After birth, skin barrier function is in state of flux and at risk of dysfunction. In a prospective clinical study, we compared the effects of 2 standard cleansing procedures on skin barrier function in newborns.
Fifty-seven healthy full-term neonates aged < or = 48 h were randomly assigned to either a bathing group (group B; n = 29), who were bathed with clear water twice weekly, or to a washing group (group W; n = 28), who were washed with a washcloth moistened with clear water twice weekly. Transepidermal water loss (TEWL), skin pH, stratum corneum hydration (SCH) and sebum production were measured at days 2, 7 and 28 of life on the forehead, abdomen, upper leg and buttock.
Group B showed significantly lower TEWL on the buttock and higher SCH on the abdomen and forehead compared to group W at day 28.
Both skin care regimens do not harm the adaptation of the skin barrier in healthy neonates within the first 4 weeks of life. Skin barrier function differentiates after birth in a regionally specific fashion.
"Three relevant RCT's, two by the same authors, were published after the completion of our pilot trial. Bartels study  tested the hypothesis that neither twice-weekly washing nor bathing would harm the natural adaptation of the skin barrier with respect to long-term effects on skin function in healthy newborns. The bathed group showed statistically significant lower TEWL on the buttock and higher hydration on abdomen and forehead compared to the wash group at day 28. "
[Show abstract][Hide abstract] ABSTRACT: The vulnerability of newborn babies' skin creates the potential for a number of skin problems. Despite this, there remains a dearth of good quality evidence to inform practice. Published studies comparing water with a skin-cleansing product have not provided adequate data to inform an adequately powered trial. Nor have they distinguished between babies with and without a predisposition to atopic eczema. We conducted a pilot study as a prequel to designing an optimum trial to investigate whether bathing with a specific cleansing product is superior to bathing with water alone. The aims were to produce baseline data which would inform decisions for the main trial design (i.e. population, primary outcome, sample size calculation) and to optimize the robustness of trial processes within the study setting.
100 healthy, full term neonates aged <24 hours were randomly assigned to bathing with water and cotton wool (W) or with a cleaning product (CP). A minimum of bathing 3 times per week was advocated. Groups were stratified according to family history of atopic eczema. Transepidermal water loss (TEWL), stratum corneum hydration and skin surface pH were measured within 24 hours of birth and at 4 and 8 weeks post birth. Measurements were taken on the thigh, forearm and abdomen. Women also completed questionnaires and diaries to record bathing practices and medical treatments.
Forty nine babies were randomized to cleansing product, 51 to water. The 95% confidence intervals (CI) for the average TEWL measurement at each time point were: whole sample at baseline: 10.8 g/m(2)/h to 11.7 g/m(2)/h; CP group 4 weeks: 10.9 g/m(2)/h to 13.3 g/m(2)/h; 8 weeks: 11.4 g/m(2)/h to 12.9 g/m(2)/h; W group 4 weeks:10.9 g/m(2)/h to 12.2 g/m(2)/h; 8 weeks: 11.4 g/m(2)/h to 12.9 g/m(2)/h.
This pilot study provided valuable baseline data and important information on trial processes. The decision to proceed with a superiority trial, for example, was inconsistent with our data; therefore a non-inferiority trial is recommended.
[Show abstract][Hide abstract] ABSTRACT: Development of the skin barrier continues up to 12 months after birth; therefore, care must be taken when cleansing and bathing infants' skin. Available guidelines for skin care in newborns are, however, limited. In 2007, the 1st European Round Table meeting on 'Best Practice for Infant Cleansing' was held, at which a panel of expert dermatologists and paediatricians from across Europe aimed to provide a consensus on infant bathing and cleansing.
Based on discussions at the meeting and a comprehensive literature review, the panel developed a series of recommendations relating to several aspects of infant skin care, including initial and routine bathing, safety while bathing, and post-bathing procedures. The panel also focused on the use of liquid cleansers in bathing, particularly relating to the benefits of liquid cleansers over water alone, and the criteria that should be used when choosing an appropriate liquid cleanser for infants. Alkaline soaps have numerous disadvantages compared with liquid cleansers, with effects on skin pH and lipid content, as well as causing skin drying and irritation. Liquid cleansers used in newborns should have documented evidence of their mildness on skin and eyes, and those containing an emollient may have further benefits. Finally, the panel discussed seasonal differences in skin care, and issues relating to infants at high risk of atopic dermatitis. The panel further discussed the need of clinical studies to investigate the impact of liquid cleansers on skin physiology parameters on newborns' and infants' skin.
Bathing is generally superior to washing, provided basic safety procedures are followed, and has psychological benefits for the infant and parents. When bathing infants with a liquid cleanser, a mild one not altering the normal pH of the skin surface or causing irritation to skin or eyes should be chosen.
Journal of the European Academy of Dermatology and Venereology 08/2009; 23(7):751-9. DOI:10.1111/j.1468-3083.2009.03140.x · 2.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Die optimale und altersgemäße Hautpflege bei Neugeborenen und Säuglingen
ist ein wichtiges Thema für Eltern, Hebammen und ärztliche Ratgeber. Zu Recht, denn die Ergebnisse neuer Publikationen (1-3)
zeigen, dass die Hautschutzbarriere von Säuglingen nicht, wie oft angenommen,
bereits nach vier Lebenswochen mit Erwachsenenhaut vergleichbar ist. Sie belegen für den Zeitraum des ersten Lebensjahres
und sogar darüber hinaus, dass sich die Beschaffenheit der Säuglingshaut
signifikant von der Erwachsener unterscheidet.
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