The neonatal microbiome

Studies presented at dermatology meetings this year reveal important clues about the microbiome’s development in newborns, as well as how certain topicals might improve the microbiome of adults with atopic dermatitis.

Researchers report that cesarean section newborns have a slightly delayed microbiome response. The richness - meaning how many different kinds of microorganisms are present in their skin microbes - appears to be less than that of vaginally delivered infants by three to seven days, according to the study’s lead author Kimberly Capone, Ph.D., research fellow, Johnson & Johnson Consumer Inc. Dr. Capone presented the findings in March at the American Academy of Dermatology (AAD) annual meeting.

Dr. Capone“When we measured [the infants] again, when they came back at days 11 to 18, that difference had gone away,” she said.

Dr. Capone says that, as far as she knows, this is the first description of how the microbiome evolves through the first 30 days of life. In 2011, she published a study in the Journal of Investigative Dermatology demonstrating that after one month, the skin microbiota has evolved from birth, where it is dominated by vaginal and, or environmentally-acquired microbes.

The new study’s main intent was to determine how well infants’ skin tolerated a Johnson & Johnson treatment regimen of baby wash, baby shampoo and baby lotion. Dr. Capone and colleagues studied 29 babies in the treatment group which received over-the-counter Johnson & Johnson products developed for neonatal skin. A control group of 15 was instructed to use any products parents chose. 

While the study didn’t have the statistical power to conclude the Johnson & Johnson product routine drove neonatal skin diversity, the researchers found that the routine was well tolerated on neonatal skin and associated with significant microbial diversity increases within the first month of life. The study suggests that use of the right kinds of products and practices for infants’ skin helps to facilitate the natural evolution of the microbiome that is already occurring early in life, Dr. Capone said.

The delay period the researchers observed in cesarean section infants is an area that begs more research, as does the rapid evolution of the skin’s microbiome in the first month of life, she said.

While researchers have known that babies born by cesarean section tend to have a different skin microbiome than babies born vaginally, this research offers insight about how long it takes before cesarian section babies appear to catch up to vaginally-delivered newborns, said Paul Horowitz, M.D., a pediatrician with Discovery Pediatrics, Valencia, Calif. 

Dr. Horowitz says the long-term impact of understanding how the microbiome develops could be far-reaching and powerful.

“This is a foundational understanding that really needs to be fleshed out because the better we understand how infant skin changes, the more likely we are to be able to influence it in a positive way. And who knows what that might do for the lifelong risk of atopic dermatitis, or acne, overall skin health or immune sensitization?” he said.

For now, this and other research helps confirm the traditional approach physicians recommend to parents:  Use products on neonatal skin that are designed for neonatal skin in terms of pH and the effects on skin structure and function, Dr. Capone says. 

“My advice is that they put a product on that is made for babies and has been tested for being safe and effective in babies. Preferably, one that is properly preserved, so you know it is safe and not contaminated. And, ideally, something that is not going to make the baby tear up when it gets in the eyes and something that may enhance the barrier function of the skin. I try not to be too heavy-handed when recommending brand names, but there are only certain off-the-shelf products that meet those criteria,” Dr. Horowitz said.

Disclosures: The studies featured in this article were funded by Johnson & Johnson. Dr. Horowitz has received research funding from Johnson & Johnson. Dr. Capone is a Johnson & Johnson employee. 

References:

Kimberly Capone, Ph.D., Research Fellow at Johnson & Johnson Consumer Inc. “Longitudinal Development of the Skin Microbiome During the Neonatal Period,” March 4, 2017, American Academy of Dermatology (AAD) annual meeting, abstract #5324.