Visscher Marty O, Summers Aimee, Narendran Vivek, Khatry Subarna, Sherchand Jeevan, LeClerq Steven, Katz Joanne, Tielsch James, Mullany Luke
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Biomed Hub. 2021 Jan 18;6(1):17-34. doi: 10.1159/000512274. eCollection 2021 Jan-Apr.
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.
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).
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.
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.
已实施皮肤干预措施以降低新生儿死亡率，这表明皮肤在新生儿先天免疫中发挥作用。我们研究了出生体重和环境条件对尼泊尔农村接受油按摩婴儿皮肤完整性的影响。
在一项基于社区的整群随机对照试验中，991名早产和足月婴儿按出生体重分组为：(1)920 - 1560克，(2)1570 - 2450克，(3)2460 - 2990克，以及(4)3000 - 4050克，并按高或低热指数(HI)分组。皮肤完整性通过红斑、皮疹、干燥、pH值、蛋白质浓度和经表皮水分流失(TEWL)来衡量。
最小的婴儿(第1组)皮肤pH值高于最大的婴儿(第4组)，第2组高于第3组和第4组。所有4组婴儿手臂和腿部的皮疹情况不同，最小的婴儿皮疹最少。第1组的红斑低于其他所有组。与低热指数相比，高热指数时第1天的pH值、TEWL和蛋白质值在28天内一直较低。高热指数时pH值下降更快。高热指数时红斑(手臂、腿部)更严重。每天高热指数时手臂和腿部的皮疹严重程度更高。
出生体重影响皮肤对油按摩的反应。最小的婴儿皮肤刺激最小，表明炎症反应能力减弱。在资源匮乏地区，高热指数可能对早产儿有保护作用。
