Percutaneous respiration in the newborn infant

Area of Science:

• Neonatal Physiology
• Dermatology
• Respiratory Medicine

Background:

• The skin's role in gas exchange is well-established in adults but less understood in neonates.
• Infant skin differs significantly from adult skin in barrier function and water loss.
• Understanding neonatal percutaneous respiration is crucial for assessing alternative gas exchange methods.

Purpose of the Study:

• To investigate percutaneous respiration in newborn infants across a range of gestational ages.
• To quantify gas exchange rates (oxygen absorption and carbon dioxide excretion) through neonatal skin.
• To explore the relationship between gestational age, skin water loss, and gas exchange efficiency.

Main Methods:

• A closed skin cell system was used to introduce saturated air to the infant's upper abdomen.
• Gas exchange was measured in 27 newborn infants with varying birth weights and gestational ages (27-40 weeks).
• Measurements included oxygen absorption and carbon dioxide excretion rates, correlated with gestational age and skin water loss.

Main Results:

• Gas exchange rates were strongly correlated with gestational age, being significantly higher in preterm infants (<31 weeks gestation).
• Term infants exhibited lower gas exchange rates compared to adults.
• Preterm infants showed five to six times higher gas exchange rates initially, decreasing towards term levels by 2 weeks.
• Gas exchange correlated with skin water loss, indicating the epidermal barrier's role in limiting both.
• Oxygen absorption increased linearly with oxygen concentration in the skin cell.

Conclusions:

• Neonatal percutaneous respiration varies significantly with gestational age, with higher rates in preterm infants.
• The epidermal barrier plays a key role in limiting both gas exchange and water loss.
• Percutaneous oxygen delivery, potentially around 13% of resting requirements in preterm infants under specific conditions, may have clinical applications.