izers. For this purpose, selected information from the literature searches, coupled with expert opinion and experience of the panel, was used to adopt statements. The consensus process consisted of a modified Delphi technique.6
The panel voted on the inclusion of statements after group discussion; consensus required a minimum of 83.3% (five of the six physicians who voted) agreement.
During the meeting, the consensus statements were assessed systematically and refined further following established standards. 6
Statements Defined by the Panel
Starting from a list of twenty-four draft messages, advisors developed and voted affirmatively on eight statements (statement 1: 6 [100%], statement 2: 5 [83.3%], statement 3: 6 [100%], statement 4 up to statement 7: 5 [83.3%], and statement 8: 6 [100%]) (Table 4).
Statement 1: At birth, the skin is structurally and functionally immature, with elevated skin surface pH and lower resistance to chemicals and pathogens.
Functional and structural skin maturation of the neonatal skin is a dynamic process, which starts at the moment of birth and continues over the first years of life.1-4,7-10
At thirty-four weeks gestation, the epidermis is well developed. By thirty-seven weeks, the fetal maturity of the stratum corneum is complete, which further matures extrauterine during the first years of life.1,4,5,7-10 In utero, there is a naturally occurring substance on the skin, the vernix caseosa, which progressively covers the fetal skin surface during the last trimester. Its production coincides in utero with terminal differentiation of the epidermis and formation of the stratum corneum (SC).7-11 In utero, the SC consists of a hydrophobic lipid matrix with embedded fetal corneocytes and possesses unique biomechanics and water-binding properties.5 The role of the vernix caseosa is “waterproofing” the fetus during the critical period of epidermal barrier development before birth.11,12 When transitioning to extrauterine life, the skin barrier with its extra-cellular lipid
