Clinical consequences of an immature barrier

The epidermal barrier is well developed in the term infant. It is poorly developed in the most immature infants, leading to three major effects: high transepidermal water loss (TEWL), percutaneous absorption, and trauma. A high TEWL leads to poor temperature control and difficulty in fluid balance: it can and should be reduced by manipulating the ambient humidity or by covering the skin. Topical antiseptics should be used sparingly and with care to prevent toxic damage from absorption. The chances of trauma can be reduced by careful choice of monitoring probes and adhesives. Since the epidermal barrier develops rapidly in the postnatal period, these effects only cause problems in the first week or two of life.