Development of skin barrier function in premature infants

Histologic analysis suggests that epidermal development is complete in utero at ≃34 wk gestational age. Infants born more prematurely have elevated rates of both transepidermal water loss and transcutaneous heat loss, and have difficulty maintaining homeostasis. The underdeveloped integument is also a portal of entry for infection and the percutaneous uptake of toxins. Previous measurements of transepidermal water loss have suggested that, regardless of gestational age, competent barrier function is attained within 2-4 wk postnatal age. In this study we have utilized another noninvasive biophysical technique, low frequency impedance spectroscopy, to complement transepidermal water loss measurements. We present longitudinal data from infants ranging from 23 to 32 wk gestational age. The results suggest that, for ultra-low birth weight infants (23-25 wk gestational age), the complete development of a fully functional stratum corneum can require significantly longer than 4 wk. In contrast, the data from the older infants suggest that a postnatal existence period of 2-4 wk may not be necessary to attain functional maturity, because infants born at 30 and 32 wk gestational age were found to have barrier function comparable with that of adults.