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Introduction
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• The efficacy of this barrier is proportional to its thickness and
lipid composition.
• During late gestation, the number of epidermal layers and
the thickness of the stratum corneum increase with fetal age.
Vernix Caseosa
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Vernix Caseosa
• During the last trimester of gestation, the fetus is covered by a protective
biofilm called vernix caseosa.
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EPIDERMIS
protects against
- Evaporation - Epidermis thickness
Epidermis - Percutaneous absorption of - Barrier lipid content
depend on
toxic substances
- Physical damage
- Microbial infection
Gestational age
The number of epidermal
cell layers
thethickness of the
stratum corneum
increase progessively
with age.
In the premature infant, TEWL is inversely proportional to gestational age (Fig. 3.3 ).
TEWL (cont’d)
In very immature infants (24 – 26 weeks ’ gestation), it can be as high as 100 g/m2/h
◦ if left in a dry atmosphere, could lose 20 – 50% of their body weight within 24 h.
◦ lead to hypernatraemia, polyglobulia and hypothermia intracranial haemorrhage and death.
Prevention of hypothermia and TEWL using polyethylene caps or wraps immediately after delivery.
In underdeveloped countries, postnatal topical emollient therapy with sunflower seed oil or mineral
oils (petrolatum) reduce mortality rates in premature infants significantly.
TEWL (cont’d)
TEWL regional variability
◦ highest through the abdominal skin, where maturation of the epidermal barrier occurs latest
Preterm infants nursed under a radiant heater exhibit higher rates of evaporation
It is increased (by 20%) during phototherapy,
◦ even if relative humidity and ambient temperature are tightly controlled;
◦ probably caused by increased dermal blood flow during phototherapy
◦ Maintenance fluid intake of preterm infants should therefore be adequately increased during
phototherapy.
Neonatal epidermis can easily be hurt (e.g. by removal of plastic adhesives), which induces a
measurable disruption of the skin barrier function.
TEWL (cont’d)
Air exposure leads to acceleration of postnatal barrier maturation.
◦ TEWL in most premature infants approaches that of term infants within 10 – 15 days.
◦ This functional maturation is paralleled by an increase in stratum corneum thickness, the number of
lamellar bodies in stratum granulosum cells and the barrier lipid content of the stratum corneum
◦ In ultra-low-birthweight infants (23 – 25 weeks of gestational age), take significantly longer.
◦ Inmature babies it takes up 12 months until TEWL normalizes to levels seen in older children and adults;
this process is paralleled by a constant increase of natural moisturizing factor levels within the
epidermis.
Percutaneous Absorption
The immature epidermis is prone also to the accidental transcutaneous resorption of toxic
substances applied to the skin surface.
Skin permeability is inversely proportional to gestational age
◦ in the term infant, transcutaneous absorption is more readily achieved.
Low - molecular - weight chemicals (< 800 Da) penetrate more easily.
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Dermis supplies
• Dermal vessels are most important for the regulation of skin and body
temperature.
• The dermis connects the epidermal sheath with the underlying fatty tissue
provides stability and protection against trauma to the skin.
Sebaceous gland activity
• Squalenes and monoester waxes sebum
• Fetal skin fibroblasts lower expression of the integrin subunits α1 and α3 and
increased expression of α2.
• Fetal skin doesn’t exhibit dermal expression of some proteoglycans following trauma
decreased inflammatory and fibrotic responses.
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