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. 2021 Jan 18;6(1):17-34.
doi: 10.1159/000512274. eCollection 2021 Jan-Apr.

Birthweight and Environmental Conditions Impact Skin Barrier Adaptation in Neonates Receiving Natural Oil Massage

Marty O Visscher  1 , Aimee Summers  2 , Vivek Narendran  1 , Subarna Khatry  3 , Jeevan Sherchand  4 , Steven LeClerq  2   3 , Joanne Katz  2 , James Tielsch  5 , Luke Mullany  2
Affiliations

Birthweight and Environmental Conditions Impact Skin Barrier Adaptation in Neonates Receiving Natural Oil Massage

Marty O Visscher et al. Biomed Hub. .

Abstract

Introduction: Skin interventions have been implemented to reduce neonatal mortality, demonstrating the skin's role in neonatal innate immunity. We examined the impact of birthweight and environmental conditions on skin integrity in infants receiving oil massage in rural Nepal.

Methods: In a community-based cluster randomized controlled trial, 991 premature and full-term infants were grouped by birthweight as: (1) 920-1,560 g, (2) 1,570-2,450 g, (3) 2,460-2,990 g, and (4) 3,000-4,050 g and by high or low heat index (HI). Skin integrity was measured as erythema, rash, dryness, pH, protein concentration, and transepidermal water loss (TEWL).

Results: Skin pH was higher for the smallest (group 1) than the largest infants (group 4) and higher for group 2 than 3 and 4. Arm and leg rash differed for all 4 groups, with the least amount of rash for the smallest babies. Erythema was lower for group 1 than all others. The lower day 1 values for pH, TEWL and protein at high versus low HI remained lower over 28 days. The pH reduction was faster at high HI. Erythema (arm, leg) was more severe at high HI. Rash severity was greater at high HI for arms and legs every day.

Conclusions: Birthweight influenced the skin response to oil massage. The smallest infants had the lowermost skin irritation, suggesting diminished ability to mount an inflammatory response. High HI may be protective for premature infants in low resource settings.

Keywords: Environmental conditions; Infant; Massage; Neonate; Premature infant; Skin barrier; Skin integrity; Skin pH; Stratum corneum; Topical natural oil; Transepidermal water loss.

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Conflict of interest statement

The authors have no financial relationships or potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Effect of birthweight group on neonatal skin integrity over time. Over 28 days, skin pH was higher for the smallest infants (920–1,560 g) than the largest infants (3,000–4,050 g) and higher for group 2 (1,570–2,450 g) than the larger groups 3 (2,460–2,990 g) and 4 (3,000–4,050 g; p < 0.05; a). Arm and leg rash scores differed for all 4 groups versus each other (p < 0.05) and the smallest infants had the lowest rash levels (b). Chest rash was of lower severity for the 2 smaller groups (1 and 2) than all other groups (p < 0.05; online suppl. Table S2). Erythema at all sites was lower for the smallest infants of group 1 than all others (p < 0.05; c).
Fig. 2
Fig. 2
Effect of HI group on neonatal skin integrity over time. At baseline, skin pH, TEWL, protein and chest erythema severities were lower and arm and leg rash severities were higher at high HI than low HI (p < 0.05). The lower pH, TEWL and protein at high HI on day 1 remained lower over 28 days than did the measurements at low HI (p < 0.05; a, b). Arm and leg erythema scores were greater at high HI beginning on days 7 and 14, respectively (p < 0.05; c). Rash severities were greater for arms and legs at high HI each day and for chest skin on days 3, 7, 14 and 28 (p < 0.05; d). Dryness was greater at high HI starting on day 14 for arms and on day 7 for legs (p < 0.05; e).
Fig. 3
Fig. 3
Effect of HI by birthweight group. The effects of birthweight group were evaluated over the 28-day period for each HI class individually. At high HI, arm rash differed for all birthweight groups and was lowest for the smallest infants (group 1; p < 0.05; a). At low HI, arm rash severity was higher for the 2 older groups 3 and 4 versus all others (p < 0.05; a). At high HI, skin pH was higher for the smallest babies (group 1) than the 2 larger groups (3 and 4) and higher for groups 1 and 2 than 4 (p < 0.05; b). At low HI, pH was higher for group 2 than group 4 (p < 0.05; b).
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