin barrier with few cornified layers and deficient dermal proteins. They are at increased risk for skin damage, increased permeability to exogenous agents and infection. The SC barrier develops rapidly after birth but complete maturation requires weeks to months. The best methods for caring for infant skin, particularly in the diaper region, are described and related to these developmental changes.

Impact of Newborn Skin-Cleansing With Chlorhexidine on Neonatal Mortality in Southern Nepal: A Community-Based, Cluster-Randomized Trial

Cleaning the newborn infant's skin with chlorhexidine may lower neonatal deaths, as suggested by hospital data from Africa, but this intervention has not been tested in communities where most births take place at home. The underlying supposition is that early neonatal sepsis is associated with colonization of the infant's skin by organisms in the vaginal canal. The present study was a community-based, placebo-controlled, cluster-randomized trial carried out in southern Nepal, where newborn infants were cleansed once with wipes containing either 0.25% chlorhexidine (n = 8650) or placebo solution (n = 8880). The treatment was carried out as soon as possible after delivery at home; the median interval was just under 6 hours. The primary outcome was mortality from all causes within 4 weeks after birth. Baseline characteristics were similar in the treatment and placebo groups. Following the randomized phase of the trial, for a period of 9 months, all newborn infants were actively treated. Intent-to-treat analysis of all live births demonstrated no substantial difference in neonatal mortality. For those infants who received their assigned treatment (98.7% of the total), neonatal mortality was 11% lower after chlorhexidine washing-not a significant effect. However, low-birth-weight (LBW) infants, those with a birth weight of less than 2500 g, experienced a significant 28% decrease in neonatal mortality when cleansed with chlorhexidine. The relative risk was 0.72, with a 95% confidence interval of 0.55-0.95. Similar results were obtained in LBW infants when the criterion was a birth weight less than 2000 g, but no such difference was found in normal-birth-weight infants. Conversion of all newborn infants to active treatment was accompanied by a 37% decline in mortality for those LBW infants initially assigned to receive placebo. The efficacy of skin cleansing did not depend on whether or not the birth attendant washed her hands before delivery. It is to be hoped that further trials will confirm that chlorhexidine washing-a simple and inexpensive measure-does in fact enhance the survival of LBW infants who are born at home and those living in places where hygienic practices are suboptimal.

The Antibacterial Peptide Ll-37 is Expressed in The Skin of Newborn Infants With Erythema Toxicum Neonatorum

The Antibacterial Peptide Ll-37 is Expressed in The Skin of Newborn Infants With Erythema Toxicum Neonatorum

Does Non-ionizing Radiant Energy Affect Determination of the Evaporation Rate by the Gradient Method?

A study was performed to investigate whether measurements of the evaporation rate from the skin of newborn infants by the gradient method are affected by the presence of non-ionizing radiation from phototherapy equipment or a radiant heater. The evaporation rate was measured experimentally with the measuring sensors either exposed to or protected from non-ionizing radiation. Either blue light (phototherapy) or infrared light (radiant heater) was used; in the former case the evaporation rate was measured from a beaker of water covered with a semipermeable membrane, and in the latter case from the hand of an adult subject, aluminium foil or with the measuring probe in the air. No adverse effect on the determinations of the evaporation rate was found in the presence of blue light. Infrared radiation caused an error of 0.8 g/m2h when the radiant heater was set at its highest effect level or when the ambient humidity was high. At low and moderate levels the observed evaporation rate was not affected. It is concluded that when clinical measurements are made from the skin of newborn infants nursed under a radiant heater, the evaporation rate can appropriately be determined by the gradient method.

Percutaneous Drug Absorption in the Newborn: Hazards and Uses

The newborn infant's skin is not a complete barrier to the absorption of externally applied agents, particularly if it is damaged, diseased, or immature. Immaturity is the most important factor that determines percutaneous absorption. Very immature infants in the early neonatal period have a poorly developed epidermis, which is readily permeable to drugs. The main consequences of percutaneous absorption are hazardous. Topically applied agents are absorbed, causing toxic systemic effects that may result in illness and even death without the cause being recognized. No drug or antiseptic agent should be applied to the premature infant's skin without consideration of the effects that might result from percutaneous absorption. On a more optimistic note, the relatively permeable skin could be an advantage to the preterm infant by providing an alternative method of drug administration. The drug theophylline for example can be absorbed and produce therapeutic blood levels for up to 3 days after a single topical application. There is a need for the development of transdermal drug delivery systems for the newborn infant similar to those currently used for therapy in adults.

Barrier properties of the newborn infant's skin

The barrier properties of the skin were examined in 223 studies in 70 newborn infants of 25 to 41 weeks' gestation, aged from 1 hour to 26 days. Percutaneous drug absorption was studied by observing the blanching response to solutions of 1% and 10% phenylephrine applied to a small area of abdominal skin. Skin water loss was measured at the same site using an evaporimeter. Infants of 37 weeks' gestation or more showed little or no drug absorption and had low skin water losses, indicating that their skin is an effective barrier. By contrast, infants of 32 weeks' gestation or less showed marked drug absorption and high skin water losses in the early neonatal period, indicating that their skin is defective as a barrier. Both drug absorption and water loss in these infants fell steadily; by about 2 weeks of age the skin of the most immature infants functioned like that of mature infants. The varying barrier properties can be explained by the poor development of the stratum corneum in the more premature infants at birth and its rapid maturation after birth. The trauma caused to the skin by use of adhesive tape and the fixation of transcutaneous oxygen electrodes resulted in increased drug absorption and water loss from the damaged area.

Water evaporation and heat exchange with the environment in newborn infants.

The amount of water evaporated from the skin of newborn infants and the temperatures of the skin, the ambient air and the surfaces facing the infants were measured and used to calculate the evaporative, radiative and convective heat exchange between the infant and the environment in infants of varying gestational ages. Immediately after birth the evaporative heat exchange was very high but it then decreased gradually. The radiative heat exchange was very high in the delivery room but lower in the incubators. In incubators the evaporative heat exchange was high in the most pre-term infants, especially when nursed at a low ambient humidity. Different modes of heat exchange were interrelated, so that when the pre-term infants had a high evaporation rate, a high ambient temperature was needed and the heat exchange through radiation and convection decreased. Net heat exchange was lowest in very pre-term infants at an ambient humidity of 60%.

TRANSEPIDERMAL WATER LOSS IN NEWBORN INFANTS

The amount of water evaporated from the skin of newborn infants and the temperatures of the skin, of the ambient air, and of the surfaces facing the infants were measured and used as a basis for calculation of the evaporative, radiative and convective heat exchange between the infant and the environment. The infants were of varying gestational ages, from 25 to 39 completed weeks of gestation. Evaporative heat exchange was high in the most preterm infants when nursed at a low ambient humidity, while the high ambient humidity needed to maintain these infants at a stable body temperature led to a low loss of heat through radiation and convection or even a heat gain. In the more mature infants evaporative heat exchange was lower, while radiative and convective heat exchange was higher.

Water transport through the skin of newborn infants.

Factors that may influence the water transport through the skin in infants on their first day of life were studied with a method based on determination of the vapour pressure gradient in the air layer close to the skin surface. The evaporation rate from the skin was found to vary with the site of measurement, ambient humidity, temperature, activity, gestational age and nutritional status at birth. Differences related to maturity were shown to decrease with postnatal age.

Characteristics of Non-Aqueous Electrolytes for Transcutaneous Oxygen Electrodes

We investigated the characteristics of non-aqueous solvents for tcPO2 electrolytes, using a tcPO2 electrode with three 15 micrometer platinum cathodes set in a polished glass surface, a 17.8 mm2 silver anode covered with a 25 micrometer Telfon membrane, with and without a 12 micrometer cellophane spacer, and polarized at--0.8v. We examined the effect of ethylene glycol (EG) concentration, in water, on O2 sensitivity, stirring effect, in vitro drift, in vitro response time, behaviour on the skin of newborn infants and in vivo response time. We found the following: (1) O2 sensitivity was reduced by increasing EG concentration. (2) phi, the stirring effect (gas/50% glycerine) was 1.01 at 90% EG with cellophane, but higher without cellophane. (3) In vitro drift at 44 degree C electrode temperature, in 43 degree C water (simulating skin), was reduced with 90% EG, 25 micrometer Telfon and no spacer, but increased with a spacer. (4) In vitro response time was increased with EG. (5) Correlations with arterial PO2 in a group of newborns was as excellent with an electrode made with 90% EG and 25 micrometer Telfon, without spacer, as it was with our previous study using aqueous electrolyte and 12 micrometer Telfon wint 12 micrometer cellophane: (tcPO2 = 1.32 + 0.988 PaO2 r = 0.987). In vivo response time was not prolonged. Using EG, the tc PO2 electrode membrane required changing only after 7--9 days, compared with 1--2 days when using aqueous electrolytes. No advantage of using cellophane spacers was identified in these in vivo studies.

Absorption of hexachlorophane from dusting powder on newborn infant's skin.

In a maternity hospital in which the umbilicus and trunk of healthy newborn infants were treated with 0.33% hexachlorophane dusting powder, the hexachlorophane content of blood was measured in mothers before delivery, in infants' umbilical samples at birth, and at 8 days of age in capillary blood samples. One mother and her baby had rather high blood concentrations of hexachlorophane, probably derived from a toilet preparation used before admission to hospital. Hexachlorophane was absent or barely detectable in the other mothers' blood and in the infants' umbilical blood. The hexachlorophane concentrations in the blood of 8-day-old infants ranged from nil to 0.166 mug./ml. (mean 0.066 mug./ml.). These were much less than the concentrations reported to be toxic in animals.In a previous trial now reported here, a dusting powder containing chlorhexidine instead of hexachlorophane was found to delay the separation of the umbilical cord.

STAPHYLOCOCCUS 502A-Reply

To the Editor.—To answer the points raised by Dr. Keidel's letter it is necessary to make a clear distinction between colonization with staphylococci and disease due to staphylococci in nursery infants. The newborn infant's skin is destined to become colonized with microorganisms. If one does nothing to interfere with this natural process, staphylococci will commonly establish residence. Coagulase positive staphylococci will be found on the skin of 40% to 50% of infants at the time of discharge from the hospital and approximately 10% of these are bacteriophage-typable. Hexachlorophene bathing can reduce the frequency of staphylococcalcolonizationof the skin to a level of about 5%. It is much harder to establish that hexachlorophene bathing decreases the likelihood ofdiseasedue to staphylococci. When outbreaks of staphylococcal disease appear in a nursery, it has been common experience that hexachlorophene bathing does not break the epidemic. (It should be noted that

Visual Estimate of Body Temperature in Neonates

A visual, noninvasive technique for accurately estimating body temperature using liquid crystal monitor tapes applied to the abdominal skin of newborn infants gave false-negative results in 1.9% of observations and false-positives in 5.3%. This simplified technique can be recommended for routine use in newborn nurseries.

The significance of positive blood culturesin newborn infants

I T IS not uncommon nursery experience to observe certain newborn infants who regularly lose weight beyond the usual expected time and who exhibit a lack of interest in nursing regardless of type of feeding. More often than not careful examination reveals no very convincing reason for the anorexia, listlessness, and accompanying weight loss. If allowed to go unchecked, loss of weight may be very considerable, and energetic and supportive t reatment becomes imperative. The writers observed a suggested relationship between this clinical picture and blood cultures which were quite regularly positive for hemolytic staphylococci. In August, 1946, a study was begun for the purpose of clarifying this clinical impression. This report is concerned with 323 blood culture samples taken from 240 infants, some of whom presented with surprising' regularity the above clinical picture. In others the nursery course was uneventful. The number of blood cultures and the number of infants included in this study would seem to be significant. In a partial review of the literature we find scant reference to bacteremia in the newborn infant. Older references to sepsis of the newborn infant are in most instances confusing and lacking in adequate blood studies. Usually these older reports described a severe type of illness, with death the usual rule, characterized by fever, severe gastrointestinal disturbance, jaundice, hemorrhage, and serious lesions noted at autopsy in the various body systems. The most informative study and the one most regularly referred to is that of Dunham. 1 She reported the findings in thirty-nine eases of septicemia of the newborn infant collected from the records of the New Haven Hospital and occurring over a period of five years. In thirty-four of her eases the diagnosis was made from blood cultures taken before death. She fur ther recorded the findings in 115 blood cultures taken at random from forty-nine apparently healthy newborn infants. Staphylococcus albus was recovered in thirty-five instances from these apparently well infants. Dunham concluded tha t Staph. albus, since it could regularly be cultured from the skin of newborn infants, should not be considered as a cause of illness but rather as a skin contaminant when present in blood cultures in the neonatM period. This conclusion has been generally accepted as a fact'. The data recorded in this study suggest that hemolytic Staph. albus is capable of invading, the blood stream of newborn infants with surprising regularity, and, if present in sufficient nmnbers, may cause regular and marked weight loss and at times serious signs of illness.

V. THE CHANGES IN SKIN SENSITIVITY TO SCARLATINAL STREPTOCOCCUS FILTRATE IN CHILDREN FOLLOWING THE INTRODUCTION OF HOMOLOGOUS SERUMS

In two previous papers,¹evidence has been presented to show that the skin of new-born infants is not sensitive to scarlatinal streptococcus filtrate toxin except in relatively few instances, and that the absence of this skin sensitivity is not due entirely to the presence of antitoxin. It was shown also that the skin of almost all infants more than 6 months of age has become sensitive to the toxin, although in some the sensitivity is more marked than in others. In a relatively small number, the skin does not show any reaction to considerable amounts of toxin. Some of these nonreactors have antitoxin in the blood, which presumably affects the sensitivity of the skin, while in the others antitoxin is not demonstrable. It was suggested²that the skin sensitivity might be evidence of a specific hypersusceptibility of the body cells to protein substances formed by the scarlatinal streptococcus.