Most guidelines on neonatal skin care emphasize issues pertaining to healthy, term infants; only a few addresses the complex task of skin barrier maintenance in preterm, very preterm and extremely preterm infants.

A recent article published in Pediatric Dermatology provided an evidence-based review of the literature on skin care of preterm neonates.

The authors reported that the stratum corneum does not fully develop until late in the third trimester. Thus, the barrier function of preterm skin is significantly compromised. Numerous interventions are available to augment the weak skin barrier of neonates. For instance, plastic wraps – reduce the incidence of hypothermia, while semipermeable and transparent adhesive dressings – improve skin quality and decrease the incidence of electrolyte abnormalities. Additionally, tub bathing causes less body temperature variability than sponge bathing and can be performed as infrequently as once every four days without increasing bacterial colonization of the skin. Additionally, the use of topical emollients like sunflower seed oil, appear to reduce the incidence of skin infections in premature neonates; however, they have been found to be effective only in the developing countries. Whereas, in developed countries, topical petrolatum ointment led to an increased risk of candidemia and coagulase-negative Staphylococcus infection in the preterm population—perhaps by creating a milieu similar to occlusive dressings. On the other hand, for preterm infants with catheters, povidone-iodine and chlorhexidine are comparably effective in preventing catheter colonization.

Source: Pediatric Dermatology. 2019 Jan;36(1):16-23. doi: 10.1111/pde.13725. Epub 2018 Dec 12.