The Infant Skin Microbiome: Supporting a Hidden Layer of Protection in Neonatal Care
By: D. Joshua Parris, PhD, Sr. Scientist-Microbiome & Bioinformatics
GR&D, Kimberly-Clark Corporation
In the first moments during and after birth, a newborn’s skin becomes home to a rapidly diversifying microbial ecosystem that will influence aspects of baby’s health including infection risk, skin barrier function, and immunity. While many of the factors controlling assembly of these microbes are out of our control, care practices have a significant impact on establishment and maintenance of a beneficial microbiome. This is especially true during the neonatal period and for diapered infant skin. Every choice from antibiotic exposure to products used in hospital diapering protocols has consequences for infant skin health. Neonatal nurses are uniquely positioned to influence care decisions in a way that will have positive and lasting effects on the infant microbiome.
What is the skin microbiome and where does it come from?
The infant skin microbiome is the assemblage of microorganisms residing on the outermost surface of infant skin (Figure 1). This microbial community begins forming at birth and is shaped by a combination of maternal, environmental, and caregiver-derived microbes.1-3 During vaginal delivery, newborns are colonized by microbes from mom’s vaginal microbiota, whereas infants born by cesarean section are first colonized by hospital- and skin-associated microbes.3,4 In the days after birth, skin-to-skin contact with parents and breastfeeding supply baby’s skin with microbes.1,2,4 For babies who spend their first days in the NICU, hospital-associated bacteria (including Staphylococcus, Enterococcus, and Acinetobacter) are often more abundant on skin through transfer from medical equipment and the hands of healthcare workers. Environmental exposure is magnified in most NICU babies due to limited contact with maternal microbes, higher antibiotic usage, and delayed skin-to-skin contact. As a result, the skin microbiome of NICU infants tends to more closely resemble microbes found in the clinical environment, which has been linked to greater risk for infection and other negative health outcomes.2,4,6
Figure 1. Cross-section of human skin showing the microbiome and acid mantle.
Why should you care about baby’s skin microbiome?
The microbiome functions as an additional, invisible layer of skin (Figure 1) performing services essential to skin health and immune development.2,3,5 Foremost, the microbiome plays an active role in maintaining the skin barrier, and once a healthy microbiome is established, this network of microbes acts as a shield deterring pathogens and irritants and helping lock away skin moisture.1–3,5 Beneficial microbes help generate and maintain the slightly acidic skin surface pH, support lipid processing, and contribute compounds that nourish the stratum corneum and promote barrier integrity.1–3,5 The infant skin microbiome is also intimately linked to the developing immune system: microbial exposure trains immune cells to distinguish between harmless and harmful organisms, promotes immune tolerance, and early disruption of the microbiome is associated with long-term risk of inflammatory skin conditions such as eczema and allergies.2,5,6
The role of nurses in supporting the infant skin microbiome
Neonatal nurses play a central role in supporting the assembly of a strong and healthy infant skin microbiome through care practices that promote beneficial microbial exposure while minimizing disruption. Encouraging early and frequent skin-to-skin contact between the infant and parents is essential for transferring protective parental microbes. Supporting and facilitating breastfeeding is also important, as breast milk provides beneficial microbes and nutrients that shape microbial communities in the gut and on skin. Nurses can also help by encouraging delayed first baths, avoiding unnecessary bathing, and choosing gentle cleansers when needed. Careful use of antibiotics and antiseptics, only when medically necessary, can minimize disruption of beneficial microbes. Finally, when caring for diapered skin, it is important to use gentle and effective products designed to support a healthy skin barrier, limit irritant exposure, and help preserve a healthy skin pH.
Caring for the diapered skin microbiome
Dermatitis in the diapered area is one of the most common skin concerns for newborns, affecting an estimated 20–35% of NICU infants during their hospital stay.7,8 Although we don’t know the exact role of the microbiome in the onset of irritation in diapered skin, research shows clear shifts in the diapered skin microbiome—especially increases in pathogenic Staphylococcus aureus—during rash episodes and in rash-prone babies.9 Diapering and frequent wiping, while necessary, can create a constant challenge for baby’s developing microbiome.
Choosing gentle and effective diapers and wipes, designed to meet the unique needs of infant skin is essential for supporting baby’s developing skin microbiome.¹⁰⁻¹³ It is important that diapers are designed to minimize skin contact with urine and feces and to help keep skin comfortably dry. Diapered skin is routinely exposed to excess moisture and higher-pH waste that deposits large numbers of gut and urinary bacteria onto the skin surface, making an ideal environment for microbes to thrive. Diapers that can help create a favorable environment for infant skin, like Huggies® Little Snugglers®, are carefully engineered with super-absorbent materials and a breathable design to quickly draw fluid away from the skin, lock it into the core, and still allow air to circulate, helping to reduce excess moisture on skin. At the same time, diaper-changing routines—including changing promptly after soiling and cleansing gently and thoroughly—help limit the time skin spends in contact with irritants present in urine and feces. Together with diaper design, these practices help keep skin clean, dry, and comfortable while supporting a healthy skin microbiome.
Wipe product choice is also particularly important because diapered skin is cleaned so frequently. Wipe formulations should follow three key design principles. First, wipes should be exceptionally gentle, minimizing friction against baby’s skin while effectively removing soils.10-12 Second, they should remain biologically pure over their use period; mild, well-tolerated preservatives are essential to prevent growth of environmental bacteria in the package.10-13 Finally, wipes should help support the skin barrier by incorporating pH buffers that support the natural, slightly acidic pH of healthy skin.14 Huggies® wipes are designed with these design principles in mind (Figure 2) combining a thoughtfully engineered basesheet with skin gentle emollients and mild surfactants so they glide smoothly over skin while effectively removing mess. In clinical testing on compromised skin, Huggies® Natural Care® Extra Sensitive wipes significantly outperformed cloth and water by minimizing irritation and maintaining transepidermal water loss at levels similar to unwiped control skin following wiping, demonstrating a gentler impact on the skin barrier. Huggies® wipes are also formulated with pH buffers to help support the natural healthy pH of baby skin after every change.
Figure 2. Attributes of properly formulated wipes for infant skin.
Summary
The microbiome plays a critical role in maintaining healthy skin by directly contributing to skin barrier function, deterring pathogens, producing compounds that nourish skin, and training the developing immune system. During the neonatal phase, and while the microbiome is still being established, care practices can have a profound and lasting impact on the microbiome. Nurses are uniquely positioned to influence caregivers and establish skin care practices early on that can make a lifelong difference in baby’s overall skin health.
References
- Capone KA, Dowd SE, Stamatas GN, Nikolovski J. Diversity of the human skin microbiome early in life. J Invest Dermatol. 2011;131(10):2026-2032.
- Jain A, Meshram RJ, Lohiya S, Patel A, Kaplish D. Exploring the microbial landscape of neonatal skin flora: a comprehensive review. Cureus. 2024;16(1):e52972.
- Byrd AL, Belkaid Y, Segre JA. The human skin microbiome. Nat Rev Microbiol. 2018;16(3):143-155.
- Dominguez-Bello MG, Costello EK, Contreras M, et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci U S A. 2010;107(26):11971-11975.
- Kong HH, Segre JA. Skin microbiome: looking back to move forward. J Invest Dermatol. 2012;132(3 Pt 2):933-939.
- Zhang C, Li L, Jin B, et al. The effects of delivery mode on the gut microbiota and health: state of art. Front Microbiol. 2021;12:724449.
- Esser, M. S., Ngui, E. M., & Johnson, T. S. Contributing factors to diaper dermatitis and NICU length of stay. Journal of Neonatal Nursing, 2021. 27(5), 358-364.
- Stoltman SS, Brodbeck A, Patel JD, Moore TA. Human Milk as Diaper Dermatitis Prevention in the NICU: A Quasi-Experimental Study. Advances in Neonatal Care. 2025 Oct 1;25(5):518-24.
- Hertiš Petek T, Petek M, Petek T, Marčun Varda N. Emerging links between microbiome composition and skin immunology in diaper dermatitis: a narrative review. Children. 2022 Jan 15;9(1):112.
- Vongsa R, Rodriguez K, Koenig D, Cunningham C. Benefits of using an appropriately formulated wipe to clean diapered skin of preterm infants. Glob Pediatr Health. 2019;6:2333794X19829186.
- Rodriguez KJ, Cunningham C, Foxenberg R, Hoffman D, Vongsa R. The science behind wet wipes for infant skin: ingredient review, safety, and efficacy. Pediatr Dermatol. 2020;37(3):447-454.
- Petrović T, Poljarević J, Nikolić S, Stojković-Filipović J, Mihajlović-Lalić LE. A review of the key ingredients in industrial formulations of baby wet wipes. Int J Dermatol. 2024;63(12):1668-1675.
- Gregorio J, Rodriguez KJ. Diaper dermatitis in infant skin: causes and mitigation. Neonatal Intensive Care. 2017;30:38-40.
- Vongsa R, Ngai D, Rodriguez K, Kerl C, Basehoar A, Stabe L, Mundschau S. Enhanced Recovery of the Barrier of Compromised Skin with pH-Buffered Emollient Baby Wipes. Sage Open Pediatrics. 2026 Mar;13:30502225261428881.
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