Parents look to pediatricians for advice on bathing their newborn and avoiding diaper rash. Discolorations and lesions (usually benign) are another concern. This review also updates the best way to care for the umbilical cord and addresses special skin-care considerations in premature infants.
At birth, the infant emerges from an aqueous environment to a dry one. The term neonate's natural covering, the vernix, is wiped off or shed, and as the skin evolves it protects the individual from water loss, trauma, absorption of toxins, and infection. The skin also helps to regulate the infant's temperature in a world that is generally much colder than what it was used to in the uterus. Finally, the skin must contribute to neurosensory perception and immunologic surveillance. How can we best care for this vital organ in the first months of life? How does the skin of a premature infant differ from that of a term infant? How should we advise parents on the care of the umbilical cord? What common skin problems should parents be aware of? In answering these questions, we need to keep in mind that there are many ways to skin (care for) a baby
Before addressing general guidelines on caring for the skin of the newborn, we will discuss the special needs of preterm infants and how to care for the umbilical cord.
Preterm infants face many obstacles during the transition to life outside the uterus. Problems associated with skin immaturity are evident at birth and may affect how well the infant fares. The thickness of infant skin is 40% to 60% of that of adult skin, and in preterm infants the epidermis, dermis, and subcutaneous fat are even thinner than in full-term infants. The skin of infants of very low gestational age is markedly thin, and quite translucent (Figure 1). The stratum corneum, which becomes fully keratinized between 32 and 34 weeks' gestation, is immature in infants born before that time. Because of this immaturity, the infant loses an enormous amount of fluid through the skin: Infants weighing less than 1,000 g have approximately 65 mL/kg/d of transepidermal water loss (TEWL), and those weighing 1,750 to 2,000 g have about 30 mL/kg/d of TEWL. This loss of water may affect thermal stability, hydration, and electrolyte balance. TEWL has been decreased in premature infants with polyurethane wraps, humidi fied air, and application of ointment. The skin's barrier function also is compromised by prematurity. The infant becomes more susceptible to trauma and systemic absorption of topical substances.  Immature skin is vulnerable to infection and damage from monitor leads and procedures that often confront infants in intensive care.
Although studies have shown that the skin matures rapidly in the two to three weeks after birth, the most recent research indicates that in infants of very low gestational age skin function may be compromised for a longer time than was thought. A study using low-frequency impedance spectroscopy and TEWL measurements shows that in infants of 25 weeks' gestation and...
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