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The newborn skin
Semin Neonatol 2000; 5: 271 doi:10.1053/siny.2000.0012, available online at http://www.idealibrary.com on
EDITORIAL
The newborn skin Nicholas Rutter Academic Division of Child Health, School of Human Development, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK
The skin of the newborn infant is viewed in different ways. Parents marvel at it and can be seen touching, stroking and staring at it. Any minor blemish in this perfect organ is a cause for concern. The nurse or midwife may take it for granted, using it as a convenient site for the attachment of monitoring probes. However, the neonatal intensive care nurse recognizes it as a delicate and easily damaged organ in the very immature infant and worries about how to prevent or treat any damage. This worry increases greatly when caring for an infant with a rare congenital disorder in which the skin is intensely fragile. The doctor usually does not give the skin a second thought—it is a layer to be pierced to reach a vein or artery underneath. However, if it is malformed or diseased, there is uncertainty. Is the lesion an innocuous blemish or an early sign of serious disorder? Will it get better or persist? The uncertainty leads to insecurity and anxiety but access to a dermatologist with paediatric expertise is often limited. The aim of this edition of Seminars in Neonatology is to help all these groups. It is an edition of two halves. The first relates to the normal skin of an abnormal group of infants, those born prematurely. The second is concerned with the abnormal skin of infants who may be otherwise normal. The increasing application of intensive care to infants on the borderline of viability has introduced neonatologists to the failure of organs which usually work well. The skin is such an organ. ‘Skin failure’ is a concept which is recognized by burns units or by dermatologists who treat patients with extensive weeping skin disease. The infant of 24 weeks’ gestation shares the problems of such 1084–2756/00/040271+01 $35.00/0
patients and the principles of management are similar. In Chapter 1, Cartlidge describes the epidermal barrier, its structure, its development and its function. Much is now known about this. In Chapter 2, Rutter outlines the clinical problems associated with an immature epidermal barrier. Again, much is now known about these, although the solutions are not always easy. In Chapter 3, Hoath and Narendran discuss the difficult area of use of adhesives and emollients, particularly in the very preterm infant. It is an area which until recently was driven by the skin-care industry rather than neonatology, based on extrapolation from adult experience rather than on any good scientific research in the newborn. Happily this is now changing—US neonatologists, dermatologists and industry are combining to develop products specifically suited to the preterm infant. In Chapter 4, Rutter reviews the function of the other skin layer, the dermis. The second half is dermatology for the neonatologist. Verbov in Chapter 5 reviews the various common skin lesions found in the newborn, including infection. Although the various genetically determined disorders of skin are individually rare, they commonly present first to the neonatologist who has to recognize that one is present, even if an exact diagnosis cannot be made. Moss covers these disorders in Chapter 6. One group of these disorders, the blistering diseases, has very important implications for the neonatal doctor and nurse. Denyer provides clear, practical guidelines on how to minimize skin damage in these infants in Chapter 7. Finally the large birthmark and its management is another difficult area which is covered by Batta in Chapter 8. © 2000 Harcourt Publishers Ltd
EDITORIAL
The newborn skin Nicholas Rutter Academic Division of Child Health, School of Human Development, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK
The skin of the newborn infant is viewed in different ways. Parents marvel at it and can be seen touching, stroking and staring at it. Any minor blemish in this perfect organ is a cause for concern. The nurse or midwife may take it for granted, using it as a convenient site for the attachment of monitoring probes. However, the neonatal intensive care nurse recognizes it as a delicate and easily damaged organ in the very immature infant and worries about how to prevent or treat any damage. This worry increases greatly when caring for an infant with a rare congenital disorder in which the skin is intensely fragile. The doctor usually does not give the skin a second thought—it is a layer to be pierced to reach a vein or artery underneath. However, if it is malformed or diseased, there is uncertainty. Is the lesion an innocuous blemish or an early sign of serious disorder? Will it get better or persist? The uncertainty leads to insecurity and anxiety but access to a dermatologist with paediatric expertise is often limited. The aim of this edition of Seminars in Neonatology is to help all these groups. It is an edition of two halves. The first relates to the normal skin of an abnormal group of infants, those born prematurely. The second is concerned with the abnormal skin of infants who may be otherwise normal. The increasing application of intensive care to infants on the borderline of viability has introduced neonatologists to the failure of organs which usually work well. The skin is such an organ. ‘Skin failure’ is a concept which is recognized by burns units or by dermatologists who treat patients with extensive weeping skin disease. The infant of 24 weeks’ gestation shares the problems of such 1084–2756/00/040271+01 $35.00/0
patients and the principles of management are similar. In Chapter 1, Cartlidge describes the epidermal barrier, its structure, its development and its function. Much is now known about this. In Chapter 2, Rutter outlines the clinical problems associated with an immature epidermal barrier. Again, much is now known about these, although the solutions are not always easy. In Chapter 3, Hoath and Narendran discuss the difficult area of use of adhesives and emollients, particularly in the very preterm infant. It is an area which until recently was driven by the skin-care industry rather than neonatology, based on extrapolation from adult experience rather than on any good scientific research in the newborn. Happily this is now changing—US neonatologists, dermatologists and industry are combining to develop products specifically suited to the preterm infant. In Chapter 4, Rutter reviews the function of the other skin layer, the dermis. The second half is dermatology for the neonatologist. Verbov in Chapter 5 reviews the various common skin lesions found in the newborn, including infection. Although the various genetically determined disorders of skin are individually rare, they commonly present first to the neonatologist who has to recognize that one is present, even if an exact diagnosis cannot be made. Moss covers these disorders in Chapter 6. One group of these disorders, the blistering diseases, has very important implications for the neonatal doctor and nurse. Denyer provides clear, practical guidelines on how to minimize skin damage in these infants in Chapter 7. Finally the large birthmark and its management is another difficult area which is covered by Batta in Chapter 8. © 2000 Harcourt Publishers Ltd