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Barrier function of neonatal skin

1998; Elsevier BV; Volume: 133; Issue: 3 Linguagem: Inglês

10.1016/s0022-3476(98)70291-4

1097-6833

Mary L. Williams, Kenneth R. Feingold,

Infant Health and Development

To the Editor:Because avoidance of iatrogenic injury to the premature infant's skin barrier is clearly important, Lund et al.1Lund CH Nonato LB Kuller JM Franck LS Cullander C Durand JD. Disruption of barrier function in neonatal skin associated with adhesive removal.J Pediatr. 1997; 131: 367-372Abstract Full Text PDF PubMed Scopus (70) Google Scholar are to be congratulated for their careful analysis of the impact of commonly used adhesives on the integrity of the neonate's barrier to transepidermal water loss (TEWL). The authors interpret their data to show that pectin barriers and plastic tape are damaging to the skin of premature infants (in contrast to the nondamaging, but unfortunately in some instances insufficiently adhesive, gel adhesives). We propose an alternate interpretation. They indicated that TEWL across epidermis of control sites and underlying the gel adhesive declined by approximately 25% during the 24-hour period of the study. The decline in TEWL across untreated skin was greatest in the lower birth weight cohorts. These data are consistent with the interpretation that barrier function matured in this period, with greater maturation observed among the more immature infants. This finding is not surprising because barrier function after premature birth rapidly improves, reaching mature function within 2 to 3 weeks of birth, regardless of the gestational age.2Cartlidge PHT Rutter N. Skin barrier function.in: Fetal and neonatal physiology. WB Saunders, Philadelphia1998: 569-585Google Scholar Recent studies from our laboratory have provided further insight into this phenomenon.3Hanley K Jiang Y Elias PM Feingold KR Williams ML. Acceleration of barrier ontogenesis in vitro through air exposure.Pediatr Res. 1997; 41: 293-299Crossref PubMed Scopus (45) Google Scholar Using an in vitro model of fetal rat skin development, we have shown that covering the surface of the fetal epidermis with an occlusive wrap (eg, a latex film) prevents the acceleration of barrier maturation that is normally observed when late gestational fetal skin is exposed to the air environment. In contrast, application of a vapor-permeable membrane (eg, Gore-Tex) does not prevent accelerated barrier maturation. Hence, evaporative water loss appears to signal accelerated barrier maturation. Furthermore, it has been recognized for some time that, in mature skin, air exposure accelerates recovery after experimental barrier disruption.4Elias PM Holleran WM Menon GK Ghadially R Williams ML Feingold KR. Normal mechanisms and pathophysiology of epidermal barrier homeostasis.Curr Opin Dermatol. 1994; 1: 231-237Google Scholar This response is thought to be mediated by ion fluxes, particularly those of calcium and potassium. Whether changing the concentrations of these ions also mediates the accelerated maturation of fetal skin on air exposure is unknown. In the study by Lund et al,1Lund CH Nonato LB Kuller JM Franck LS Cullander C Durand JD. Disruption of barrier function in neonatal skin associated with adhesive removal.J Pediatr. 1997; 131: 367-372Abstract Full Text PDF PubMed Scopus (70) Google Scholar TEWL at sites where the pectin barrier and plastic tapes had been used was essentially unchanged from results on the day of application (ie, 24 hours earlier). We therefore propose that the pectin barrier and plastic tape applications prevented the normal, accelerated barrier maturation of air-exposed skin, whereas the hydrophilic gel adhesive permitted barrier maturation to proceed. The likely explanation for the differences in response to the adhesives is that the pectin barrier and plastic tapes are occlusive (ie, water-vapor impermeable), whereas the hydrophilic gel is a semipermeable membrane. The authors also interpret their data to show that the barrier in premature infant skin is more readily perturbed after tape stripping than is adult skin. Though their interpretation is undoubtedly correct, this particular study does not directly address this point, because the experimental parameters are different. In adult studies, epidermis is repeatedly tape stripped until a break in the barrier is first observed. In this study, barrier function was not examined until 24 hours later. As noted above, the difference between experimental and control groups at this time point appears to reflect inhibition of maturation and not "damage" per se. Indeed, our interpretation of the data of Lund et al1Lund CH Nonato LB Kuller JM Franck LS Cullander C Durand JD. Disruption of barrier function in neonatal skin associated with adhesive removal.J Pediatr. 1997; 131: 367-372Abstract Full Text PDF PubMed Scopus (70) Google Scholar suggests that these agents (plastic tape and pectin barrier) may not be as damaging to the skin barrier as the authors have suggested. If the agents could be modified to be nonocclusive, one might have both a "gentle" and an effective adhesive. To the Editor:Because avoidance of iatrogenic injury to the premature infant's skin barrier is clearly important, Lund et al.1Lund CH Nonato LB Kuller JM Franck LS Cullander C Durand JD. Disruption of barrier function in neonatal skin associated with adhesive removal.J Pediatr. 1997; 131: 367-372Abstract Full Text PDF PubMed Scopus (70) Google Scholar are to be congratulated for their careful analysis of the impact of commonly used adhesives on the integrity of the neonate's barrier to transepidermal water loss (TEWL). The authors interpret their data to show that pectin barriers and plastic tape are damaging to the skin of premature infants (in contrast to the nondamaging, but unfortunately in some instances insufficiently adhesive, gel adhesives). We propose an alternate interpretation. They indicated that TEWL across epidermis of control sites and underlying the gel adhesive declined by approximately 25% during the 24-hour period of the study. The decline in TEWL across untreated skin was greatest in the lower birth weight cohorts. These data are consistent with the interpretation that barrier function matured in this period, with greater maturation observed among the more immature infants. This finding is not surprising because barrier function after premature birth rapidly improves, reaching mature function within 2 to 3 weeks of birth, regardless of the gestational age.2Cartlidge PHT Rutter N. Skin barrier function.in: Fetal and neonatal physiology. WB Saunders, Philadelphia1998: 569-585Google Scholar Recent studies from our laboratory have provided further insight into this phenomenon.3Hanley K Jiang Y Elias PM Feingold KR Williams ML. Acceleration of barrier ontogenesis in vitro through air exposure.Pediatr Res. 1997; 41: 293-299Crossref PubMed Scopus (45) Google Scholar Using an in vitro model of fetal rat skin development, we have shown that covering the surface of the fetal epidermis with an occlusive wrap (eg, a latex film) prevents the acceleration of barrier maturation that is normally observed when late gestational fetal skin is exposed to the air environment. In contrast, application of a vapor-permeable membrane (eg, Gore-Tex) does not prevent accelerated barrier maturation. Hence, evaporative water loss appears to signal accelerated barrier maturation. Furthermore, it has been recognized for some time that, in mature skin, air exposure accelerates recovery after experimental barrier disruption.4Elias PM Holleran WM Menon GK Ghadially R Williams ML Feingold KR. Normal mechanisms and pathophysiology of epidermal barrier homeostasis.Curr Opin Dermatol. 1994; 1: 231-237Google Scholar This response is thought to be mediated by ion fluxes, particularly those of calcium and potassium. Whether changing the concentrations of these ions also mediates the accelerated maturation of fetal skin on air exposure is unknown. In the study by Lund et al,1Lund CH Nonato LB Kuller JM Franck LS Cullander C Durand JD. Disruption of barrier function in neonatal skin associated with adhesive removal.J Pediatr. 1997; 131: 367-372Abstract Full Text PDF PubMed Scopus (70) Google Scholar TEWL at sites where the pectin barrier and plastic tapes had been used was essentially unchanged from results on the day of application (ie, 24 hours earlier). We therefore propose that the pectin barrier and plastic tape applications prevented the normal, accelerated barrier maturation of air-exposed skin, whereas the hydrophilic gel adhesive permitted barrier maturation to proceed. The likely explanation for the differences in response to the adhesives is that the pectin barrier and plastic tapes are occlusive (ie, water-vapor impermeable), whereas the hydrophilic gel is a semipermeable membrane. The authors also interpret their data to show that the barrier in premature infant skin is more readily perturbed after tape stripping than is adult skin. Though their interpretation is undoubtedly correct, this particular study does not directly address this point, because the experimental parameters are different. In adult studies, epidermis is repeatedly tape stripped until a break in the barrier is first observed. In this study, barrier function was not examined until 24 hours later. As noted above, the difference between experimental and control groups at this time point appears to reflect inhibition of maturation and not "damage" per se. Indeed, our interpretation of the data of Lund et al1Lund CH Nonato LB Kuller JM Franck LS Cullander C Durand JD. Disruption of barrier function in neonatal skin associated with adhesive removal.J Pediatr. 1997; 131: 367-372Abstract Full Text PDF PubMed Scopus (70) Google Scholar suggests that these agents (plastic tape and pectin barrier) may not be as damaging to the skin barrier as the authors have suggested. If the agents could be modified to be nonocclusive, one might have both a "gentle" and an effective adhesive. Because avoidance of iatrogenic injury to the premature infant's skin barrier is clearly important, Lund et al.1Lund CH Nonato LB Kuller JM Franck LS Cullander C Durand JD. Disruption of barrier function in neonatal skin associated with adhesive removal.J Pediatr. 1997; 131: 367-372Abstract Full Text PDF PubMed Scopus (70) Google Scholar are to be congratulated for their careful analysis of the impact of commonly used adhesives on the integrity of the neonate's barrier to transepidermal water loss (TEWL). The authors interpret their data to show that pectin barriers and plastic tape are damaging to the skin of premature infants (in contrast to the nondamaging, but unfortunately in some instances insufficiently adhesive, gel adhesives). We propose an alternate interpretation. They indicated that TEWL across epidermis of control sites and underlying the gel adhesive declined by approximately 25% during the 24-hour period of the study. The decline in TEWL across untreated skin was greatest in the lower birth weight cohorts. These data are consistent with the interpretation that barrier function matured in this period, with greater maturation observed among the more immature infants. This finding is not surprising because barrier function after premature birth rapidly improves, reaching mature function within 2 to 3 weeks of birth, regardless of the gestational age.2Cartlidge PHT Rutter N. Skin barrier function.in: Fetal and neonatal physiology. WB Saunders, Philadelphia1998: 569-585Google Scholar Recent studies from our laboratory have provided further insight into this phenomenon.3Hanley K Jiang Y Elias PM Feingold KR Williams ML. Acceleration of barrier ontogenesis in vitro through air exposure.Pediatr Res. 1997; 41: 293-299Crossref PubMed Scopus (45) Google Scholar Using an in vitro model of fetal rat skin development, we have shown that covering the surface of the fetal epidermis with an occlusive wrap (eg, a latex film) prevents the acceleration of barrier maturation that is normally observed when late gestational fetal skin is exposed to the air environment. In contrast, application of a vapor-permeable membrane (eg, Gore-Tex) does not prevent accelerated barrier maturation. Hence, evaporative water loss appears to signal accelerated barrier maturation. Furthermore, it has been recognized for some time that, in mature skin, air exposure accelerates recovery after experimental barrier disruption.4Elias PM Holleran WM Menon GK Ghadially R Williams ML Feingold KR. Normal mechanisms and pathophysiology of epidermal barrier homeostasis.Curr Opin Dermatol. 1994; 1: 231-237Google Scholar This response is thought to be mediated by ion fluxes, particularly those of calcium and potassium. Whether changing the concentrations of these ions also mediates the accelerated maturation of fetal skin on air exposure is unknown. In the study by Lund et al,1Lund CH Nonato LB Kuller JM Franck LS Cullander C Durand JD. Disruption of barrier function in neonatal skin associated with adhesive removal.J Pediatr. 1997; 131: 367-372Abstract Full Text PDF PubMed Scopus (70) Google Scholar TEWL at sites where the pectin barrier and plastic tapes had been used was essentially unchanged from results on the day of application (ie, 24 hours earlier). We therefore propose that the pectin barrier and plastic tape applications prevented the normal, accelerated barrier maturation of air-exposed skin, whereas the hydrophilic gel adhesive permitted barrier maturation to proceed. The likely explanation for the differences in response to the adhesives is that the pectin barrier and plastic tapes are occlusive (ie, water-vapor impermeable), whereas the hydrophilic gel is a semipermeable membrane. The authors also interpret their data to show that the barrier in premature infant skin is more readily perturbed after tape stripping than is adult skin. Though their interpretation is undoubtedly correct, this particular study does not directly address this point, because the experimental parameters are different. In adult studies, epidermis is repeatedly tape stripped until a break in the barrier is first observed. In this study, barrier function was not examined until 24 hours later. As noted above, the difference between experimental and control groups at this time point appears to reflect inhibition of maturation and not "damage" per se. Indeed, our interpretation of the data of Lund et al1Lund CH Nonato LB Kuller JM Franck LS Cullander C Durand JD. Disruption of barrier function in neonatal skin associated with adhesive removal.J Pediatr. 1997; 131: 367-372Abstract Full Text PDF PubMed Scopus (70) Google Scholar suggests that these agents (plastic tape and pectin barrier) may not be as damaging to the skin barrier as the authors have suggested. If the agents could be modified to be nonocclusive, one might have both a "gentle" and an effective adhesive.