Keywords
Newborn
Neonates
Premature Infants
Skin Care
Skin Integrity
How to Cite
Abstract
Introduction. Neonatal skin is essential for maintaining physiological homeostasis; however, its structural and functional immaturity - particularly in preterm infants - makes it highly susceptible to dehydration, infection, thermal instability, and environmental damage. Maintaining skin integrity is therefore a critical component of neonatal and early pediatric care to reduce morbidity and support healthy development.
Methods. A scoping review was conducted following the PRISMA-ScR guidelines to synthesize current global evidence on neonatal and pediatric skin care practices. Five electronic databases were systematically searched for studies published between 2014 and 2025 in English, Italian, or Spanish. Eligible studies addressed skin care interventions in neonates and children, including bathing practices, emollient use, perineal care, prevention of atopic dermatitis and management of skin lesions. A total of 38 studies met the inclusion criteria, encompassing randomized controlled trials, observational and quasi-experimental studies, qualitative research, and expert consensus documents.
Results. The reviewed evidence indicates that delayed bathing after birth, gentle cleansing routines, and careful selection of skin care products contribute to improved skin barrier function. Early and regular use of emollients containing physiological lipids was associated with enhanced hydration, reduced transepidermal water loss, and a lower incidence of irritant and atopic dermatitis. Structured perineal care protocols were shown to reduce diaper-related skin breakdown. Preterm infants emerged as a particularly vulnerable group, requiring highly cautious and individualized approaches due to their markedly underdeveloped skin barrier. The review also highlights substantial global disparities in skin care practices, especially in low-resource settings, where access to appropriate products and standardized protocols is limited.
Discussion. Overall, the findings underscore the importance of evidence-based, standardized, and culturally sensitive skin care guidelines tailored to neonatal and pediatric populations. Implementing consistent practices across diverse clinical settings may improve skin integrity, reduce preventable complications, and support optimal neonatal outcomes, particularly among high-risk neonates.
References
1. Allaway R, Gardiner C, Hanson J, Murphy J, Sharma A. Principles of wound management in paediatric patients. 2nd ed. London: Wounds UK; 2024. Available from: https://wounds-uk.com/best-practice-statements/principles-of-wound-management-in-paediatric-patients-second-edition/.
2. Coolen NA, Schouten KCWM, Middelkoop E, Ulrich MMW. Comparison between human fetal and adult skin. Arch Dermatol Res. 2010;302(1):47-55. https://doi.org/10.1007/s00403-009-0989-8.
3. Nicolosi B, Parente E. Use of antimicrobial dialkyl carbamoyl chloride (DACC) surface dressings for the treatment of infected post-surgical complications in neonates with low risk of adverse reactions: case series in the AOU Meyer NICU. Inferm J. 2023;2(1):39-45. https://doi.org/10.36253/if-2105.
4. Oranges T, Dini V, Romanelli M. Skin physiology of the neonate and infant: clinical implications. Adv Wound Care. 2015;4(10):587-95. https://doi.org/10.1089/wound.2015.0642.
5. Visscher MO, McKeown K, Nurre M, Strange R, Mahan T, Kinnett M, et al. Skin care for the extremely low-birthweight infant. NeoReviews. 2023;24(4):e229-42. https://doi.org/10.1542/neo.24-4-e229.
6. Marissen J, Gomez de Agüero M, Chandorkar P, Reichert L, Glaser K, Speer CP, et al. The delicate skin of preterm infants: barrier function, immune-microbiome interaction, and clinical implications. Neonatology. 2023;120(3):295-307. https://doi.org/10.1159/000529026.
7. Visscher MO, Adam R, Brink S, Odio M. Newborn infant skin: physiology, development, and care. Clin Dermatol. 2015;33(3):271-80. https://doi.org/10.1016/j.clindermatol.2014.12.003.
8. Bamalan OA, Moore MJ, Menezes RG. Vernix caseosa. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559238/.
9. Kusari A, Han AM, Virgen CA, Matiz C, Rasmussen M, Friedlander SF, et al. Evidence-based skin care in preterm infants. Pediatr Dermatol. 2019;36(1):16-23. https://doi.org/10.1111/pde.13725.
10. Telofski LS, Morello AP, Mack Correa MC, Stamatas GN. The infant skin barrier: can we preserve, protect, and enhance the barrier? Dermatol Res Pract. 2012;2012:198789. https://doi.org/10.1155/2012/198789.
11. Sidbury R. Newborn skin development. In: Avery's Diseases of the Newborn. Philadelphia: Elsevier; 2018. p. 1468-1474.e1.
12. Taşdemir Hİ, Efe E. The effect of delaying first bathing on skin barrier function in late preterm infants: a study protocol for multi-centre, single-blind RCT. J Adv Nurs. 2021;77(2):1051-61. https://doi.org/10.1111/jan.14657.
13. Gözen D, Çaka SY, Beşirik SA, Perk Y. First bathing time of newborn infants after birth: a comparative analysis. J Spec Pediatr Nurs. 2019;24(2):e12239. https://doi.org/10.1111/jspn.12239.
14. Lund C, Kuller J, Durand DJ. Baby's first bath: changes in skin barrier function after bathing full-term newborns with water vs liquid baby cleanser. Pediatr Dermatol. 2020;37(1):115-9. https://doi.org/10.1111/pde.14037.
15. Gfatter R, Hackl P, Braun F. Effects of soap and detergents on skin surface pH, stratum corneum hydration and fat content in infants. Dermatology. 1997;195(3):258-62. https://doi.org/10.1159/000245955.
16. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73. https://doi.org/10.7326/M18-0850.
17. Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Syst Rev. 2022;18:e1230. https://doi.org/10.1002/cl2.1230.
18. Rehbinder EM, Wärnberg Gerdin S, Hoyer A, Bradley M, Lødrup Carlsen KC, Granum B, et al. Frequent oil baths and skin barrier during infancy in the PreventADALL study. Br J Dermatol. 2024;191(1):49-57. https://doi.org/10.1093/bjd/ljae091.
19. Brogan J, Rapkin G. Implementing evidence-based neonatal skin care with parent-performed, delayed immersion baths. Nurs Womens Health. 2017;21(6):442-50. https://doi.org/10.1016/j.nwh.2017.10.009.
20. Lee JC, Lee Y, Park HR. Effects of bathing interval on skin condition and axillary bacterial colonization in preterm infants. Appl Nurs Res. 2018;40:34-8. https://doi.org/10.1016/j.apnr.2017.12.012.
21. Gözen D, Akarsu Ö, Dur Ş, Akça B. Timing of post-bath skin moisturizer application to newborn infants: a randomized controlled study. Adv Skin Wound Care. 2023;36(1):1-8. https://doi.org/10.1097/01.ASW.0000901860.26683.7f.
22. Karakoç IB, Ekici B. Maintaining skin integrity in neonates with sunflower seed oil and liquid Vaseline: a prospective randomized controlled study. Adv Skin Wound Care. 2022;35(12):1-8. https://doi.org/10.1097/01.ASW.0000891080.13305.75.
23. Caglar S, Yildiz GK, Bakoglu I, Salihoglu O. The effect of sunflower seed and almond oil on preterm infant skin: a randomized controlled trial. Adv Skin Wound Care. 2020;33(8):1-6. https://doi.org/10.1097/01.ASW.0000672500.18525.2e.
24. Topçuoglu Arslan İZ, Karakoç A. Effect of almond and extra virgin olive oils on maintaining skin integrity in neonates admitted to the neonatal intensive care unit. Adv Skin Wound Care. 2025;38(7):381-6. https://doi.org/10.1097/ASW.0000000000000306.
25. Kanti V, Grande C, Stroux A, Bührer C, Blume-Peytavi U, Garcia Bartels N. Influence of sunflower seed oil on the skin barrier function of preterm infants: a randomized controlled trial. Dermatology. 2014;229(3):230-9. https://doi.org/10.1159/000363380.
26. Nangia S, Paul VK, Deorari AK, Sreenivas V, Agarwal R, Chawla D. Topical oil application and trans-epidermal water loss in preterm very low birth weight infants: a randomized trial. J Trop Pediatr. 2015;61(6):414-20. https://doi.org/10.1093/tropej/fmv049.
27. Tiryaki Ö, Zengin H, Çınar N, Karabay M, Caner İ, Güçlü E. Comparison of coconut and sunflower seed oils in improving the skin integrity and weight gain of infants in the neonatal ICU. Adv Skin Wound Care. 2024;37(11-12):1-8. https://doi.org/10.1097/ASW.0000000000000241.
28. Amare Y, Shamba DD, Manzi F, Bee MH, Omotara BA, Iganus RB, et al. Current neonatal skin care practices in four African sites. J Trop Pediatr. 2015;61(6):428-34. https://doi.org/10.1093/tropej/fmv053.
29. Sacks E, Moss WJ, Winch PJ, Thuma P, van Dijk JH, Mullany LC. Skin, thermal and umbilical cord care practices for neonates in southern, rural Zambia: a qualitative study. BMC Pregnancy Childbirth. 2015;15:149. https://doi.org/10.1186/s12884-015-0584-2.
30. Yonezawa K, Haruna M, Matsuzaki M, Shiraishi M, Kojima R. Effects of moisturizing skincare on skin barrier function and the prevention of skin problems in 3-month-old infants: a randomized controlled trial. J Dermatol. 2018;45(1):24-30. https://doi.org/10.1111/1346-8138.14080.
31. Schachner L, Andriessen A, Benjamin L, Bree A, Lechman P, Pinera-Llano A, et al. A consensus about the importance of ceramide containing skincare for normal and sensitive skin conditions in neonates and infants. J Drugs Dermatol. 2020;19(8):769-76. https://doi.org/10.36849/JDD.2020.5252.
32. Schachner LA, Blume-Peytavi U, Andriessen A, Izakovic J, Maruani A, Micali G, et al. Expert consensus on ceramides containing skincare in newborns and infants and potential mitigation of atopic dermatitis. Ital J Dermatol Venereol. 2022;157(1):23-32. https://doi.org/10.23736/S2784-8671.21.07172-3.
33. Gustin J, Bohman L, Ogle J, Fadayel G, Mitchell MC, Narendran V, et al. Improving newborn skin health: effects of diaper care regimens on skin pH and erythema. Pediatr Dermatol. 2021;38(4):768-74. https://doi.org/10.1111/pde.14602.
34. Gozen D, Caglar S, Bayraktar S, Atici F. Diaper dermatitis care of newborns: human breast milk or barrier cream. J Clin Nurs. 2014;23(3-4):515-23. https://doi.org/10.1111/jocn.12047.
35. Rogers S, Thomas M, Chan B, Hinckley SK, Henderson C. A quality improvement approach to perineal skin care: using standardized guidelines and novel diaper wipes to reduce diaper dermatitis in NICU infants. Adv Neonatal Care. 2021;21(3):189-97. https://doi.org/10.1097/ANC.0000000000000795.
36. Schachner LA, Blume-Peytavi U, Andriessen A, Izakovic J, Maruani A, Micali G, et al. Algorithm to attenuate atopic dermatitis and for promoting a healthy skin barrier using skincare in newborns and infants. Ital J Dermatol Venereol. 2023;158(3):224-35. https://doi.org/10.23736/S2784-8671.23.07336-X.
37. Yuguchi A, Nakajima T, Ishii Y, Yoshino Y, Takahashi A, Endo K, et al. Prevention of atopic dermatitis in babies by skin care from the newborn period. Int Arch Allergy Immunol. 2025;186(5):491-5. https://doi.org/10.1159/000542037.
38. Coelho Timbó C, Braga Godinho D, Cavalcante Fontenele F, De Jesus Barbosa MR, Lancia L, Melo Dodt RC, et al. Skin lesions in preterm infants in a neonatal intensive care unit. Child Nurses - Ital J Pediatr Nurs Sci. 2015;7(4):132-5.
39. Boyar V. Successful management of moisture-, friction-, and trauma-associated skin damage in the pediatric and neonatal population using cyanoacrylate skin protectant. Wounds. 2022;34(3):83-9. https://doi.org/10.25270/wnds/2022.8389.
40. Bargos-Munárriz M, Bermúdez-Pérez M, Martínez-Alonso AM, García-Molina P, Orts-Cortés MI. Prevention of pressure injuries in critically ill children: a preliminary evaluation. J Tissue Viability. 2020;29(4):310-8. https://doi.org/10.1016/j.jtv.2020.08.005.
41. Uysal G, Sönmez Düzkaya D, Yakut T, Bozkurt G. Effect of pressure injury prevention guides used in a pediatric intensive care. Clin Nurs Res. 2020;29(4):249-55. https://doi.org/10.1177/1054773818817696.
42. Smith HA, Moore Z, Tan MH. Cohort study to determine the risk of pressure ulcers and developing a care bundle within a paediatric intensive care unit setting. Intensive Crit Care Nurs. 2019;53:68-72. https://doi.org/10.1016/j.iccn.2019.04.008.
43. Santos S, Ramos F, Costa R, Batalha L. Validation of nursing interventions to prevent skin lesions in hospitalized newborns. Texto Contexto Enferm. 2021;30:e20190136. https://doi.org/10.1590/1980-265X-TCE-2019-0136.
44. Simsic JM, Dolan K, Howitz S, Peters S, Gajarski R. Prevention of pressure ulcers in a pediatric cardiac intensive care unit. Pediatr Qual Saf. 2019;4(3):e162. https://doi.org/10.1097/pq9.0000000000000162.
45. Burns R, Bell T. Skincare bundle for the very low birth weight and extremely low birth weight neonate. J Neonatal Nurs. 2024;30(1):98-101. https://doi.org/10.1016/j.jnn.2023.06.003.
46. Ozyurt N, Kucuk S, Senel E. The effect of short intervention training for nurses about pediatric pressure injuries on their knowledge and on pressure injuries: a randomized controlled trial. J Pediatr Nurs. 2024;79:e239-46. https://doi.org/10.1016/j.pedn.2024.10.029.
47. Ahn YM, Lee SM, Cho JA. Development of a nursing guideline for improving skin integrity in high-risk infants. J Contin Educ Nurs. 2020;51(5):238-44. https://doi.org/10.3928/00220124-20200415-09.
48. Amer M, Diab N, Soliman M, Amer A. Neonatal skin care: what should we do? A four-week follow-up randomized controlled trial at Zagazig University Hospitals. Int J Dermatol. 2017;56(11):1198-203. https://doi.org/10.1111/ijd.13735.
49. Delgado BS, Costa R, Vesco SNPD, Santos FA, Santos SV. Newborn skin care strategies in neonatal unit. ESTIMA Braz J Enterostomal Ther. 2019;16:e1319. https://doi.org/10.30886/estima.v16.745_IN.
50. Khalifian S, Golden WC, Cohen BA. Skin care practices in newborn nurseries and mother-baby units in Maryland. J Perinatol. 2017;37(6):615-21. https://doi.org/10.1038/jp.2016.226.
51. Jani P, Mishra U, Buchmayer J, Maheshwari R, D'Cruz D, Walker K, et al. Global variation in skin injuries and skincare practices in extremely preterm infants. World J Pediatr. 2023;19(2):139-57. https://doi.org/10.1007/s12519-022-00625-2.
52. Cummins KA, Watters R, Leming-Lee T. Reducing pressure injuries in the pediatric intensive care unit. Nurs Clin North Am. 2019;54(1):127-40. https://doi.org/10.1016/j.cnur.2018.10.005.
53. World Health Organization. WHO recommendations on postnatal care of the mother and newborn. Geneva: World Health Organization; 2014 [cited 2025 Dec 13]. Available from: https://iris.who.int/handle/10665/97603.
54. Beeckman D, Campbell J, Campbell K, Chimentão D, Domansky R, Gray M, et al. Incontinence-associated dermatitis: moving prevention forward. London: Wounds International; 2015.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Francesco Beneforti, Giorgia Locatelli, Alessandra Reddi, Daniele Ciofi, Paola Stillo, Biagio Nicolosi