Transepidermal Water Loss in Neonates: Baseline Values Using a Closed-Chamber System

Background: Transepidermal water loss (TEWL) is the normal, constitutive loss of water vapor from the skin in the absence of sweat gland activity. It is regarded as one of the most important parameters for characterizing skin barrier function, and the values are dependent on multiple variables. The objective of this study was to evaluate TEWL in neonates using a closed-chamber system, and determine if there is a variation of TEWL with the mode of delivery, pre-term birth, low birthweight or phototherapy. Methods: This prospective study was conducted in 104 healthy neonates, 30 neonates in the Neonatal Intensive Care Unit (NICU) and 40 adults using a noninvasive, closed-chamber system (VapoMeter (TM)). Results: A statistically significant difference in TEWL was noted between newborns and adults. No remarkable difference in TEWL was seen between boys or men and girls or women or those born via normal vaginal birth and caesarean section, but TEWL was significantly higher in preterm and low birthweight neonates. Significantly higher TEWL was noted from the antecubital fossa of the neonates who received phototherapy when compared with six other sites. Conclusions: The closed-chamber system is an acceptable alternative to the more widely used open-chamber system. The higher mean TEWL in neonates suggests that the epidermal barrier is still adapting to extrauterine life, making newborn skin more sensitive and requiring appropriate, age adapted care.