DISRUPTION OF BARRIER FUNCTION IN NEONATAL SKIN ASSOCIATED WITH ADHESIVE REMOVAL

Objective: Patients in the neonatal intensive care unit require life s upport and monitoring equipment that must be securely attached to the skin; removal or replacement often causes skin trauma. In this study, we compared the effects of application and removal of three different adhesives on the skin barrier function of premature neonates. The effe cts were measured by transepidermal water loss (TEWL), colorimetric me asurements, and visual inspection. Design: Thirty neonates, between 26 and 40 weeks of gestational age and with birth weights ranging from 6 90 to 3000 gm, were enrolled in the study during the first week of lif e. Pieces of plastic tape (I cm(2)), pectin barrier, and hydrophilic g el were applied to previously undisturbed sites on the back. A fourth site was used as a control. We measured TEWL, colorimetric readings, a nd visual inspection scores of skin irritation and stripping at each o f the four sites serially: before adhesive application, 30 minutes aft er adhesive removal, and 24 hours later. Results: Thirty minutes after adhesive removal, TEWL, colorimetric measurements, and visual inspect ion scores were all significantly higher at the sites of plastic tape and pectin barrier removal than at the control and gel adhesive sites (p < 0.01), demonstrating greater disruption of skin barrier function with removal of the plastic tape and pectin barrier. When the neonates were divided into three groups on the basis of birth weight (<1000 gm [n = 10], 1000 to 1500 gm [n = 11], and >1500 gm [n = 9]), the same p attern of greater disruption in skin barrier function, as measured by TEWL, was observed in each birth weight group. Twenty-four hours after adhesive removal, TEWL of the plastic tape and pectin barrier sites w ere not significantly different from the control site, indicating reco very of skin barrier function. Conclusions: This study demonstrates th at a single application and removal of two commonly used adhesives, pl astic tape and pectin barrier disrupts skin barrier function in neonat es of varying gestational ages.