I. INTRODUCTION. The skin performs a vital role in the newborn period. It provides a protective barrier that assists in the prevention of infection, facilitates thermoregulation, and helps control insensible water loss and electrolyte balance. Other functions include tactile sensation and protection against toxins. The neonatal intensive care unit (NICU) environment presents numerous challenges to maintaining skin integrity. Routine care practices including bathing, application of monitoring devices, intravenous (IV) catheter insertion and removal, tape application, and exposure to potentially toxic substances disrupt normal barrier function and predispose both premature and term newborns to skin injury. This chapter will describe developmental newborn aspects of skin integrity, skin care practices in the immediate newborn period, and common skin disorders.

II. ANATOMY. The two layers of the skin are the epidermis and dermis. The epidermis is the outermost layer providing the first line of protection against injury. It performs a critical barrier function, retaining heat and fluid and providing protection from infection and environmental toxins. Its structural development has generally occurred by 24 weeks’ gestation, but epidermal barrier function is not complete until after birth. Maturation typically takes 2 to 4 weeks following exposure to the extrauterine environment. The epidermis is composed primarily of keratinocytes, which mature to form the stratum corneum. The dermis is composed of collagen and elastin fibers that provide elasticity and connect the dermis to the epidermis. Blood vessels, nerves, sweat glands, and hair follicles are another integral part of the dermis. The subcutaneous layer, composed of fatty connective tissue, provides insulation, protection, and calorie storage.