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Care of the skin in premature neonates

Paediatric Dermatologist Dr David Atherton (MA (Cantab) MB BChir FRCP) is skincare adviser for Fairy Non Bio and Fairy Fabric Softener, which aim to support the ongoing education and development of healthcare professionals in the area of infant skincare

Important organ functions are immature in the preterm neonate so that it is obliged to face the hostile outside environment with inadequate resources. The principal functions of the skin are protective; the result is increased vulnerability so long as skin defences remain inadequate.

The functional anatomy of the skin in premature neonates
The most important protective functions of the skin are properties of its very outer layer, the stratum corneum. This layer does not start to form in the fetus until around 22-24 weeks gestation. It is more or less fully developed by the 34th week. The result is that between 22 and 34 weeks, the protective barrier functions of this layer will be relatively immature, depending on the exact gestational age.

Effects of immaturity of skin barrier function
Increased absorption of substances applied to
the skin
An important consequence of skin barrier immaturity is increased penetration of topically applies substances, which has sometimes had lethal consequences. This phenomenon has, however, also been harnessed for the experimental therapeutic delivery of drugs such as theophyline and diamorphine and, indeed, even as a means of increasing oxygen supply.

It is very important to be aware that toxicity from percutaneous absorption will not apply exclusively to topical medicaments, but will also need to be considered in relation to the excipients present in those formations, including preservatives, emulsifiers, fragrances and plant extracts, which may also cause toxicity problems. Furthermore, toxicity from percuataneous absorption can be caused by harsh substances used to wash nappies, clothing or bedding.

Vulnerability to physical injury
All layers of the skin are immature in the premature neonate, resulting in greatly increased mechanical fragility. This is most likely to be expressed by loss of skin following the use of adhesive tapes to secure airways, monitoring equipment and intravenous lines. Premature neonates are also at increased risk of irritant contact dermatitis following contact with chemicals such as antiseptics and body fluids, particularly urine and faeces.

Vulnerability to infection
Mature skin is good at keeping out pathogenic micro-organisms, partly as a reflection of its function as a mechanical barrier, but also because it manufactures powerful antimicrobial substances. These defences are not adequate in the premature neonate, and the situation is made even worse by the frequent presence of iatrogenic skin breaks that so often develop in these infants, and is made even more threatening by the almost invariable presence of transcutaneous catheters. This is aggravated further by the fact that the immune system is itself immature, the result being that micro-organisms such as Staphylococcus epidermis, that are of low pathogenicity in the mature infant, can be lethal to the premature neonate.

Soft on skin
Fairy Fabric Care products have been designed to leave fabrics soft and gentle next to sensitive skin.

According to Dr Atherton, "For sensitive skin, use a suitable fabric softener to minimise the friction of clothing; choose products that have been thoroughly evaluated for skin safety, like Fairy Fabric Softener for use on all clothes and fabrics". Its softening effect reduces friction from clothing and makes it particularly suitable for sensitive skin. The Fairy Fabric Care range has been evaluated by Allergy UK and awarded their British Allergy Foundation Seal of Approval.

Muriel Simmons, Chief Executive of Allergy UK comments: "We have carefully reviewed the new Fairy Fabric Care range and are delighted to recommend it to new mums." Fairy Non Bio is available in a variety of formats, including new gel. For more information on baby skincare and the full Fairy fabric care range, please visit: