Dear Lacnetters,

The discussion on vernix interested me, so I did a quick PubMed search to learn more about it.
Below is a review article which describes the importance of not using soap or removing the vernix 
of the newborn. It also points to increased risk of nosocomial infections in infants where the 
epidermal barrier is compromised.

I would recommend a PubMed search for anyone who is interested. There are several primary 
journal article which examine the innate immune functions of the vernix.

Curr Opin Pediatr. 2005 Aug;17(4):480.
Cutaneous bacterial infections in the newborn.
Larson AA, Dinulos JG.

PURPOSE OF REVIEW: This review examines neonatal bacterial skin infections with respect to host 
immunity, bacterial pathogens, patterns of infection, and new therapeutic approaches. RECENT 
FINDINGS: Advances have been made in our understanding of innate host defense and the 
emerging role of cutaneous antimicrobial peptides of the cathelicidin and defensin families. Toll-
like receptors are being investigated with respect to their interactions with bacteria and other 
components of the innate immune defense, such as the antimicrobial peptides. The epidermal 
barrier remains an active area of research. Studies confirm that maintaining an intact epidermal 
barrier by minimizing exposure to soap and by not removing vernix caseosa are simple measures 
to improve skin barrier function. Active barrier-enhancing measures such as the application of 
topical emollients have shown mixed results in the prevention of nosocomial infection. A meta-
analysis of studies performed in developed countries showed a trend of increasing risk for 
coagulase-negative staphylococcal infection. By contrast, a randomized controlled trial showed 
that infants treated with sunflower oil are less likely to experience nosocomial infections than are 
control infants. Infants with bacteremia and no known source of infection should be carefully 
examined because cutaneous abscesses have been shown to be an important nidus of infection. 
Methicillin-resistant Staphylococcus aureus is reaching epidemic proportions, making surface 
cultures an essential part of the evaluation of cutaneous bacterial infection. SUMMARY: New 
insights have been gained regarding the basic science of neonatal host defense and these 
advances may produce new ways of approaching the prevention and treatment of bacterial skin 
infections in the newborn period.

Warmly,
Laurie Shornick, PhD
St. Louis, MO

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