Neonatal Skin: Structure and Function PDF

Preface to the Second Edition

Over two decades have passed since publication of the first edition of Neonatal Skin: Structure and Function. During this time, sweeping changes have occurred in all aspects of healthcare, from the molecular diagnosis of disease to the advent of the Internet. In this climate of explosive change, the second edition of Neonatal Skin seeks to illuminate a topic both scientifically complex and aesthetically compelling-the skin of the newborn human infant. It is our belief that this topic deserves careful study and quantitative attention. It is toward this goal that this book was written.

The picture that emerges from the study of newborn skin is unexpectedly complex. The migration of melanocytes into the epidermis, the participation of the pilosebaceous apparatus in the development of the epidermal permeability barrier, and the production of a complex proteolipid skin ‘‘cream,'' the vernix caseosa, all occur in utero. These fetal developments presage the abrupt transition to extrauterine life marked by birth. In mammals, few events are as transformative as the moment of birth. Certainly, no organ is more suddenly exposed to the exigencies and extremes of the external environment than the skin. Postnatally, the skin surface becomes rapidly colonized with selected microorganisms. It undergoes a complex process of surface acidification and interacts with a variety of environmental agents, including cleansers, drugs, and adhesives. Temperature control becomes a new and vital function requiring not only a barrier to transepidermal water loss but also an active system of eccrine sweating and vasomotor control. Not least in the rich panoply of functions subserved by the skin of the newborn is its ability to evoke emotional attachment and physical connectivity in adults. Aesthetically, newborn skin serves to beckon caregivers, thereby providing an apparent teleological reason for its being.

This edition of Neonatal Skin seeks to summarize and interweave these multiple functions and their cutaneous support structures into a coherent scientific pattern. Our guiding belief is that the study and story of newborn skin are only now beginning to be articulated. The true functions of skin are at the highest level of biological organization (1). It is common knowledge, for example, that the evolutionary features which most clearly distinguish humans from other primates are, first and foremost, a large and versatile central nervous system and, second, a vulnerable and relatively hairless skin surface (2). The brain and the epidermis share a common ectodermal origin, and the skin and the brain are inextricably linked in everyday life at the level of perception. We anticipate growing interest in these complex areas of skin structure and function. As Aristotle is purported to have said, ‘‘He who sees things from their beginnings will have the clearest view of them.'' It is in this spirit that the authors have collaborated to produce this second edition.