Vernix Caseosa

Highlights from the Hot Topics in Neonatology Conference in Washington , D.C.
December 12-14 , 2004

Vernix Caseosa

A NOVEL ROLE FOR VERNIX CASEOSA AS A SKIN CLEANSER.
S.B. Hoath, Cincinnati Medical Center. Article from Biology of the Neonate, 741 DOI: 10.1159/

Skin cleansing is a complex process involving endogenous and exogenous mechanism. The role of vernix caseosa in the process of skin cleansing in the perinatal period was studied. Image analysis showed that exogenous application of vernix exhibited a cleansing capability comparable or superior to standard skin cleansers. Vernix caseosa is a fetally derived biofilm unique to humans. Vernix is a uniquely human skin product first seen towards the end of the second trimester. It consists of fetal corneocytes embedded in a proteolipid matrix. Routine clinical care often treats vernix as an unwanted “soil” and dictates its removal at birth.

Recent studies reveal that vernix has ante-infective, water modularity, and antioxidant properties that are potentially involved in the neonatal transition to an extrauterine environment. Hypothetically, it also functions in newborn skin cleansing. This desquamation is a major endogenous mechanism for skin self cleaning, and vernix detachment before and after birth can be considered the physiological precursor of this life long process. Vernix, typically regarded as a soil, paradoxically functions as a cleanser when exogenously applied to human skin. Due to properties mentioned above arguably vernix should be left intact when present on newborn skin.

A current recommendation by the WHO is to leave residual vernix intact after initial drying in the delivery room. They also recommend delaying the first bath for at least 6 hours, but to remove soils such as blood and meconium; but leave vernix intact.

Fetal skin is continually exposed to circulating amniotic fluid, mimicking ex utero bathing. In vitro evidence supports a role for pulmonary surfactant to mediate vernix detachment (although multifactorial ). In the last trimester, vernix accumulates on the skin surface and detaches concomitantly with increasing amounts of pulmonary surfactant in the amniotic fluid.

Conclusion: Results demonstrate a possible role for vernix caseosa as a skin cleanser. Previous views of vernix as a soil or skin contaminant at birth need to be re-evaluated. Clinically, a synthetic vernix equivalent may be therapeutic in ELBW infants.

Comments: Should the AAP make standard recommendations about vernix removal? Or should they leave it to each individual center? EV.

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