Running head: Retention of vernix caseosa 1

Retention of Vernix Caseosa on the Newborn Integument

Blake Renner
Clinical Practicum III Spring 2016
Nell Hodgson Woodruff School of Nursing
Emory University

Retention of vernix caseosa 2

Retention of Vernix Caseosa on the Newborn Integument
When considering the care of a newborn, great care must be taken in order to insure the
best transition possible to the extra uterine environment. For years, hospitals bathed newborns
almost immediately after birth in order to rid the skin of fluids and vernix caseosa layered on the
skin from its time in the uterus. Recent evidence shows that this action may not be helpful in
keeping the infant hydrated, protected, and assisting in its adjustment to a new atmosphere. This
paper will review the research on bathing newborns immediately after birth and interventions
that should be made in the labor and delivery setting.
When searching for evidence on this topic, I used the PubMed database. Search terms
that I used include: bathing, newborn, neonate, washing, cleansing, vernix, and evidence based
practice. The search returned a plethora of studies and literature reviews on the topic of newborn
bathing and the benefits of vernix. In this paper, two studies and four literature reviews are
referenced. Three references come from various countries in Europe, one from Africa, and two
from the United States. All of the articles are written in English. Most of the articles address the
different practices of bathing newborns, the benefits of vernix, and recommendations based on
scientific results. The article originating from Africa, by Adejuyigbe et al. (2015), introduces the
factor of culture and the beliefs of many African people regarding thermal care and bathing of
infants. This article allows me to address interventions when working with patients of another
culture. One limitation I encountered was the dates of the articles being over ten years ago. This
required me to pass on a few great articles from the 1990s. Otherwise, my search was relatively
successful in finding the information I needed in order to provide a look into the method that is
newborn bathing. A quality review table can be found in Appendix I.

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The most important function of the skin is to protect against the loss of water, absorption
of noxious substances, intrusion of microorganisms, and physical trauma (Blume-Peytavi,
Hauser, Stamatas, Pathirana, & Bartels, 2012). The skin of a newborn continues to adapt after
birth in order to transition from a wet environment to a dry environment. During this crucial
period, the skin of the newborn needs special care. Newborns are commonly covered in vernix, a
cheesy, white substance, post-birth. This substance is a mixture of protein, lipids, and water that
is uniquely suited to aid in the transition of the newborn from the high hydrostatic pressure,
hydrated environment of the uterus to the low pressure, relatively dry extra uterine environment
(Dyer, 2013). Often, the vernix caseosa is wiped off newborns immediately after birth.
According to Afsar (2009), this practice is inadvisable as the vernix does not contain any harmful
material and has antibacterial properties that contribute to protection against bacterial infections.
Vernix has also been shown to lead to higher skin hydration, lower skin pH, and less erythema in
infants (Dyer, 2013). Furthermore, in a study done by Visscher et al. (2011), it was discovered
that retention of the vernix led to significantly higher levels of free amino acids 24 hours after
birth compared to infants in which the vernix was removed immediately after birth. These free
amino acids are crucial to the integumentary transition process.
The reason in which the vernix covering is so important, is due to the fact that the skin of
a neonate is very different than that of an adult. In a study reviewed by Blume-Peytavi et al.
(2012), researchers observed newborn skin at the microscopic level. Results showed that the skin
of a newborn has a thinner, smaller structure and higher absorption and desorption rates. These
observations demonstrate the variability and fragility of neonatal integument. Newborns are
more susceptible to dehydration and heat loss until their skin further develops.

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A study done by Adejuyigbe et al. (2015), addressed cultural beliefs in the bathing of
newborns in Africa. Through interviews with new mothers, the researchers discovered that the
vernix was described as dirty and was linked to poor maternal behavior such as eating certain
foods, not drinking enough water, not taking herbs, and sex late in pregnancy. Because of this,
the vernix is removed immediately after birth. Cultural practices and beliefs are important factors
when determining care that are often overlooked.
While most articles I found were adamant about avoiding bathing newborns immediately
after birth, a few articles discussed differing results. According to the literature review, based on
a round table consensus by multiple health care practitioners, by Blume-Peytavi, Cork,
Faergemann, Szczapa, Vanaclocha, & Gelmetti (2009), newborns may be wiped immediately
after delivery in order to remove the vernix caseosa. The researchers describe a study that
measured axillary temperatures of infants bathed within the first hour of birth and infants bathed
4-6 hours after birth. Results showed that the temperatures did not differ significantly which
contradicts Afsars (2009) statement that neonates should not be bathed within the first 6 hours of
birth due to the increased risk for hypothermia. Blume-Peytavi et al. (2009), goes on to say that
bathing does not harm the baby and bathing times may be flexible depending on the
characteristics and stability of the newborn and family preferences. Blume-Peytavi et al. (2012)
reported finding six studies, with large sample sizes, concluding that bathing of the newborn
poses no risks.
Ultimately, the majority of the articles I found described several different reasons as to
why not bathing a newborn immediately after delivery is beneficial. The two articles that differed
simply stated that it will not harm a newborn to be bathed after delivery. With this being said,

Retention of vernix caseosa 5

there is also no harm in not bathing the newborn and allowing the vernix caseosa to remain intact
for a few hours after birth to take advantage of the benefits.
One recommendation for practice, based on Dyers (2013) review, is to dry the infant
immediately after birth to prevent hypothermia, leaving the vernix as intact as possible,
considering the benefits. The newborn may be gently dried and placed on its mothers chest for
skin-to-skin temperature regulation. A second recommendation is to postpone the first bath until
at least 6 hours after delivery to ensure the newborn has received the benefits of the vernix and is
stable. A third recommendation, according to Blume-Peytavi et al. (2009), after the first bath,
bathing should be limited to 2-3 times a week to aid in skin transition and reduce the risk of
irritation. A fourth recommendation is to be familiar with cultural practices and beliefs when it
comes to care of the newborn. If a nurse is familiar with the culture of a patient, it helps her to
better understand how to educate the patient in a way that is effective.
There are many different opportunities for research on the skin care of newborns in the
future. As of now, these are the current findings and recommendations to ensure the best care of
the integument of newborn babies after delivery. More research is warranted on the relationship
between retention of the vernix and decreased hypothermia.

Retention of vernix caseosa 6

References
Adejuyigbe, E. A., Bee, M. H., Amare, Y., Omotara, B. A., Iganus, R. B., Manzi, F., . . . Hill, Z.
E. (2015). Why not bathe the baby today?: A qualitative study of thermal care beliefs
and practices in four African sites. BMC Pediatrics BMC Pediatr, 15(1).
Doi:10.1186/s12887-015-0470-0
Afsar, F. S. (2009). Skin care for preterm and term neonates. Clinical and Experimental
Dermatology, 34(8), 855-858. Doi:10.1111/j.1365-2230.2009.03424.x
Blume-Peytavi, U., Cork, M. J., Faergemann, J., Szczapa, J., Vanaclocha, F., & Gelmetti, C.
(2009). Bathing and cleansing in newborns from day 1 to first year of life:
recommendations from a European round table meeting. Journal Of The European
Academy Of Dermatology & Venereology, 23(7), 751-759. Doi:10.1111/j.14683083.2009.03140.x
Blume-Peytavi, U., Hauser, M., Stamatas, G. N., Pathirana, D., & Bartels, N. G. (2012). Skin
Care Practices for Newborns and Infants: Review of the Clinical Evidence for Best
Practices. Pediatric Dermatology, 29(1), 1-14. Doi:10.1111/j.1525-1470.2011.01594.x
Dyer, J. A. (2013). Newborn skin care. Seminars in Perinatology, 37(1), 3-7.
Doi:10.1053/j.semperi.2012.11.008
Visscher, M. O., Utturkar, R., Pickens, W. L., LaRuffa, A. A., Robinson, M., Wickett, R. R., &
Hoath, S. B. (2011). Neonatal Skin Maturation-Vernix Caseosa and Free Amino Acids.
Pediatric Dermatology, 28(2), 122-132. Doi:10.1111/j.1525-1470.2011.01309.x

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Appendix I: Quality Review
Author
Adejuyigbe et al.

Date

Type of

Sample

Methods/Results/Recommendation

Strength of

2015

Evidence
Qualitative

Size
131

s
Data collection included newborn

Evidence
III

Study

women

care narratives, observations of

from

bathing, and in-depth interviews

differing

(IDIs) with new mothers,

parts of

grandmothers, fathers, health

Africa

workers, and birth attendants.

All health care workers shared
negative views regarding the
vernix, except in Tanzania.

Since the negative beliefs are deeprooted in culture, implementers

should be realistic about the time it
will take for behavior change to
occur. Yet, the participants shared a
similar belief that thermal care is
important for the infant which may
make the adoption of appropriate
practices more likely.

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Afsar

2009

Review

N/A

Article

Neonatal bathing should be

postponed until after the first 6

hours of birth due to the increased
risk of hypothermia.
The vernix caseosa should remain

Blume-Peyetavi et

2009

al.

Review

N/A

Article

intact until the neonate is bathed.

Bathing a newborn soon after

IV

delivery has no significant effect on

temperature and does not harm the
baby.
Bathing times can be kept flexible
based on the characteristics and
stability of the newborn and family
preferences.
Baby can be wiped with water

Blume-Peytavi et al.

2012

Review
Article

N/A

immediately after delivery.

It is recommended to gently wipe
the baby with water immediately
after delivery.
Limited evidence exists that the
first bath can take place within a
few hours after birth if thermal and
cardiorespiratory stability is
ensured.

Retention of vernix caseosa 9

Dyer

2013

Review

N/A

Article

Extensive review of the evidence

supporting the benefits of vernix

caseosa.
Immediately after birth, dry the
infant. Leave vernix as intact as
possible and allow it to dry and

Visscher et al.

2011

Randomize

30 healthy

peel naturally.
The skin of healthy neonates

d Controlled full term

containing vernix was compared

Trial

with the skin of healthy neonates in

neonates

which the vernix was removed.

The moisture accumulation rate
was significantly higher for the
vernix retained group compared to
the vernix removed group.
Vernix retention also led to higher
levels of FAA 24 hours after birth.

Findings provide support for

retention of vernix on the skin after
birth.

II