Influence of antenatal steroids and sex on maturation of the epidermal barrier in the preterm infant
- aAcademic Division of Child Health, Nottingham City Hospital, University of Nottingham, Hucknall Road, Nottingham NG5 1PB, UK, bDepartment of Child Health, University of Wales College of Medicine, Cardiff CF14 4XW, UK
- Professor Rutter, Academic Division of Child Health, School of Human Development, Queen's Medical Centre, Nottingham NG7 2UH, UK email:
- Accepted 4 May 2000
BACKGROUND The epidermal barrier is well developed in term infants but defective in the immature infant with important clinical consequences. The development of the barrier shares similarities with production of pulmonary surfactant. Studies in the rat have shown that barrier maturation is accelerated by antenatal steroids, both structurally and functionally. Females have a more mature barrier than males at the same gestational age. These factors have not been studied in the human.
AIM To examine the influence of antenatal steroids and sex on maturation of the epidermal barrier in the preterm infant.
SUBJECTS A total of 137 infants born before 34 weeks gestation, 80 boys and 57 girls, were studied: 87 had been exposed to antenatal steroids, and 50 had not; 99 were studied prospectively, and 38 had been studied previously.
METHOD Barrier function was measured as transepidermal water loss from abdominal skin by evaporimetry. Measurements were made within the first 48 hours and corrected to a standard relative humidity of 50% (TEWL50).
RESULTS The relation between TEWL50 and gestation was exponential with very high levels in the most immature infants. No influence of antenatal steroids or sex could be shown. When infants who were optimally exposed to antenatal steroids were considered alone, no effect could be shown.
CONCLUSION Epidermal maturation in the preterm infant does not appear to be influenced by antenatal steroids or sex, suggesting that the mechanism of maturation differs from that of the rat.
Epidermal maturation is strongly dependent on gestation. High transepidermal water loss (TEWL) is the major consequence of an immature barrier
Antenatal steroids and sex have a strong maturational effect on the epidermis in the experimental animal
In the human preterm infant, no maturational effect of antenatal steroids or sex can be shown
Alternative strategies are needed to manage the high TEWL of the most immature infants