Q. “Can True Moisture® cream be used as a moisturizer for premature infants in the intensive care unit?”

ANSWER

This is a good question. As a pediatric resident, I worked in neonatology. Because of its gentle ingredient profile and physiologic lipid cream base, True Moisture® Clinical Lipid Therapy® Cream A and Cream B, plus, True Moisture® Clinical Lipid Therapy® Gentle Facial Lotion are ideal for use on premature infants greater than 4 weeks old in the neonatal intensive care unit, and in all full term newborns. In the next few paragraphs we will review a bit of background info on the subject of neonatal skin. Please see articles by Rutter, Cartlidge, and others in the reference section on the subject of neonatal skin.

The skin is an indispensable organ, often neglected and taken for granted. Though it serves several purposes, its most important task is its skin barrier function. The skin barrier protects the body against invading organisms, protects against poisoning from toxic exposures, and protects against total body water loss. In the mother’s womb, the early fetus is covered with a permeable membrane called “periderm” and has no need for a skin barrier in this special protected environment. It’s almost as if the skin barrier is asleep inside the womb and is waiting for the time when the alarm clock goes off. That special skin barrier alarm clock is set to go off at the moment a child is born.

The stratum corneum does not begin to develop until about the 24th week of gestation. After this, the skin continues to thicken, though it is not until about 34 weeks gestation that a well organized stratum corneum has completely formed. Thus, when we are discussing premature infants, we are talking about a very inadequate skin barrier that is not well formed.
Premature infants have both immature lungs and an inadequate skin barrier. Low levels of lipid surfactants cause the immature lung sacs to collapse. Thus, premature babies have difficulty exchanging oxygen in their lungs. Lung maturity is monitored by the L/S ratio which stands for lecithin / sphingomyelin ratio. When the ratio is less than 2, the premature infant is at greater risk for respiratory distress syndrome. Lecithin is a physiologic lipid. Neonatalogists may prescribe physiologic lipid therapy to enhance alveolar lung function in premature infants. Thus, physiologic lipid therapy is not a new concept in the world of neonatology, as immature lungs need physiologic lipids.

Can physiologic lipid therapy benefit premature skin? Can we reduce neonatal skin infections? Logically speaking, it makes perfect sense. Just add basic physiologic lipids such as Questamide H and phytosterol. This is the subject of True Moisture’s proposed Clinical Lipid Therapy® Cream Neonatal Skin Research Study. In it, we plan to test the efficacy of Clinical Lipid Therapy® in premature skin barrier function.

In fact, regardless of the age of prematurity, whether the infant is 26 weeks or 30 weeks, by 2 to 3 weeks of age, the infant’s skin is microscopically
similar to that of a full term infant. It appears that fetal skin development is amazingly quickened by preterm birth. Exposure to air and ransepidermal loss The ABC's of Dry and Sensitive Skin of water are the driving forces behind this rapid skin maturation. Thus, the skin barrier is intact by the
time the premature infant is 2 or 3 weeks old.

Life threatening neonatal infections often begin in premature skin. As skin barrier function in preterm
infants is not adequate, microbes may easily enter and contribute to infant mortality. Studies show that simple petrolatum / mineral oil based moisturization can prevent secondary infections in premature infants. However, there is no agreement on standard of care on how to safely moisturize a premature infant. One issue is to avoid any harmful ingredients that could pass through the immature skin barrier.

It appears that infants, even premature infants, come fully equipped with adequate cholesterol, ceramides, and free fatty acids. It’s just a matter of birth and exposure to the outside air that “wakes up” the sleeping skin barrier. In early premature infants, this “awakening” of skin barrier function can take up to 3 weeks.

Until our research is finished, here is my suggestion for premature neonates for the first four weeks of life: Take 30 ml pure petrolatum, mix with 30 ml (equal parts) pure mineral oil, add enough sterile saline to give a creamy consistency (try 10cc), and mix very well. Do not add lanolin as it may sensitize skin. Use this mixture to moisturize the infant for the first 4 weeks of life. This mineral oil-petrolatum mixture should be adequate for the first four weeks of life. After four weeks of life, the baby’s skin barrier is awake and functional, but is now a target for lipid depletion and bilayer damage. At this point, I suggest True Moisture® Clinical Lipid Therapy® Cream A in the morning and Cream B in the evening or as needed for moisturization of the baby’s body skin, and True Moisture® Clinical Lipid Therapy® Gentle Facial Lotion for moisturization of the baby’s face.