Skin Maturation in Premature Infants

Premature infants have a poor epidermal barrier with few cornified layers, putting them at
significant risk for increased permeability to external agents, skin compromise, high water
loss and infection. While the skin develops rapidly after birth upon exposure to the dry
environment, the ontogeny of the skin maturation and the time to a fully functional and
protective stratum corneum (SC) barrier is largely unknown. The impact of a poor skin barrier
on nosocomial infections and the morbidity associated with prematurity is not well defined.
The purpose is to evaluate skin barrier maturation in premature infants compared to full term
infants. The skin barrier lipids will be lower in premature infants than in full term infants
and will become normal over 3-4 months after birth. The higher skin surface acidity in
premature infants will be related to an altered lipid composition which will change as the
skin acidifies.

Full thickness skin samples will be collected from premature and full term infants during the
time of medically necessary surgical procedures for genomic/transcriptomics analyses. The
gene profiles will be compared to the corresponding biomarker profiles to determine the
relationship between genes and gene expression products, i.e., biomarkers. The
genomic/transcriptomics, biomarker, instrumental and clinical assessments will be examined
for relationships and compared between premature and full term cohorts.

Inclusion Criteria:

(1) Premature infants of gestational ages 24 to 36.9 weeks or healthy full term infants of
gestational age ≥ 37 weeks (2) Premature infants who are patients in the Neonatal Intensive
Care Unit of University Hospital (3) Healthy full term infants (who were born at University
Hospital (4) Full term infants (≥ 37 weeks gestational age) who were transported to
Cincinnati Children's Hospital Medical Center for care after birth (4) Free of congenital
conditions known to affect the skin such as epidermolysis bullosa, ichthyosis, trisomy 2
(5) Free of skin infections such as herpes simplex (6) Sufficiently medically stable such
that study procedures can be tolerated (7) Parent/guardian willing to provide written
informed consent for participation

Direct admit surgical subjects

Inclusion Criteria:

1. Premature infants of gestational ages 24 to 36.9 weeks

2. Full term infants ≥ 37 weeks gestational age

(2) Infant admitted directly to the Neonatal Intensive Care Unit of Cincinnati Childrens
for surgical procedures after delivery (3) Free of congenital conditions known to affect
the skin such as epidermolysis bullosa, ichthyosis and trisomy 21 (5) Free of skin
infections such as herpes simplex (4) Sufficiently medically stable such that study
procedures can be tolerated (5) Parent/guardian willing to provide written informed consent
for participation

Exclusion Criteria:

1. Gestational age < 24 weeks

2. Have congenital conditions that affect the skin such as epidermolysis bullosa,
ichthyosis, trisomy 21

3. Have a skin infection such as herpes simplex

4. Judged to be medically unstable such that study procedures cannot be tolerated

5. Parent/guardian unwilling to provide written informed consent for participation.

Direct admit surgical subjects

Exclusion Criteria:

1. Infants ≥ 43 weeks gestational age

2. Have congenital conditions known to affect the skin such as epidermolysis bullosa,
ichthyosis, trisomy 21

3. Have a skin infection such as herpes simplex

Adult subject controls:

Inclusion Criteria:

1. Parent of an infant enrolled in the study

2. Free from skin irritation, rash, scars, wounds or other skin damage in an area of at
least 200 cm2 on one volar forearm

3. Able to come to the infant's hospital for study measurements on one day when infant
measurements are made

4. Willing to provide written informed consent for participation

Exclusion Criteria:

(1) Not a parent of an infant enrolled in the study (2) Have skin irritation, rash, scars,
wounds or other skin damage in an area of at least 200 cm2 on one volar forearm (3) Unable
to come to the infant's hospital for study measurements on one day when infant measurements
are made (4) Unwilling to provide written informed consent for participation