Abstract
Background
We aimed to evaluate the trajectory of skin barrier properties in full-term newborns during the first four days after birth.
Methods
Based on the MKNFOAD cohort (NCT02889081), transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin pH, and sebum content at five anatomical sites (cheek, forehead, volar forearm, abdomen, and dorsal lower leg) were examined once within 96 h after birth in 384 full-term infants. Multivariable linear regression analysis was performed to assess variations in these skin barrier parameters with age adjusted for gestational age, neonate’s sex, parents’ allergy history, delivery mode, amniotic fluid characteristics, and birth weight. The regression coefficient (ß) and 95% confidence interval were reported.
Results
We analyzed a total of 384 neonates including 198 (51.6%) boys. TEWL values remained stable and showed no significant association with age (days). pH values exhibited a declining trend with age (p for trend <0.001). Both SCH values and sebum content grew with age (p for trend <0.001).
Conclusion
During the first four days after birth, the skin TEWL remained stable, pH decreased, and the SCH and sebum content increased over time. These findings provide insights into the neonatal skin physiological development at the beginning of life.
Impact
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From birth to 96 h, TEWL was stable, pH showed a steep decline, SCH and sebum content increased.
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This study provides the first evidence of skin adaptation in the newborn due to changes in utero to after birth in the first 4 days of life in an Asian population.
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These findings will provide a new theoretical basis for neonatal skin physiology and clinical strategies for guiding newborn skin care.
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Data availability
The data that support the findings of this study are available from the corresponding author on reasonable request.
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Acknowledgements
We thank all mothers and their infants for participation in the MKNFOAD study, and all of the staff involved in the study at the recruiting hospital for their cooperation.
Funding
National Natural Science Foundation of China (82304017); Children’s Atopic Dermatitis Research Program of Beijing Health Alliance Charitable Foundation (KH000678-04) and Canada‐China Clinical Research Program (201607).
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Contributions
Project management and study design: Weitao Tang, Liuhui Wang and Ying Ye (principal investigator). Data collection: Weitao Tang. Skin barrier examination: Yalan Dou. Data input and statistical analysis: Weitao Tang, Yuanzhou Peng and Yi Zhan. Manuscript drafting: Weitao Tang and YingYe. Ming Li, Liuhui Wang and Xiaohua Zhang conceived the study. Weili Yan supervised the statistical analyses. Ying Ye made the final approval of the manuscript. All authors contributed to data interpretation and reviewing the manuscript.
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The authors declare no competing interests.
Ethics approval
The study population was from the MKNFOAD birth cohort in Shanghai. The MKNFOAD protocol was approved by the institutional ethics review board (approval number: 2016-34) and was registered at www.cliinicaltrials.org (NCT 02889081). Signed informed consent was obtained from the legal guardians of participants before data collection began.
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Tang, W., Peng, Y., Dou, Y. et al. Changes in skin barrier over the first four days of life: a cross-sectional study. Pediatr Res 97, 1072–1078 (2025). https://doi.org/10.1038/s41390-024-03530-8
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DOI: https://doi.org/10.1038/s41390-024-03530-8
