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Skin care of the newborn infant
3. Homo-Delarche F, Fitzpatrick F, Christeff N, Nunez EA, Bach JF, Dardenne M. Sex steroids, glucocorticoids, stress and autoimmunity. J Steroid Biochem Mol Biol 1991;40:619-37. 4. Cutolo M, Sulli A, Seriolo B, Accardo S, Masi AT. Estrogens, the immune response and autoimmunity. Clin Exp Rheumatol 1995;13:217-26. 5. Jacobson JD, Ansari MA, Mansfield ME, McArthur CP, Clement LT. Gonadotropin-releasing hormone increases CD4+ T-lymphocyte numbers
in an animal model of immunodeficiency. J Allergy Clin Immunol 1999;104:653-8. 6. Jacobson JD. Gonadotropin-releasing hormone: potential role in autoimmunity. Int Immunopharmacol 2001;1:1077-83. 7. Metcalfe W, Boulton-Jones JM. Exacerbation of lupus nephritis in association with leuprorelin injection for uterine leiomyoma. Nephrol Dial Transplant 1997;12:1699-700.
50 Years Ago in The Journal of Pediatrics SKIN CARE OF THE NEWBORN INFANT Pennoyer MM, Sullivan MP. J Pediatr 1954;44:258-63 Few care practices in infancy have shown more variability over the years than the first bath and subsequent care of the skin. Pennoyer and Sullivan reported on their experience with ‘‘dry care,’’ a technique practiced at the St Louis Maternity Hospital. The practice of dry care allowed the coating of vernix caseosa to remain on the skin after birth regardless of the length of hospitalization. Blood and debris were removed from the head and face in the delivery room using warm oil and any remaining vernix removed from skin creases with a moist cotton ball at 24 hours. Advocates of dry care suggested vernix acted as a kind of protective vanishing cream. This care practice was not associated with any infectious outbreak but sporadic cases of impetigo due to Staphylococcus aureus were noted, particularly in the infants of private mothers whose hospital stays were, in general, 10 days! In an attempt to eradicate the sporadic cases of hospital-acquired impetigo, an elaborate bathing schema was introduced in which each infant was placed naked on a bath slab on the 3rd day of life and sprayed with pHisoderm (a synthetic, sudsing, skin detergent containing 3% hexachlorophene). This skin care practice was immediately successful in reducing the incidence of impetigo from 2% to less than 0.3%. Unfortunately, like other practices in neonatology, such as oxygen therapy for retinopathy of prematurity and postnatal steroids for bronchopulmonary dysplasia, unforeseen consequences occurred. In the mid-1970s the neurotoxicity of hexachlorophene was reported in human infants and linked to bathing practices. The development of vacuolar encephalopathy was particularly prominent in premature infants whose epidermal barrier was least developed and the absorption of hexachlorophene greatest. Today we have come full circle. Skin care practices for the infant vary widely from hospital to hospital and culture to culture. To our knowledge, there are no definitive recommendations from the American Academy of Pediatrics regarding the first bath other than avoidance of hypothermia. Interestingly, the World Health Organization recommends leaving vernix intact on the skin surface after birth. Recent data has demonstrated a plethora of antimicrobial peptides in vernix as well as cleansing, moisturizing, and antioxidant functions. Thus, the question of ‘‘dry care’’ again comes to the fore. How can we facilitate bacterial colonization while avoiding infections with pathogens? What is the best skin care practice for the newborn infant? Time will tell what the next 50 years will bring. Steven B. Hoath, MD Vivek Narendran, MD Division of Neonatology and the Skin Sciences Institute Cincinnati Children’s Hospital Medical Center Cincinnati, OH 45267-0541 YMPD684 10.1016/j.jpeds.2003.12.024
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The Journal of Pediatrics March 2004
in an animal model of immunodeficiency. J Allergy Clin Immunol 1999;104:653-8. 6. Jacobson JD. Gonadotropin-releasing hormone: potential role in autoimmunity. Int Immunopharmacol 2001;1:1077-83. 7. Metcalfe W, Boulton-Jones JM. Exacerbation of lupus nephritis in association with leuprorelin injection for uterine leiomyoma. Nephrol Dial Transplant 1997;12:1699-700.
50 Years Ago in The Journal of Pediatrics SKIN CARE OF THE NEWBORN INFANT Pennoyer MM, Sullivan MP. J Pediatr 1954;44:258-63 Few care practices in infancy have shown more variability over the years than the first bath and subsequent care of the skin. Pennoyer and Sullivan reported on their experience with ‘‘dry care,’’ a technique practiced at the St Louis Maternity Hospital. The practice of dry care allowed the coating of vernix caseosa to remain on the skin after birth regardless of the length of hospitalization. Blood and debris were removed from the head and face in the delivery room using warm oil and any remaining vernix removed from skin creases with a moist cotton ball at 24 hours. Advocates of dry care suggested vernix acted as a kind of protective vanishing cream. This care practice was not associated with any infectious outbreak but sporadic cases of impetigo due to Staphylococcus aureus were noted, particularly in the infants of private mothers whose hospital stays were, in general, 10 days! In an attempt to eradicate the sporadic cases of hospital-acquired impetigo, an elaborate bathing schema was introduced in which each infant was placed naked on a bath slab on the 3rd day of life and sprayed with pHisoderm (a synthetic, sudsing, skin detergent containing 3% hexachlorophene). This skin care practice was immediately successful in reducing the incidence of impetigo from 2% to less than 0.3%. Unfortunately, like other practices in neonatology, such as oxygen therapy for retinopathy of prematurity and postnatal steroids for bronchopulmonary dysplasia, unforeseen consequences occurred. In the mid-1970s the neurotoxicity of hexachlorophene was reported in human infants and linked to bathing practices. The development of vacuolar encephalopathy was particularly prominent in premature infants whose epidermal barrier was least developed and the absorption of hexachlorophene greatest. Today we have come full circle. Skin care practices for the infant vary widely from hospital to hospital and culture to culture. To our knowledge, there are no definitive recommendations from the American Academy of Pediatrics regarding the first bath other than avoidance of hypothermia. Interestingly, the World Health Organization recommends leaving vernix intact on the skin surface after birth. Recent data has demonstrated a plethora of antimicrobial peptides in vernix as well as cleansing, moisturizing, and antioxidant functions. Thus, the question of ‘‘dry care’’ again comes to the fore. How can we facilitate bacterial colonization while avoiding infections with pathogens? What is the best skin care practice for the newborn infant? Time will tell what the next 50 years will bring. Steven B. Hoath, MD Vivek Narendran, MD Division of Neonatology and the Skin Sciences Institute Cincinnati Children’s Hospital Medical Center Cincinnati, OH 45267-0541 YMPD684 10.1016/j.jpeds.2003.12.024
396
Eyal and Rose
The Journal of Pediatrics March 2004