The skin has multiple functions crucial for well being and survival, includ
ing control of transcutaneous water fluxes, thermo-regulation, prevention o
f infections, exclusion of toxins, tactile sensations, and protection from
ultraviolet radiation. As gestational age of surviving neonates decreases a
nd developmental maturation of their epidermal barrier function is increasi
ngly compromised, the potential importance of the skin as a barrier is magn
ified. Despite the importance of maintaining and promoting skin integrity a
nd barrier function, few guidelines regarding optimal care of neonatal skin
have been published. The authors review fundamental care and hygiene of ne
onatal skin, encompassing bathing and emolliation practices, prevention and
management of skin injury, and reduction of transcutaneous loss of water a
nd heat or percutaneous absorption of toxins. Particular reference is given
to the very low-birth weight and the hospitalized neonate who require inte
nsive care. Further optimization of these practices and the development of
new approaches in skin care is one of the greatest challenges in pediatric
dermatology and holds promise for improving neonatal outcome in the future.