Preemie Skin in the NICU

July 6, 2020

Our skin has many important functions. It plays an important role in sensation and tactile feeling (touch is the first sense to develop). It serves as a barrier to water loss in the body. Our skin also prevents irritants and toxins from entering the body and helps with thermal regulation.

Preemie skin vs. skin of term babies

The skin of a preemie is very different from that of a term baby. Preemie skin is thinner: the epidermis, or outer layer, and the dermis, the middle layer, are much thinner and less developed. “Premature babies or preterm babies have fewer layers of skin because they were born early and they didn’t have that ability to develop those extra layers,” says Dr. Media Esser, a neonatal nurse practitioner in Milkaukee, WI. “It takes them a little bit longer to develop those layers and mature their skin once they’re born.”

Dr. Esser also says that even full-term babies don’t have fully developed skin, as they still have days or weeks to mature as their bodies adjust to the drier air, to nutrition, to the water capacity of their skin and how it mixes with the air.

Preemie skin issues

Issues with water loss, electrolyte management and thermal regulation in preemies are all due to their thin skin.

Invasive procedures in the NICU can also threaten the skin’s integrity. The outer layer of the skin is not as well attached to the dermis. Friction may cause tears when adhesives are removed or other actions are applied to the skin.

Preemies may also be susceptible to diaper dermatitis, more commonly known as diaper rash. Listen to NICU Now Episode 29: Preemies and Diaper Dermatitis to learn more with guest Dr. Media Esser.

Promoting healthy skin in the NICU

To promote healthy skin in the NICU, practitioners and parents are advised to evaluate the baby’s skin, looking for evidence of damage due to friction or redness, especially in the diaper area. Dr. Esser recommends using clear ointments, such as petroleum jelly, in the first few days after birth, then switching to a stronger cream, such as zinc, once the baby is stooling more often.

Learn more in NICU Now Episode 29: Preemies and Diaper Dermatitis.

NICU professionals: Listen to NICU Heroes Episode 9: Developmental Diapering in the NICU. Each NICU Heroes episode is worth one contact hour of nursing continuing education.