Journal articles on the topic 'Infant skin barrier'
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Telofski, Lorena S., A. Peter Morello, M. Catherine Mack Correa, and Georgios N. Stamatas. "The Infant Skin Barrier: Can We Preserve, Protect, and Enhance the Barrier?" Dermatology Research and Practice 2012 (2012): 1–18. http://dx.doi.org/10.1155/2012/198789.
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Infant skin is different from adult in structure, function, and composition. Despite these differences, the skin barrier is competent at birth in healthy, full-term neonates. The primary focus of this paper is on the developing skin barrier in healthy, full-term neonates and infants. Additionally, a brief discussion of the properties of the skin barrier in premature neonates and infants with abnormal skin conditions (i.e., atopic dermatitis and eczema) is included. As infant skin continues to mature through the first years of life, it is important that skin care products (e.g., cleansers and emollients) are formulated appropriately. Ideally, products that are used on infants should not interfere with skin surface pH or perturb the skin barrier. For cleansers, this can be achieved by choosing the right type of surfactant, by blending surfactants, or by blending hydrophobically-modified polymers (HMPs) with surfactants to increase product mildness. Similarly, choosing the right type of oil for emollients is important. Unlike some vegetable oils, mineral oil is more stable and is not subject to oxidation and hydrolysis. Although emollients can improve the skin barrier, more studies are needed to determine the potential long-term benefits of using emollients on healthy, full-term neonates and infants.
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Rahma, Annisa, and Majella E. Lane. "Skin Barrier Function in Infants: Update and Outlook." Pharmaceutics 14, no. 2 (February 17, 2022): 433. http://dx.doi.org/10.3390/pharmaceutics14020433.
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A good understanding of infant skin should provide a rationale for optimum management of the health of this integument. In this review, we discuss the skin barrier function of infants, particularly with reference to the use of diapers and baby wipes. The skin barrier of newborns continues to develop with age. Two years after birth, the barrier properties of infant skin closely resemble those of adult skin. However, several risk factors may contribute to impaired skin barrier and altered skin permeability in infants. Problems may arise from the use of diapers and baby wipes. The skin covered by a diaper is effectively an occluded environment, and thus is vulnerable to over-hydration. To date there has been no published information regarding dermal absorption of ingredients contained in baby wipes. Similarly, dermal absorption of topical ingredients in infants with underlying skin conditions has not been widely explored. Clearly, there are serious ethical concerns related to conducting skin permeation studies on infant skin. However, the increasing availability of non-invasive methods for in vivo studies is encouraging and offers new directions for studying this important patient group.
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Yonezawa, Kaori, Megumi Haruna, and Reiji Kojima. "Validity of infant face skin assessment by parents at home." Asian/Pacific Island Nursing Journal 4, no. 4 (January 28, 2020): 159–64. http://dx.doi.org/10.31372/20190404.1071.
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Parents had better to assess their infant’s skin daily to prevent the development of any skin problems. However, there are no standard methods for assessing infant skin at home. This study aimed to validate the assessment of infant face skin conditions by parents as compared to using skin barrier function clinical tests. In addition, we evaluated the degree of agreement between parents and physicians/midwives when assessing an infant’s skin. A cross-sectional study involving 184 infants aged 3 months was conducted. To evaluate the parents’ infant skin assessment, we used the Neonatal Skin Condition Score (NSCS). On the same day, we evaluated the skin barrier function on the infant’s forehead and cheek, including transepidermal water loss (TEWL), stratum corneum hydration, skin pH, and sebum secretion. Skin barrier function values were correlated with infant skin condition assessed by parents, especially in cases of TEWL of the cheek, for which a moderate positive correlation was found between parental assessment score (ρ = 0.448). In addition, infant with skin problems based on parental assessment had a significantly higher TEWL, lower SCH, and higher skin pH. However, there was weak agreement between parental and physician/midwife assessment. Thus, there was a relationship between parental assessment and skin barrier function; thus, parents can use at-home assessment to assist with infant skin care. In the future, research focused on developing methods of examining infant skin conditions should consider incorporate parental daily skin assessment.
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Liu, Qiwei, Yanhui Zhang, Simon G. Danby, Michael J. Cork, and Georgios N. Stamatas. "Infant Skin Barrier, Structure, and Enzymatic Activity Differ from Those of Adult in an East Asian Cohort." BioMed Research International 2018 (July 12, 2018): 1–8. http://dx.doi.org/10.1155/2018/1302465.
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Skin physiology is dynamically changing over the first years of postnatal life; however, ethnic variations are still unclear. The aim of this study was to characterize infant skin barrier function, epidermal structure, and desquamation-related enzymatic activity as compared to that of adult skin in an East Asian population. The skin properties of 52 infants (3-24 months) and 27 adults (20-40 years) were assessed by noninvasive methods at the dorsal forearm and upper inner arm. Transepidermal water loss and skin surface conductance values were higher and more dispersed for infants compared to adults. Infant skin surface pH was slightly lower than adult on the dorsal forearm. The infant SC and viable epidermis were thinner compared to adults with differences that were site-specific. Although the chymotrypsin-like activity for infant skin was comparable to adult level, the caseinolytic specific activity was significantly higher for the infant cohort. These observations indicate a differently controlled pattern of corneocyte desquamation in infants. In conclusion, structural and functional differences exist between infant and adult skin in the East Asian population pointing to dynamic maturation of the epidermal barrier early in life.
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Holvoet, Sébastien, Sophie Nutten, Lénaïck Dupuis, Dominique Donnicola, Tristan Bourdeau, Betsy Hughes-Formella, Dagmar Simon, et al. "Partially Hydrolysed Whey-Based Infant Formula Improves Skin Barrier Function." Nutrients 13, no. 9 (September 4, 2021): 3113. http://dx.doi.org/10.3390/nu13093113.
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Specific partially hydrolysed whey-based infant formulas (pHF-W) have been shown to decrease the risk of atopic dermatitis (AD) in infants. Historically, AD has been associated primarily with milk allergy; however, defective skin barrier function can be a primary cause of AD. We aimed to ascertain whether oral supplementation with pHF-W can improve skin barrier function. The effect of pHF-W was assessed on transepidermal water loss (TEWL) and antibody productions in mice epicutaneously exposed to Aspergillus fumigatus. Human primary keratinocytes were stimulated in vitro, and the expression of genes related to skin barrier function was measured. Supplementation with pHF-W in neonatal mice led to a significant decrease in TEWL and total IgE, but not in allergen-specific antibody levels. The whey hydrolysate was sufficient to decrease both TEWL and total IgE. Aquaporin-3 gene expression, linked with skin hydration, was modulated in the skin of mice and human primary keratinocytes following protein hydrolysate exposure. Skin barrier improvement may be an additional mechanism by which pHF-W may potentially reduce the risk of AD development in infants. Further human studies are warranted to confirm the clinical efficacy of these observations.
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Kelleher, M. "Quantifying the skin barrier from infant to adult." Toxicology Letters 238, no. 2 (October 2015): S50. http://dx.doi.org/10.1016/j.toxlet.2015.08.141.
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Färdig, Martin, Hrefna Katrín Gudmundsdóttir, Angela Hoyer, Karen Eline Stensby Bains, Catarina Almqvist, Christine Monceyron Jonassen, Eva Maria Rehbinder, et al. "Skin Barrier Function and Infant Tidal Flow-Volume Loops—A Population-Based Observational Study." Children 10, no. 1 (December 31, 2022): 88. http://dx.doi.org/10.3390/children10010088.
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Background: The relationship between skin barrier- and lung function in infancy is largely unexplored. We aimed to explore if reduced skin barrier function by high transepidermal water loss (TEWL), or manifestations of eczema or Filaggrin (FLG) mutations, were associated with lower lung function in three-month-old infants. Methods: From the population-based PreventADALL cohort, 899 infants with lung function measurements and information on either TEWL, eczema at three months of age and/or FLG mutations were included. Lower lung function by tidal flow-volume loops was defined as the ratio of time to peak tidal expiratory flow to expiratory time (tPTEF/tE) <0.25 and a tPTEF <0.17 s (<25th percentile). A high TEWL >8.83 g/m2/h (>75th percentile) denoted reduced skin barrier function, and DNA was genotyped for FLG mutations (R501X, 2282del4 and R2447X). Results: Neither a high TEWL, nor eczema or FLG mutations, were associated with lower tPTEF/tE. While a high TEWL was associated with a lower tPTEF; adjusted OR (95% CI) 1.61 (1.08, 2.42), the presence of eczema or FLG mutations were not. Conclusions: Overall, a high TEWL, eczema or FLG mutations were not associated with lower lung function in healthy three-month-old infants. However, an inverse association between high TEWL and tPTEF was observed, indicating a possible link between the skin barrier- and lung function in early infancy.
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Yuan, Chao, Ying Zou, Yao Xueqiu, Kyoko Shima, Yuki Miyauchi, Ayano Naoe, Satoru Naito, et al. "Properties of Skin in Chinese Infants: Developmental Changes in Ceramides and in Protein Secondary Structure of the Stratum Corneum." BioMed Research International 2017 (2017): 1–6. http://dx.doi.org/10.1155/2017/3594629.
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The properties of infant skin regarding its structure and stratum corneum (SC) properties during development compared to adult skin have been reported only for a few races and body sites. The aim of this study was to understand the developmental changes of skin properties in Chinese infants, focusing on SC ceramides and protein secondary structure, which are important for skin barrier function. Three body sites with distinct characteristics (cheeks, inner upper arms, and buttocks) were assessed. Sixty pairs of Chinese infants and their mothers were measured for SC hydration, transepidermal water loss, ceramide levels, sebum with an ester bond, and protein secondary structure of superficial SC. Skin hydration decreased with age at all body sites. TEWL was similar between the 2–12- and 13–24-month-old groups but was higher than the adult group at the buttocks and inner upper arms and was equal to the adult group at the cheeks. These differences coincided with differences in protein secondary structure. Ceramide and sebum levels were lower in the infant groups. We conclude that both the SC functions and the components of infant skin are still developing and are not fully adapted as in adult skin at each body site examined.
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Kledzik, Theresa. "Holding the Very Low Birth Weight Infant: Skin-to-Skin Techniques." Neonatal Network 24, no. 1 (January 2005): 7–14. http://dx.doi.org/10.1891/0730-0832.24.1.7.
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Skin-to-skin holding has been reported as a valuable intervention for preterm infants for over a decade. However, many neonatal intensive care units are not practicing this therapy and cite lack of protocols and techniques as a barrier. This article describes in detail the nursing considerations and techniques involved to successfully implement skin-to-skin holding for very low birth weight, technology-dependent infants. NICU protocols can be derived from this article.
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Mancini, Anthony J. "Skin." Pediatrics 113, Supplement_3 (April 1, 2004): 1114–19. http://dx.doi.org/10.1542/peds.113.s3.1114.
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Human skin provides a barrier between the host and the physical, chemical, and biological environment. It is also a potential portal of entry for hazardous or infectious agents and a potential target of environmental toxins. Cutaneous vulnerability may take on many forms in the embryo, infant, child, and adolescent. Teratogenic agents may occasionally target skin, as appreciated in the proposed association of the antithyroid medication methimazole, with the congenital malformation known as aplasia cutis congenita. Percutaneous absorption of topically applied substances and the potential for resultant drug toxicities are important considerations in the child. Many topical agents have been associated with systemic toxicity, including alcohol, hexachlorophene, iodine-containing compounds, eutectic mixture of local anesthetics, and lindane. Percutaneous toxicity is of greatest concern in the premature infant, in whom immaturity of the epidermal permeability barrier results in disproportionately increased absorption. Immature drug metabolism capabilities may further contribute to the increased risk in this population. Ultraviolet (UV) radiation exposure, which increases an individual’s risk of cutaneous carcinogenesis, may be a particularly significant risk factor when it occurs during childhood. The “critical period hypothesis” suggests that UV exposure early in life increases the risk of eventual development of malignant melanoma. Other risk factors for malignant melanoma may include severe sunburns during childhood, intense intermittent UV exposure, and increased susceptibility of pediatric melanocytes to UV-induced DNA damage. Last, percutaneous exposure to environmental toxins and chemicals, such as insecticides and polychlorinated biphenyls, may differ between children and adults for several reasons, including behavioral patterns, anatomic and physiologic variations, and developmental differences of vital organs.
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Okah, Felix A., R. Randall Wickett, William L. Pickens, and Steven B. Hoath. "Surface Electrical Capacitance as a Noninvasive Beside Measure of Epidermal Barrier Maturation in the Newborn Infant." Pediatrics 96, no. 4 (October 1, 1995): 688–92. http://dx.doi.org/10.1542/peds.96.4.688.
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Objective. The classical studies of epidermal barrier function in infants have relied on measurement of transepidermal water loss by evaporimetry. This technique, although valuable, is, in practice, slow, expensive, and susceptible to error because of convective air currents. In this prospective study, we evaluated gestation-dependent and postnatal age-dependent changes in epidermal barrier function by measurement of skin surface electrical capacitance (SEC) in 40 newborn infants ranging from 25 to 40 weeks' gestational age. SEC was measured in picofarads with a dermal phase meter. Methodology. The measurements were recorded continuosuly during a 12-second period from the forehead at 12 to 24 hours of life. The baseline (CBL) surface hydration at 1 second and the rate of change of SEC during probe occlusion (CSL) were used as measures of surface hydration and transepidermal water movement, respectively. In the most premature infants (<30 weeks), these measurements were repeated daily for 5 days. Data were analyzed by analysis of variance after logarithmic (Ln) transformation. Results. We found a significant difference in Ln(CBL) in infants born before and after 30 weeks' gestation (4.91 ± 0.36 Ln[pF] vs 2.67 ± 0.21 Ln[pF], respectively). Similarly, CSL was significantly different in infants born before and after 30 weeks' gestation (16.42 ± 5.55 pF/s vs 1.59 + 0.22 pF/s, respectively). In infants born at less than 27 weeks, both Ln(CBL) and CSL decreased significantly by postnatal day 5. In the term group (n = 25), CSL was significantly greater in white than in black infants (1.96 ± 1.32 pF/s vs. 0.95 ± 0.55 pF/s, respectively). Conclusion. These results demonstrate impaired epidermal barrier properties in immature infants, less than 30 weeks' gestation, and reveal a remarkable rate of barrier maturation of this group in the first few days of postnatal life. Also, the finding of decreased CSL in black infants supports the hypothesis of differences in barrier function attributable to skin types. Overall, these findings demonstrate the feasibility of bedside SEC measurements in the evaluation of epidermal barrier properties in the newborn infant.
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Boyer, Gaëtan, Clarence De Belilovsky, Stéphanie Brédif, Caroline Baudouin, Laurent Misery, and Gaëlle Bellemère. "Clinical and Instrumental Exploration of Sensitive Skin in a Pediatric Population." Cosmetics 8, no. 2 (May 30, 2021): 43. http://dx.doi.org/10.3390/cosmetics8020043.
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Studies on sensitive skin pathophysiology in infants are challenging because most assessment methods require self-reporting of signs. In this study, we aimed to identify and characterize sensitive skin in children for the first time. A newly developed parent-reported questionnaire was used to recruit children with sensitive skin. This questionnaire was also tested on an adult group. Hydration, transepidermal water loss (TEWL), and inflammatory markers (cytokines, and polyunsaturated fatty acids (PUFAs)) were quantified. A total of 77 children and 20 adults (33 and 10 with sensitive skin, respectively) were recruited. The groups with sensitive skin had more clinical signs of skin dryness. Skin hydration was lower in children in the sensitive compared with the nonsensitive skin group. TEWL levels were similar between sensitive and nonsensitive subjects in both infant and adult groups. Sensitive skin exhibited higher levels of cytokines and proinflammatory PUFAs as well as lower levels of anti-inflammatory PUFAs. Sensitive skin syndrome was associated with normal skin barrier function but lower hydration in infants and children. The higher levels of proinflammatory markers suggest that sensitive skin is associated with low-level inflammation. It is hypothesized, for the first time, that PUFAs are involved in sensitive skin syndrome in infants.
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Ghosh, Arnab, B. C. Dutta, and Sudipta Pal. "Harlequin ichthyosis - a rare genetic disorder : a case report." National Journal of Clinical Anatomy 04, no. 04 (October 2015): 199–201. http://dx.doi.org/10.1055/s-0039-3401570.
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AbstractHarlequin lchthyosis(HI) is a type of genodermatosis. It is a rare and fatal genetic disease. Life expectancy in an affected infant is only a few days. The defect lies in mutation of ABCA12 gene. The barrier action of skin is severely compromised making the infant prone to infections and dehydration. Present treatment protocol consists mainly of conservative and supportive therapies. The authors report this case as it is a rare disease. The main purpose of this report is to create awareness about the disease and discuss the genetic factors along with micro anatomy of skin ultimately leading to this condition.
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Knauth, Alison, Margaret Gordin, Wendy McNelis, and Stephen Baumgart. "Semipermeable Polyurethane Membrane as an Artificial Skin for the Premature Neonate." Pediatrics 83, no. 6 (June 1, 1989): 945–50. http://dx.doi.org/10.1542/peds.83.6.945.
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A thin and semipermeable polyurethane membrane adherently applied to premature neonates as an artificial skin was investigated as an atraumatic surface barrier sufficient to reduce transepidermal water loss without inhibiting natural infant skin development during the first few days of life. A sample group of 18 neonates (birth weight [mean ± SEMI] 1.39 ± 0.12 kg, gestation [mean ± SEMI] 31 ± 1 weeks) received two 3 x 3-cm polyurethane patches adherent over the chest and abdomen. Transepidermal water loss was measured before and after application and after membrane removal. During longitudinal study, seven infants were treated day 1 through day 4 of life and were evaluated for skin integrity 24 hours after patch removal on day 5. Polyurethane membranes produced an acute and significant reduction in transepidermal water loss for the 18 subjects: 21.1 ± 2.0 g/m2/h before application v 10.5 ± 1.4 g/m2/h with membranes in place (P < .001). Immediately after patch removal, transepidermal loss returned to 22.8 ± 3.0 g/m2/h. Throughout the first four days of life, daily measurements of water loss were significantly less: 53% to as much as 72% reduction from polyurethane-covered sites when compared with adjacent naked skin. After polyurethane membrane removal, skin development of transepidermal barrier function was comparable over both sites. Dressings did not lose adhesive or plastic properties during an extended time in either radiant warmer or incubator environments, electronic monitoring through membranes was not impeded, and adhesive injuries were not observed. An adherent, semipermeable polyurethane membrane may be effective as an atraumatic artificial barrier to prevent large transepidermal water loss and protect the skin of the premature neonate.
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Tamrazova, O. B., S. P. Seleznev, and A. V. Tamrazova. "NATURAL COSMETICS IN THE CARE OF YOUNG CHILDREN." Pediatria. Journal named after G.N. Speransky 99, no. 6 (December 14, 2020): 155–62. http://dx.doi.org/10.24110/0031-403x-2020-99-6-155-162.
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The article provides general information about the skin physiology of newborns and infants. Structural features of the skin and main adaptive shifts in newborns, are described. Тhe child has an increase in the skin barrier function of the skin, which prevents transepidermal water loss; active synthesis of natural moisturizing factor (NMF) components that control skin hydration; shift of pH to acidic environment; normalization of thermoregulatory functions; enhancement of the photoprotective function; immune restructuring for antimicrobial protection; formation of a normal microbiome. The article describes the consequences of improper skin care of a newborn, using the example of diaper dermatitis, irritant dermatitis, prickly heat and vesiculopustulosis. The importance of using specialized children's cosmetics in caring for an infant is assessed. The basic recommendations for the choice of these products are presented, where the main emphasis is on the choice of products consisting of natural ingredients. Giving preference to natural cosmetics, everyone should carefully study the composition of these products and trust the manufacturers who can guarantee safety of care products for the youngest children.
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Reed, Robyn C., Deanna E. Johnson, and Ann Marie Nie. "Preterm Infant Skin Structure Is Qualitatively and Quantitatively Different From That of Term Newborns." Pediatric and Developmental Pathology 24, no. 2 (January 20, 2021): 96–102. http://dx.doi.org/10.1177/1093526620976831.
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Background The immature skin of preterm infants is uniquely vulnerable to pressure and chemical injury. We sought to qualitatively and quantitatively describe the histopathologic patterns of skin development in preterm infants. Methods Autopsy skin samples were examined for 48 liveborn preterm infants born at 18+ to 36 weeks, and control groups of term neonates and older infants/children. Quantitative variables included thickness of the stratum corneum, epidermis, and dermis. Qualitative features included stratum corneum, rete ridges, and hair follicles. Results Patterns of maturation were reproducible. Compact keratin appeared beginning at 21–22 weeks. Basketweave keratin appeared first around hair follicles, and then became more generalized from ∼28 weeks corrected gestational age (CGA) onward. Rete ridges began to appear at ∼30 weeks. Epidemal and dermal thickness increased with age. Infants who survived ≤7 days had thicker dermis than those who survived longer, even adjusted for CGA. Conclusions Skin development in preterm infants has reproducible milestones. Significant structural changes occurring around 28–30 weeks may improve barrier function, with implications for use of topical compounds such as chlorhexidine. The findings also highlight challenges in evaluating pressure injuries in preterm infants, and postnatal changes in skin parameters.
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Kumar, Neeraj, Balraj Saini, and Rajwinder Kaur. "A nontoxic ionic liquid composition for the delivery of biological macromolecular anions across the skin barrier." Pharmaceutical Patent Analyst 10, no. 4 (July 2021): 191–94. http://dx.doi.org/10.4155/ppa-2021-0012.
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The development of biocompatible ionic liquids is needed in order to explore their vastly underutilized pharmaceutical potential. US10912834 patent discloses ionic liquids comprising macromolecular biological anions and alkylated cations, which provides enhanced dermal delivery and cell internalization of the large biological anions. The studies of ex vivo permeation through excised pig skin indicated significantly higher skin penetration of percent dose and enhanced drug internalization was achieved using these ionic liquids. Although, the patent advances an infant field of biological macromolecule-based ionic liquids, the evaluation of these claimed ionic liquids relies only on the in vivo cytotoxicity data and ex vivo skin permeation behavior. Exhaustive studies, including dermatokinetic evaluation and long-term animal toxicity experiments, should be performed in order to unravel the potential of the aforementioned ionic liquids.
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Nielsen, Sandra C. A., Krishna M. Roskin, Katherine J. L. Jackson, Shilpa A. Joshi, Parastu Nejad, Ji-Yeun Lee, Lisa E. Wagar, et al. "Shaping of infant B cell receptor repertoires by environmental factors and infectious disease." Science Translational Medicine 11, no. 481 (February 27, 2019): eaat2004. http://dx.doi.org/10.1126/scitranslmed.aat2004.
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Antigenic exposures at epithelial sites in infancy and early childhood are thought to influence the maturation of humoral immunity and modulate the risk of developing immunoglobulin E (IgE)–mediated allergic disease. How different kinds of environmental exposures influence B cell isotype switching to IgE, IgG, or IgA, and the somatic mutation maturation of these antibody pools, is not fully understood. We sequenced antibody repertoires in longitudinal blood samples in a birth cohort from infancy through the first 3 years of life and found that, whereas IgG and IgA show linear increases in mutational maturation with age, IgM and IgD mutations are more closely tied to pathogen exposure. IgE mutation frequencies are primarily increased in children with impaired skin barrier conditions such as eczema, suggesting that IgE affinity maturation could provide a mechanistic link between epithelial barrier failure and allergy development.
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Turksen, Kursad, and Tammy-Claire Troy. "Permeability barrier dysfunction in transgenic mice overexpressing claudin 6." Development 129, no. 7 (April 1, 2002): 1775–84. http://dx.doi.org/10.1242/dev.129.7.1775.
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A defective epidermal permeability barrier (EPB) in premature birth remains a leading cause of neonatal death as a result of its associated complications, which include poor temperature stability, infection by micro-organisms through the skin, and the outflow of water. Despite its importance in survival, the mechanisms involved in the formation and maintenance of the EPB are not well understood. To address the possibility that claudins, a new superfamily of tight junctional molecules, are involved, we engineered transgenic mice with claudin 6 (Cldn6) overexpressed via the involucrin (Inv) promoter. Interestingly, the Inv-Cldn6 transgenic animals die within 2 days of birth, apparently due to the lack of an intact EPB as evidenced by increased water loss and the penetration of X-gal through the skin. Barrier dysfunction was manifested biochemically by the aberrant expression of late epidermal differentiation markers, including K1, filaggrin, loricrin, transglutaminase 3, involucrin, repetin, members of the SPRR family and the transcriptional regulator Klf4. The overall claudin profile of the epidermis was also modified. Our data suggest that repetin and SPRR1A and 2A are downregulated in response to the downregulation of Klf4 in the transgenic animals, which would contribute to decreased protein crossbridging leading to fragile, defective cornified envelopes. These results provide new insights into the role of claudin 6 in epithelial differentiation and EPB formation. In addition, the epidermal phenotype of these transgenic mice, which is very reminiscent of that in pre-term infant skin, suggest that they will be an important and novel model for studies on human premature EPB-related morbidity.
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OʼNeil, Amanda, and Bette Schumacher. "Application of a Pectin Barrier for Medical Adhesive Skin Injury (Epidermal Stripping) in a Premature Infant." Journal of Wound, Ostomy & Continence Nursing 41, no. 3 (2014): 219–21. http://dx.doi.org/10.1097/won.0000000000000029.
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Kumar, Aarti, Shambhavi Mishra, Shambhavi Singh, Sana Ashraf, Peiyi Kan, Amit Kumar Ghosh, Alok Kumar, et al. "Effect of sunflower seed oil emollient therapy on newborn infant survival in Uttar Pradesh, India: A community-based, cluster randomized, open-label controlled trial." PLOS Medicine 18, no. 9 (September 28, 2021): e1003680. http://dx.doi.org/10.1371/journal.pmed.1003680.
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Background Hospitalized preterm infants with compromised skin barrier function treated topically with sunflower seed oil (SSO) have shown reductions in sepsis and neonatal mortality rate (NMR). Mustard oil and products commonly used in high-mortality settings may possibly harm skin barrier integrity and enhance risk of infection and mortality in newborn infants. We hypothesized that SSO therapy may reduce NMR in such settings. Methods and findings This was a population-based, cluster randomized, controlled trial in 276 clusters in rural Uttar Pradesh, India. All newborn infants identified through population-based surveillance in the study clusters within 7 days of delivery were enrolled from November 2014 to October 2016. Exclusive, 3 times daily, gentle applications of 10 ml of SSO to newborn infants by families throughout the neonatal period were recommended in intervention clusters (n = 138 clusters); infants in comparison clusters (n = 138 clusters) received usual care, such as massage practice typically with mustard oil. Primary analysis was by intention-to-treat with NMR and post-24-hour NMR as the primary outcomes. Secondary analysis included per-protocol analysis and subgroup analyses for NMR. Regression analysis was adjusted for caste, first-visit weight, delivery attendant, gravidity, maternal age, maternal education, sex of the infant, and multiple births. We enrolled 13,478 (52.2% male, mean weight: 2,575.0 grams ± standard deviation [SD] 521.0) and 13,109 (52.0% male, mean weight: 2,607.0 grams ± SD 509.0) newborn infants in the intervention and comparison clusters, respectively. We found no overall difference in NMR in the intervention versus the comparison clusters [adjusted odds ratio (aOR) 0.96, 95% confidence interval (CI) 0.84 to 1.11, p = 0.61]. Acceptance of SSO in the intervention arm was high at 89.3%, but adherence to exclusive applications of SSO was 30.4%. Per-protocol analysis showed a significant 58% (95% CI 42% to 69%, p < 0.01) reduction in mortality among infants in the intervention group who were treated exclusively with SSO as intended versus infants in the comparison group who received exclusive applications of mustard oil. A significant 52% (95% CI 12% to 74%, p = 0.02) reduction in NMR was observed in the subgroup of infants weighing ≤1,500 g (n = 589); there were no statistically significant differences in other prespecified subgroup comparisons by low birth weight (LBW), birthplace, and wealth. No severe adverse events (SAEs) were attributable to the intervention. The study was limited by inability to mask allocation to study workers or participants and by measurement of emollient use based on caregiver responses and not actual observation. Conclusions In this trial, we observed that promotion of SSO therapy universally for all newborn infants was not effective in reducing NMR. However, this result may not necessarily establish equivalence between SSO and mustard oil massage in light of our secondary findings. Mortality reduction in the subgroup of infants ≤1,500 g was consistent with previous hospital-based efficacy studies, potentially extending the applicability of emollient therapy in very low-birth-weight (VLBW) infants along the facility–community continuum. Further research is recommended to develop and evaluate therapeutic regimens and continuum of care delivery strategies for emollient therapy for newborn infants at highest risk of compromised skin barrier function. Trial registration ISRCTN Registry ISRCTN38965585 and Clinical Trials Registry—India (CTRI/2014/12/005282) with WHO UTN # U1111-1158-4665.
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Tokumasu, Reitaro, Kosuke Yamaga, Yuji Yamazaki, Hiroyuki Murota, Koya Suzuki, Atsushi Tamura, Kana Bando, Yasuhide Furuta, Ichiro Katayama, and Sachiko Tsukita. "Dose-dependent role of claudin-1 in vivo in orchestrating features of atopic dermatitis." Proceedings of the National Academy of Sciences 113, no. 28 (June 24, 2016): E4061—E4068. http://dx.doi.org/10.1073/pnas.1525474113.
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Atopic dermatitis (AD) is a chronic inflammatory skin disease in humans. It was recently noted that the characteristics of epidermal barrier functions critically influence the pathological features of AD. Evidence suggests that claudin-1 (CLDN1), a major component of tight junctions (TJs) in the epidermis, plays a key role in human AD, but the mechanism underlying this role is poorly understood. One of the main challenges in studying CLDN1's effects is that Cldn1 knock-out mice cannot survive beyond 1 d after birth, due to lethal dehydration. Here, we established a series of mouse lines that express Cldn1 at various levels and used these mice to study Cldn1’s effects in vivo. Notably, we discovered a dose-dependent effect of Cldn1’s expression in orchestrating features of AD. In our experimental model, epithelial barrier functions and morphological changes in the skin varied exponentially with the decrease in Cldn1 expression level. At low Cldn1 expression levels, mice exhibited morphological features of AD and an innate immune response that included neutrophil and macrophage recruitment to the skin. These phenotypes were especially apparent in the infant stages and lessened as the mice became adults, depending on the expression level of Cldn1. Still, these adult mice with improved phenotypes showed an enhanced hapten-induced contact hypersensitivity response compared with WT mice. Furthermore, we revealed a relationship between macrophage recruitment and CLDN1 levels in human AD patients. Our findings collectively suggest that CLDN1 regulates the pathogenesis, severity, and natural course of human AD.
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Marchini, G., S. Lindow, H. Brismar, B. Stabi, V. Berggren, A.-K. Ulfgren, S. Lonne-Rahm, B. Agerberth, and G. H. Gudmundsson. "The newborn infant is protected by an innate antimicrobial barrier: peptide antibiotics are present in the skin and vernix caseosa." British Journal of Dermatology 147, no. 6 (December 2002): 1127–34. http://dx.doi.org/10.1046/j.1365-2133.2002.05014.x.
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Lee, Bee Wah, and Patrick R. Detzel. "Treatment of Childhood Atopic Dermatitis and Economic Burden of Illness in Asia Pacific Countries." Annals of Nutrition and Metabolism 66, Suppl. 1 (2015): 18–24. http://dx.doi.org/10.1159/000370221.
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Atopic dermatitis (AD) is a common chronic inflammatory skin condition in children. In Asia, the prevalence of AD is increasing, which is largely attributed to environmental and socioeconomic factors including family income, parental education, lifestyle and metropolitan living. Current clinical guidelines recommend a stepped approach in the management of eczema in children, with treatment steps tailored to the severity of the eczema. To address the skin barrier dysfunction, skin hydration and the application of emollients is essential. There is evidence supporting the use of bleach baths as an antimicrobial therapy against Staphylococcus aureus. In patients in whom topical treatment fails, wet wrap therapy may be considered as a treatment option before considering systemic therapies. In the second part of this article, the economic burden of AD is addressed. AD not only negatively impacts the child's quality of life but also that of the whole family and is associated with a burden on health-care costs and society. AD in an infant will lead to frequent additional visits to the pediatrician, to additional and partially expensive treatment costs and, in rare cases, to hospitalization. It is thus of utmost importance to define efficient strategies to not only treat AD but also to decrease the risk of developing the disease.
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Kaplan, Mark H., Sarah Engle, Ching-Yun Chang, Allyson Satterwhite, Benjamin Ulrich, Tristan Hayes, Robert Tepper, and Jonathan Sims. "Biomarker prediction of pediatric atopic dermatitis severity." Journal of Immunology 204, no. 1_Supplement (May 1, 2020): 147.20. http://dx.doi.org/10.4049/jimmunol.204.supp.147.20.
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Abstract Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects 25% of children and 1–3% of adults worldwide, and has increased 2- to 3-fold over the past several decades. The pathogenesis of AD may result from complex interactions between environmental and genetic factors, barrier defects and immune dysregulation resulting in epidermal hyperplasia and increased penetration of allergens and microbial pathogens. Although most cases of AD are transient, and AD is often thought of as the first step of the atopic march, some AD patients have active disease throughout life. In this study, we analyzed a population of infants that were at high risk for atopic disease and sampled serum, analyzed peripheral blood mononuclear cells, and clinical parameters upon entry (mean age 10.3 months) and five years later. We tested 161 serum analytes using a combination of single-plex, multiplex, Olink, and Quanterix assays. Broadly, the concentration of many analytes fell over time, while SDF and sCD40L concentration increased at the later time point. Several analytes correlated with AD severity as assessed by SCORAD, and most significantly, IL-13 and MCP-4 correlated with SCORAD at both time points. Subsets of cytokines were significantly correlated with each other, consistent with early disease skewing toward type 2 immune response, and two subsets were correlated with percentages of NKT cells or Th2 cells in the peripheral blood. Importantly, forward selection modeling identified 33 infant serum analytes that could be used to predict AD severity five years later (r2=0.85, p=0.042). This dataset will likely have predictive value for AD persistence past infancy and will be useful in further defining the pathogenesis of atopic disease.
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Kader, Hidaya A., Muhammad Azeem, Suhib A. Jwayed, Aaesha Al-Shehhi, Attia Tabassum, Mohammed Akli Ayoub, Helal F. Hetta, et al. "Current Insights into Immunology and Novel Therapeutics of Atopic Dermatitis." Cells 10, no. 6 (June 4, 2021): 1392. http://dx.doi.org/10.3390/cells10061392.
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Atopic dermatitis (AD) is one of the most prevalent inflammatory disease among non-fatal skin diseases, affecting up to one fifth of the population in developed countries. AD is characterized by recurrent pruritic and localized eczema with seasonal fluctuations. AD initializes the phenomenon of atopic march, during which infant AD patients are predisposed to progressive secondary allergies such as allergic rhinitis, asthma, and food allergies. The pathophysiology of AD is complex; onset of the disease is caused by several factors, including strong genetic predisposition, disrupted epidermal barrier, and immune dysregulation. AD was initially characterized by defects in the innate immune system and a vigorous skewed adaptive Th2 response to environmental agents; there are compelling evidences that the disorder involves multiple immune pathways. Symptomatic palliative treatment is the only strategy to manage the disease and restore skin integrity. Researchers are trying to more precisely define the contribution of different AD genotypes and elucidate the role of various immune axes. In this review, we have summarized the current knowledge about the roles of innate and adaptive immune responsive cells in AD. In addition, current and novel treatment strategies for the management of AD are comprehensively described, including some ongoing clinical trials and promising therapeutic agents. This information will provide an asset towards identifying personalized targets for better therapeutic outcomes.
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Zakharova, Irina N., Iana V. Orobinskaia, Narine G. Sugian, Tatiana A. Kovtun, and Elena V. Tabulovich. "Breast milk oligosaccharides: what do we know today?" Pediatrics. Consilium Medicum, no. 3 (September 26, 2022): 204–12. http://dx.doi.org/10.26442/26586630.2022.3.201851.
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Breastfeeding remains the "gold standard" for feeding babies in the first year of life. Breast milk contains a mixture of nutrients; their amount varies throughout the lactation period and even throughout the day. The composition of breast milk (BM) is complex and dynamic. Currently, BM oligosaccharides (BMOs) are of most interest to researchers. Due to advances in science and biotechnology, more than 200 BMOs have been identified. Human BM is the richest source of oligosaccharides among all mammals (for instance, their content in cow's milk is almost 1,000 times lower). Numerous favorable effects of BMOs on child health are related to the immune response, gut barrier function, and protection against pathogens. BMOs as prebiotics contribute to the formation of the infant's intestinal microbiome. The BM contains a complex bacterial community whose composition depends on the maternal microbiome (skin, gut, genital, urethral tracts) that forms the infant gut microbial community. In the absence of breastfeeding, modern formulas can be used; BMOs in their composition make them more like BM.
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de Sousa, Thamires Rodrigues, Beatriz Oliveira Fagundes, Andrezza Nascimento, Lorena Abreu Fernandes, Fábio da Ressureição Sgnotto, Raquel Leão Orfali, Valéria Aoki, Alberto José da Silva Duarte, Sabri Saeed Sanabani, and Jefferson Russo Victor. "IgG from Adult Atopic Dermatitis (AD) Patients Induces Thymic IL-22 Production and CLA Expression on CD4+ T Cells: Possible Epigenetic Implications Mediated by miRNA." International Journal of Molecular Sciences 23, no. 12 (June 20, 2022): 6867. http://dx.doi.org/10.3390/ijms23126867.
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Atopic dermatitis (AD) is a common relapsing inflammatory skin disorder characterized by immune-mediated inflammation and epidermal barrier dysfunction. The pathogenesis of AD is multifactorial and has not been fully elucidated to date. This study aimed to evaluate whether serum IgG from adult AD patients could modulate the thymic maturation of IL-22-producing T cells and CLA+ T cells of non-atopic infants. Given that miRNAs regulate immune response genes, we evaluated whether miRNA expression is also altered in cultured thymocytes. Thymocytes were cultured with purified IgG from AD patients or control conditions (mock, Intravenous-IgG (IVIg), non-atopic IgG, or atopic non-AD IgG). Using flow cytometry analysis, we assessed the expression of CLA and intracellular levels of IL-4, IFN-γ, and IL-22 on double-positive T cells (DP T), CD4 T cells, or CD8 T cells. We also investigated the frequency of IgG isotypes and their direct interaction with the thymic T cells membrane. The miRNA profiles were evaluated by the Illumina small RNA-seq approach. MiRNA target gene prediction and enrichment analyses were performed using bioinformatics. Increased frequencies of IL-22 and CLA+ producing CD4+ T cells cultured with IgG of AD patients was seen in non-atopic infant thymocytes compared to all control conditions. No alterations were observed in the frequency of IgG isotypes among evaluated IgG pools. Evidence for a direct interaction between IgG and thymic DP T, CD4 T, and CD8 T cells is presented. The small RNA-seq analysis identified ten mature miRNAs that were modulated by AD IgG compared to mock condition (miR-181b-5p, hsa-miR-130b-3p, hsa-miR-26a-5p, hsa-miR-4497, has-miR-146a, hsa-let-7i-5p, hsa-miR-342-3p, has-miR-148a-3p, has-miR-92a and has-miR-4492). The prediction of the targetome of the seven dysregulated miRNAs between AD and mock control revealed 122 putative targets, and functional and pathway enrichment analyses were performed. Our results enhance our understanding of the mechanism by which IgG can collaborate in thymic T cells in the setting of infant AD.
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Minot, Kacy L., Katelin P. Kramer, Colleen Butler, Michele Foster, Courtney Gregory, Kathryn Haynes, Czarina Lagon, et al. "Increasing Early Skin-to-Skin in Extremely Low Birth Weight Infants." Neonatal Network 40, no. 4 (July 1, 2021): 242–50. http://dx.doi.org/10.1891/11-t-749.
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BackgroundEarly skin-to-skin care (SSC) has been shown to improve outcomes after preterm birth, including improved clinical stability and establishment of breastfeeding. Recent evidence suggests the most unstable infants get the most benefit, yet these infants are not consistently offered opportunities for SSC because of safety concerns and discomfort of the care team.PurposeTo identify barriers and implement a multidimensional approach to increase SSC within the first 72 hours of life among infants born less than 28 weeks' gestation and less than 1,000 g in a Level IV university-based regional intensive care nursery.MethodsUsing Institute of Healthcare Improvement quality improvement methodology, a multidisciplinary team identified barriers to SSC and developed targeted interventions, including a unit-specific protocol; widespread parent, staff, and provider education; and an infant readiness checklist. The primary outcome was the rate of SSC within 72 hours. The balancing measure was the rate of severe intraventricular hemorrhage (IVH). Data were collected from monthly chart review and analyzed with statistical process control charts. The aim was to increase SSC within 72 hours of birth from 7 percent to greater than 80 percent within 12 months for infants born less than 28 weeks' gestation or less than 1,000 g.ResultsBetween June 2017 and December 2019, there were 52 extremely preterm infants included in the project (15 preintervention and 37 postintervention). The rate of SSC within the first 72 hours increased from 7 to 84 percent. There has been no increase in any or severe IVH during the project period despite the increased rate of SSC.Implications for PracticeImplementation of multidimensional, multidisciplinary interventions for reducing barriers to early SSC in extremely preterm infants resulted in rapid adoption of SSC in the first 72 hours of life without increasing severe IVH in this high-risk population.
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Bear, Rebecca J., and David J. Mellor. "Continuing Education Module—Kangaroo Mother Care 2: Potential Beneficial Impacts on Brain Development in Premature Infants." Journal of Perinatal Education 26, no. 4 (2017): 177–84. http://dx.doi.org/10.1891/1058-1243.26.4.177.
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ABSTRACTKangaroo mother care (KMC) involves infant skin-to-skin contact with the mother from as soon as possible after birth, exclusive breastfeeding, early discharge from the health facility, and supportive follow-up at home. Much evidence supports use of KMC clinically as an aid to mitigating some detrimental features of prematurity. This article—the second of two—explores impairments in brain development because of uncongenial inputs from the postnatal therapeutic environment of premature infants, not encountered in utero, and some of their negative neurobehavioral, psychosocial, sociocultural, and economic implications. It is concluded that evidence favoring the use of KMC in stable preterm infants is very strong and that, as noted by others, barriers to implementation of KMC, apart from infant infirmity, are mainly because of hesitancy from parents, health-care professional, and/or institutions, which may be unfounded.
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Tamrazova, Olga B., Nataliya F. Dubovets, Anait V. Tamrazova, and Sergey P. Seleznev. "Role of emollients in the prevention of skin diseases in young children." Meditsinskiy sovet = Medical Council, no. 1 (March 21, 2021): 158–66. http://dx.doi.org/10.21518/2079-701x-2021-1-158-166.
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Epidermis plays an important role in protecting the body from negative environmental influences. The horny layer plays a special role in carrying out these functions. Skin defense mechanisms are multistage and include 5 protective barriers responsible for maintaining the integrity and performing the main functions of the skin. The first one is a microbial barrier – determined by commensal flora which prevents contamination of pathogenic microorganisms; the second one is a physical barrier preventing mechanical skin damage, penetration of allergens and microorganisms; the third one is a chemical barrier achieved by forming pH and components of natural moisturizing factor as well as epidermal lipids; the fourth one – immune barrier – Langerhans cells, tissue basophils, lymphocytes etc.;the fifth is the neurosensory barrier – numerous nerve endings transmitting signals of skin integrity damage and controlling metabolic processes and homeostasis maintenance. Epidermal barrier of newborns and infants is imperfect and differs in its structure and functional activity from that of adults. Children’s skin is prone to excessive dryness, irritation, allergic reactions and inflammation. For young children, it is very important to minimize the risk of these manifestations. Individual selection and use of emollients in the basic care of infants promotes the functional stability of five protective «frontiers» of the epidermal barrier: prevents skin damage when exposed to unfavorable environmental factors, reduces TEWL, supports the normal microbiome, has antipruritic and anti-inflammatory action. Modern emollients restore the hydrolipidic layer of the epidermis and prevent the development of dermatitis and skin infection in children. An important role when choosing an emollient is played by its texture, which can be represented by a lotion, cream, balm, ointment. Chemically, creams, lotions and balms are emulsions, i.e. they consist of two immiscible components – fat (oil) and water. In this case, one of the components is in the other in the form of tiny droplets. Most skin diseases faced by young children are related to the integrity of the epidermis, which is why daily care should be primarily focused on protecting the skin barrier
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Lawton, Sandra. "Understanding skin care and skin barrier function in infants." Nursing Children and Young People 25, no. 7 (September 2013): 28–33. http://dx.doi.org/10.7748/ncyp2013.09.25.7.28.e358.
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Chatterjee, Nilesh, Sanjay Singh, and Genevie Fernandes. "Barriers to practice of critical newborn care behaviours: findings from a qualitative assessment in rural Madhya Pradesh, India." International Journal Of Community Medicine And Public Health 7, no. 6 (May 27, 2020): 2237. http://dx.doi.org/10.18203/2394-6040.ijcmph20202478.
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Background: In India, the state of Madhya Pradesh has one of the highest infant mortality rates (IMR) as compared to the national average. About two out of every three infant deaths in Madhya Pradesh, are of neonates. Given the high neonatal mortality rate in the state, this study aimed to explore the perceptions, practices, barriers and enablers related to critical newborn care behaviors, such as cord-care, thermal care, skin-to-skin care, and early initiation of breastfeeding, in the first 24 hours of life.Methods: In-depth interviews and focus group discussions were conducted with 53 respondents including mothers and fathers of the newborn, mothers-in-law, elected community and tribal leaders, local NGO representatives, and frontline health workers, in two districts of Madhya Pradesh.Results: Few mothers knew about the benefits of cord care, thermal care and early initiation of breastfeeding. Fathers lacked knowledge and perceived newborn care as the mother’s responsibility. Skin-to-skin care was rarely practiced; and was perceived across respondent groups as necessary only for weak infants. Older women, influential in decision making in the household, held misconceptions about thermal care and breastfeeding practices. Traditions and social norms emerged as major barriers while institutional delivery served as an enabling factor for the practice of correct newborn-care behaviors.Conclusions: To increase adoption of critical newborn behaviours, health care providers will have to move beyond mere interpersonal communication with individual mothers at facility or household levels towards a community and societal approach. A strategic behaviour change communication program that addresses deep-rooted traditional and social norms is required to help the state reduce infant deaths.
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Rehbinder, E. M., A. J. Winger, L. Landrø, A. Asarnoj, T. L. Berents, K. H. Carlsen, G. Hedlin, et al. "Dry skin and skin barrier in early infancy." British Journal of Dermatology 181, no. 1 (April 12, 2019): 218–19. http://dx.doi.org/10.1111/bjd.17626.
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Kalia, Yogeshvar N., Lourdes B. Nonato, Carolyn H. Lund, and Richard H. Guy. "Development of Skin Barrier Function in Premature Infants." Journal of Investigative Dermatology 111, no. 2 (August 1998): 320–26. http://dx.doi.org/10.1046/j.1523-1747.1998.00289.x.
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Barnes, Rosanne, Asha C. Bowen, Roz Walker, Steven Y. C. Tong, Jodie McVernon, Patricia T. Campbell, Parveen Fathima, et al. "454. Perinatal Risk Factors Associated with Skin Infection Hospitalisation in Western Australian Aboriginal and Non-Aboriginal Children." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S223. http://dx.doi.org/10.1093/ofid/ofz360.527.
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Abstract Background Hospitalisation with skin infection in Western Australian (WA) Aboriginal children is common, with the highest rates in infants and children from remote WA. We aimed to quantify infant, maternal, and sociodemographic risk factors for skin infection hospitalization in WA children, focusing on Aboriginal children aged <17 years. Methods We conducted a retrospective population-based cohort study with linked perinatal and hospitalization data on WA-born children (1996–2012), of whom 31,348 (6.7%) were Aboriginal. We used Cox regression to calculate adjusted hazard ratios and associated population attributable fractions (PAFs) for perinatal factors attributed to the first hospitalization with skin infection. To identify specific risk factors for early-onset infection, we further restricted the cohort to infants aged <1 year. Results Overall, 5,439 (17.4%) Aboriginal and 6,750 (1.5%) non-Aboriginal children were hospitalized at least once with a skin infection. Aboriginal infants aged <1 year had the highest skin infection hospitalization rate (63.2/1,000 child-years). The strongest risk factors in Aboriginal children aged <17 years were socio-economic disadvantage, very remote location at birth and multi-parity (≥3 previous pregnancies) accounting for 24%, 23% and 15% of skin infection hospitalizations, respectively. Other risk factors included maternal age <20 years, maternal smoking during pregnancy and low birthweight. Conclusion We have quantified the relative influence of perinatal risk factors associated with skin infection hospitalizations in WA children, providing measures indicating which factors have the potential to reduce the most hospitalizations. Our evidence supports existing calls for substantial government investment in addressing underlying social and environmental barriers to healthy skin in WA Aboriginal children but also identifies potential areas to target health promotion messaging at individuals/families on maternal smoking during pregnancy and skin hygiene for families. Disclosures All authors: No reported disclosures.
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Mörelius, Evalotte, Emma Olsson, Charlotte Sahlén Helmer, Ylva Thernström Blomqvist, and Charlotte Angelhoff. "External barriers for including parents of preterm infants in a randomised clinical trial in the neonatal intensive care unit in Sweden: a descriptive study." BMJ Open 10, no. 12 (December 2020): e040991. http://dx.doi.org/10.1136/bmjopen-2020-040991.
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ObjectivesPerforming randomised controlled trials (RCTs) in neonatal intensive care is challenging in many ways. While restrictive inclusion criteria or busy study protocols are obvious barriers, external barriers leading to termination of a study are seldom discussed. The aim of this study was to describe barriers for inclusion of families in neonatal intensive care in an RCT aiming to evaluate the effects of continuous skin-to-skin contact on mood and sleep quality in parents of preterm infants, as well as the quality of parent-infant interaction and salivary cortisol concentrations at the time of discharge.DesignA descriptive study.SettingThree out of seven tertiary neonatal intensive care units in Sweden participated in a two-arm RCT that was terminated because of low inclusion rate.ParticipantsBefore termination of the study, 11 out of 242 families assessed for eligibility were included for participation.ResultsThe major barriers for inclusion in this RCT were external due to (1) lack of intensive care beds in the neonatal ward, causing medically stable infants to be transferred back to the referring hospital quicker than expected, (2) moving directly from the delivery room to a family room without passing an open bay intensive care room or (3) transferring from one neonatal ward to another with the same care level to increase availability of intensive care beds where needed. Other barriers were the inclusion criteria ‘single-birth’ and ‘Swedish-speaking parent’.ConclusionsThe major barriers for including participants were external constituted by transferals between neonatal wards and cities due to lack of intensive care beds. This is a multifactorial issue related to organisational structures. However, since this affects the possibilities to perform research this study highlights some suggestions to consider when planning prospective intervention studies within a neonatal setting.Trial registration numberNCT03004677.
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Catherine Mack Correa, M., and Judith Nebus. "Management of Patients with Atopic Dermatitis: The Role of Emollient Therapy." Dermatology Research and Practice 2012 (2012): 1–15. http://dx.doi.org/10.1155/2012/836931.
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Atopic dermatitis is a common inflammatory skin disorder that afflicts a growing number of young children. Genetic, immune, and environmental factors interact in a complex fashion to contribute to disease expression. The compromised stratum corneum found in atopic dermatitis leads to skin barrier dysfunction, which results in aggravation of symptoms by aeroallergens, microbes, and other insults. Infants—whose immune system and epidermal barrier are still developing—display a higher frequency of atopic dermatitis. Management of patients with atopic dermatitis includes maintaining optimal skin care, avoiding allergic triggers, and routinely using emollients to maintain a hydrated stratum corneum and to improve barrier function. Flares of atopic dermatitis are often managed with courses of topical corticosteroids or calcineurin inhibitors. This paper discusses the role of emollients in the management of atopic dermatitis, with particular emphasis on infants and young children.
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Visscher, Marty O., Aimee Summers, Vivek Narendran, Subarna Khatry, Jeevan Sherchand, Steven LeClerq, Joanne Katz, James Tielsch, and Luke Mullany. "Birthweight and Environmental Conditions Impact Skin Barrier Adaptation in Neonates Receiving Natural Oil Massage." Biomedicine Hub 6, no. 1 (January 18, 2021): 17–24. http://dx.doi.org/10.1159/000512274.
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<b><i>Introduction:</i></b> Skin interventions have been implemented to reduce neonatal mortality, demonstrating the skin’s role in neonatal innate immunity. We examined the impact of birthweight and environmental conditions on skin integrity in infants receiving oil massage in rural Nepal. <b><i>Methods:</i></b> In a community-based cluster randomized controlled trial, 991 premature and full-term infants were grouped by birthweight as: (1) 920–1,560 g, (2) 1,570–2,450 g, (3) 2,460–2,990 g, and (4) 3,000–4,050 g and by high or low heat index (HI). Skin integrity was measured as erythema, rash, dryness, pH, protein concentration, and transepidermal water loss (TEWL). <b><i>Results:</i></b> Skin pH was higher for the smallest (group 1) than the largest infants (group 4) and higher for group 2 than 3 and 4. Arm and leg rash differed for all 4 groups, with the least amount of rash for the smallest babies. Erythema was lower for group 1 than all others. The lower day 1 values for pH, TEWL and protein at high versus low HI remained lower over 28 days. The pH reduction was faster at high HI. Erythema (arm, leg) was more severe at high HI. Rash severity was greater at high HI for arms and legs every day. <b><i>Conclusions:</i></b> Birthweight influenced the skin response to oil massage. The smallest infants had the lowermost skin irritation, suggesting diminished ability to mount an inflammatory response. High HI may be protective for premature infants in low resource settings.
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Kanti, V., A. Bonzel, A. Stroux, H. Proquitté, C. Bührer, U. Blume-Peytavi, and N. Garcia Bartels. "Postnatal Maturation of Skin Barrier Function in Premature Infants." Skin Pharmacology and Physiology 27, no. 5 (2014): 234–41. http://dx.doi.org/10.1159/000354923.
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Bharathi, M., V. Sundaram, and P. Kumar. "Skin Barrier Therapy and Neonatal Mortality in Preterm Infants." PEDIATRICS 123, no. 2 (January 26, 2009): e355-e355. http://dx.doi.org/10.1542/peds.2008-2307.
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Ryumina, I. I. "Natural oils for skincare of newborns and infants." Russian Journal of Woman and Child Health 4, no. 2 (2021): 178–83. http://dx.doi.org/10.32364/2618-8430-2021-4-2-178-183.
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The skin of a newborn is a delicate structure that is the first barrier protecting from exposures. Skin conditions in newborns are common due to adaptation to novel environment. The choice of an adequate moisturizing and skincare product is still an important issue. This paper discusses the structural and functional specificity of the skin of newborns and the role of lipids in the healthy functioning of skin barrier. Inadequate acid mantle and skin microbiome, gradual maturation of immune defense account for the frequent occurrence of infective inflammatory skin disorders, in particular, in skincare defects. Fatty oils are commonly used as emollients or the basis of care products, while essential oils and aromatic compounds are widely applied in perfume and cosmetic industries (including the production of skincare products for babies and toddlers). The effects of natural oils (e.g., olive, sunflower-seed, mustard-seed oil etc.) on skin hydration and permeability and their ability to induce inflammation. A single standard for certifying natural cosmetics including skincare products for babies is highlighted. KEYWORDS: skin, newborn, care product, natural oil, essential oil. FOR CITATION: Ryumina I.I. Natural oils for skincare of newborns and infants. Russian Journal of Woman and Child Health. 2021;4(2):178– 183. DOI: 10.32364/2618-8430-2021-4-2-178-183.
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Ludriksone, Laine, Natalie Garcia Bartels, Varvara Kanti, Ulrike Blume-Peytavi, and Jan Kottner. "Skin barrier function in infancy: a systematic review." Archives of Dermatological Research 306, no. 7 (March 5, 2014): 591–99. http://dx.doi.org/10.1007/s00403-014-1458-6.
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Braun-Falco, Markus. "Die Rolle des pH-Wertes bei Intertrigo oder zu trockener Haut." Kompass Dermatologie 7, no. 3 (2019): 134–36. http://dx.doi.org/10.1159/000496130.
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In order to maintain skin in «good condition» one can use cosmetic products. Importantly, those skin care products should fulfil specific requirements for specific life phases and specific skin conditions. In this review, we focused on 2 different age groups - namely, infants and the elderly - as well as on 2 specific skin conditions occurring in both age groups - very dry skin (Xerosis) and hyperhydrated skin (diaper rash). The goal in both conditions should be to maintain skin surface in its physiological acidic state, which is in turn crucial for the permeability barrier function, stratum corneum integrity/cohesion and antimicrobial defense. Skin care products formulated with an effective buffer system at a more acidic pH, for example 4, may be the best option to improve the acid mantle and skin barrier function and thus keep the skin in «good condition».
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Hubbard, Jessie Marie, and Kindsey Rae Gattman. "Parent–Infant Skin-to-Skin Contact Following Birth: History, Benefits, and Challenges." Neonatal Network 36, no. 2 (2017): 89–97. http://dx.doi.org/10.1891/0730-0832.36.2.89.
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AbstractIt is a practice with strong roots in nature and has a significant influence on health outcomes, particularly for at-risk newborns in low-resource settings. In this comprehensive review, benefits of SSC for newborns, mothers, and fathers after vaginal and cesarean births are discussed as well as the benefits of SSC observed for infants in the NICU. Barriers to SSC practice implementation are discussed, and proposed solutions and recommendations are offered. By understanding the many benefits of SSC and strategies for implementation, health care providers can best support and promote this high-quality, evidence-based practice with mothers, newborns, and their families.
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Migacheva, N. B. "Role of skin microbiome in epidermal barrier dysfunction and development of atopic dermatitis in high risk infants." Russian Journal of Allergy 16, no. 1 (February 15, 2019): 59–64. http://dx.doi.org/10.36691/rja26.
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Background. Colonization of skin with S. aureus in atopic dermatitis (AD) patients is a widespread phenomenon and a factor complicating the course of the disease. At present, it is not quite clear the role of S. aureus in the development of AD in children at risk. The aim of our study was to discribe the skin microbiome composition in young children at risk, as well as to investigate the role of S. aureus in skin barrier dysfunction and the development of AD. Material and methods. 12months follow-up study of 37 infants at risk has been performed. It included a general clinical examination, a microbiological investigation of skin microbiome (at 1 and 6 months), and investigation of epidermal barrier function by determining the transepidermal water loss (TEWL) at 1, 3, 6 and 12 months. Realization of AD during the observation period was considered as main outcome. Results. The prevalence of S. aureus colonization of infants aged 1 month was 45.9%, at the age of 6 months - 29.7%. Correlation analysis revealed an association between the skin colonization with S. aureus and a decrease of TEWL (p = 0.004), as well as the cumulative incidence of AD (p
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Agren, Johan, Sergey Zelenin, Lill-Britt Svensson, Lene N. Nejsum, Soren Nielsen, Anita Aperia, and Gunnar Sedin. "Antenatal Corticosteroids and Postnatal Fluid Restriction Produce Differential Effects on AQP3 Expression, Water Handling, and Barrier Function in Perinatal Rat Epidermis." Dermatology Research and Practice 2010 (2010): 1–9. http://dx.doi.org/10.1155/2010/789729.
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Loss of water through the immature skin can lead to hypothermia and dehydration in preterm infants. The water and glycerol channel aquaglyceroporin-3 (AQP3) is abundant in fetal epidermis and might influence epidermal water handling and transepidermal water flux around birth. To investigate the role of AQP3 in immature skin, we measuredin vivotransepidermal water transport and AQP3 expression in rat pups exposed to clinically relevant fluid homeostasis perturbations. Preterm (E18) rat pups were studied after antenatal corticosteroid exposure (ANS), and neonatal (P1) rat pups after an 18 h fast. Transepidermal water loss (TEWL) and skin hydration were determined, AQP3 mRNA was quantified by RT-PCR, and in-situ hybridization and immunocytochemistry were applied to map AQP3 expression. ANS resulted in an improved skin barrier (lower TEWL and skin hydration), while AQP3 mRNA and protein increased. Fasting led to loss of barrier integrity along with an increase in skin hydration. These alterations were not paralleled by any changes in AQP3. To conclude, antenatal corticosteroids and early postnatal fluid restriction produce differential effects on skin barrier function and epidermal AQP3 expression in the rat. In perinatal rats, AQP3 does not directlydeterminenet water transport through the skin.
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Sidorovich, O. I., A. A. Tsyvkina, and G. D. Abdullaeva. "The efficacy and safety of local therapy of atopic dermatitis in infants and school-age children." Meditsinskiy sovet = Medical Council, no. 12 (October 7, 2020): 54–59. http://dx.doi.org/10.21518/2079-701x-2020-12-54-59.
Full textAbstract:
Atopic dermatitis is a multifactorial genetic inflammatory skin disease associated with disturbances of skin barrier function affected by predisposition to IgE-mediated hypersensitivity, which is characterized by itching, chronic recurrent course of the disease, age-related features of localization and lesion morphology, and requires the long-term and permanent treatment.Treatment is based on the continuous use of emollients, topical calcineurin inhibitors, topical glucocorticoids, and hygienic skin care.The mechanisms of the atopic dermatitis development are primarily based on a genetic predisposition to allergies, failure of the normal development of congenital and acquired factors of the immune system, as well as the influence of environmental factors and various trigger factors, such as allergenic (food, indoor, epidermal, fungal allergens, etc.). and non-allergenic (tobacco smoke, pollutants, psycho-emotional stress, concomitant chronic and acute diseases, mainly ARVI, etc.).It has been established that atopic dermatitis is characterized by the epidermal barrier dysfunction leading to excessive tran-sepidermal water loss, increased permeability of the epidermis, the penetration of allergens and microbial agents via the skin and eventually to sensitization to allergens and the development of specific allergic skin inflammation and atopic march with the sequential development of other atopic diseases.Modern therapeutic strategies are actively aimed at repairing the epidermal barrier, preventing sensitization and atopic march development. This article describes the features of the epidermal barrier dysfunction in atopic dermatitis, lists the methods of its restoration and ways to prevent subsequent exacerbations using local therapy and emollients, and presents 3 clinical cases.
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Darmstadt, G. L., S. Ahmed, S. K. Saha, A. S. M. N. U. Ahmed, M. A. K. A. Chowdhury, P. A. Law, R. E. Rosenberg, R. E. Black, and M. Santosham. "Skin Barrier Therapy and Neonatal Mortality in Preterm Infants: In Reply." PEDIATRICS 123, no. 2 (January 26, 2009): e355-e356. http://dx.doi.org/10.1542/peds.2008-3546.
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Dawar, Rebecca, Sushma Nangia, Anu Thukral, Sapna Chopra, and Rajesh Khanna. "Factors Impacting Practice of Home Kangaroo Mother Care with Low Birth Weight Infants Following Hospital Discharge." Journal of Tropical Pediatrics 65, no. 6 (February 14, 2019): 561–68. http://dx.doi.org/10.1093/tropej/fmz007.
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Abstract Objective To identify enablers and barriers related to home Kangaroo Mother Care (KMC) adoption after hospital discharge. Study design An exploratory study, using a mixed methods evaluation, followed 60 mother–infant dyads from the hospital ward to 4 weeks post-hospital discharge. Results Fifty-three of the mothers (88.3%) completed all study visits. The majority of mothers were breastfeeding and practicing skin-to-skin contact 4 weeks post-discharge. Seven mothers (13.2%) discontinued skin-to-skin contact at 4 weeks. KMC was practiced on average 3.3 h/day and 5.1 days/week. The top two enablers reported were significantly related to the amount of time skin-to-skin was practiced, with support for household responsibilities being most significant (U = 195, p = 0.008). Lack of privacy (p = 0.002) and lack of motivation (p = 0.034) were negatively correlated to duration of skin-to-skin contact. Conclusion Future programs may increase dissemination and adoption of home KMC by specifically addressing enablers and barriers correlated to duration of skin-to-skin contact.