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The VLBW infant’s skin integrity can be compromised due to the following:

1. A less developed and thinner stratum corneum. A premature stratum corneum does not effectively prevent transepidermal water loss (TEWL), percutaneous absorption of exogenously applied compounds, or invasion of microbes.

2. Less cohesion between the epidermis and dermis. The fibrils that connect the epidermis and the dermis become stronger with gestational age and postnatal age. Early on, the cohesion between many of the currently used adhesives and the stratum corneum may be stronger than the bond between the dermis and the epidermis, leaving the young immature infant at risk for iatrogenic removal of the epidermal layer.

3. Collagen instability in the dermis leading to edema.

4. Increased permeability increases the risk of absorption and systemic toxicity from topically applied substances.

5. The acid mantle of the skin that has bactericidal properties is underdeveloped in the young preterm infant. The skin pH should drop to less than 5 by 4 days after birth, but bathing and skin prepping can disrupt acidification.

The goals of skin care for preterm infants are to promote skin integrity, decrease transepidermal water loss (TEWL), prevent excoriation, and treat skin breakdown.

BATHING & LUBRICATION

SKIN PREPPING AND ADHESIVES

AVOID SKIN BREAKDOWN

This guideline can be found in the NICU Nursing Guidelines Manual, #40:08.36.

References:

Lund, CH, et al. Disruption of barrier function in neonatal skin associated with adhesive removal. J Pediatr 1997; 131:367-72.