“Premature infants have an underdeveloped epidermal barrier with few cornified layers increasing their risk for greater permeability by noxious agents, high water loss, delayed skin maturation, skin damage, and infection. Their skin is easily torn due to deficiency of dermal structural proteins. Stratum corneum (SC) maturation is rapid upon exposure to a dry environment. At 23 weeks, it is nearly absent, with transepidermal water loss (TEWL) of
75 g/m 2 /h. By week 26, a few cornified layers have formed (TEWL of ~45 g/m 2/h), corresponding essentially to a wounded skin surface. One month later, premature SC was not fully competent, as indicated by significantly higher TEWL (17 g/m 2 /h) than normal, full-term infants. Complete skin maturation may take as long as 9 weeks and longer for complete acid mantle formation.”

Visscher, M. O., Carr, A. N., & Narendran, V. (2021). Premature infant skin barrier maturation: status at full-term corrected age. Journal of Perinatology, 41(2), 232–239.

Burns, R., & Bell, T. (2024). Skincare bundle for the very low birth weight and extremely low birth weight neonate. Journal of Neonatal Nursing, 30(1), 98–101.

Tiryaki, Ö., Zengin, H., Çınar, N., Karabay, M., Caner, İ., & Güçlü, E. (2024). Comparison of Coconut and Sunflower Seed Oils in Improving the Skin Integrity and Weight Gain of Infants in the Neonatal ICU. Advances in Skin & Wound Care, 37(11/12), 1–8.

Metallinou, D., Nanou, C., Tsafonia, P., Karampas, G., & Lykeridou, K. (2022). Investigation of Healthcare Professionals’ Knowledge of Evidence-Based Clinical Practices for Preterm Neonatal Skin Care—A Pilot Study. Children, 9(8), 1235.

Anitha, M., Sundaram, M. B., & Kumutha, J. (2022). Efficacy and Safety of Multiple Whole-Body Cleansing With Aqueous 0.5% Chlorhexidine in Stable NICU Preterm Infants—Randomized Controlled Trial. Journal of Neonatology, 36(3), 216–226.

Boyar, V., & Desai, T. (2023). Prospective, Case-Control Study Evaluating Effects of No-Sting Liquid Barrier Film on Skin Condition and Maturation of Stratum Corneum in Premature Neonates. Journal of Wound, Ostomy & Continence Nursing, 50(1), 19–25.