Vernix caseosa

 Vernix caseosa, also known as vernix, is the waxy white substance found coating the skin of newborn human babies.[1] It is produced by dedicated cells and is thought to have some protective roles during fetal development and for a few hours after birth.

Baby held in a gloved hand, with creamy substance smeared all over
Newborn baby immediately after birth, covered in vernix

EtymologyEdit

In Latin, vernix means varnish and caseosa means cheesy. The term was first published in 1846 in the Dunglison Dictionary of Medical Sciences.[1]

In-utero developmentEdit

Vernix is produced during a distinct phase of the epidermal development.[2] Around the 21st week of gestation, periderm cells are being shed and replaced with strateum corneum; these shedding mix with secretions of sebum by the sebaceous glands to form vernix, which gradually covers the body in an anteroposterior and dorsoventral pattern.[1][2][3] Vernix, in itself, is also believed to aid in the formation of strateum corneum.[4] By early third trimester, the process is complete.[5]

Soon enough, part of the vernix is emulsified by increasing concentrations of pulmonary surfactants and desiccates, only to be consumed by the fetus; a corresponding increase in amniotic fluid turbidity is noticed.[2]

CharacteristicsEdit

CompositionEdit

Vernix has a highly variable makeup but is primarily composed of sebum, cells that have sloughed off the fetus's skin and shed lanugo hair.[6] Chemically, it is water (80%), lipids (10%) and proteins (10%).[1] The lipids include ceramides, cholesterol, fatty acids, triglycerides, waxes and sterol esters, squalene, and phospholipids;[1] multiple detailed analyses of the polar components have been done.[7] The protein composition is relatively understudied.[1] Vernix of term infants has more squalene and a higher wax ester to sterol ester ratio than preterm infants.[6]

MorphologyEdit

Vernix is composed of mobile corneocytes embedded in an amorphous lipid matrix.[1] Precise biological mechanisms leading to its formation are hazily known.[8]

The cells are polygonal or ovoid in shape, malleable, and lack nuclei; typical thickness is 1-2 µm.[1] Nuclear ghosts are frequently observed and Acid Phosphatase Activity is nonuniform.[1] Keratin filaments build a scaffold like structure which form a water-storage area.[1] As opposed to stratum corneum, the vernix corneocytes lack desmosomal attachment and the lipid layer is more disordered.[9]

Physical propertiesEdit

Vernix is a white viscous cream-like substance in appearance.[1]

The water is not uniformly distributed throughout, but rather exclusively present in the sponge-like corneocytes; despite its high water content, vernix is non-polar (due to lipids) and more vapor-permeable than strateum corneum.[1][10][11]

FunctionsEdit

Vernix appears in all full term infants but with widely varying body-coverage, while premature and post-mature births generally do not display any.[6][2][12]

It is theorized (and observed) to serve several purposes:[1][2][10]

  • Electrical isolation of the fetus (this affects accurate fECG measurement of fetal heartbeat).[13]
  • Waterproofing the skin, whilst in gestation.
  • Lubricating the infant's skin, and facilitating easy passage through the birth canal.
  • Preventing infections — primarily as a mechanical barrier and secondarily via the presence of lysozyme, lactoferrin and antimicrobial components in peptide layer.
  • Moisturizing the stratum corneum whilst in gestation (and controlled drying in post-partum phase).
  • Thermoregulation in post-partum phase — evidence is mixed.
  • Quick healing of epidermal wounds.
  • Development of gut, after intra-uterine consumption.

Medical usesEdit

Vernix is used as a reliable site-of-record for measuring cocaine exposure in pregnant women.[2] Using vernix for diagnosing uterine rupture and amniotic fluid embolism has been proposed.[2]

DisordersEdit

Granuloma and peritonitis of vernix have been observed in Caesarean sections.[2] High volumes of vernix cause Neonatal Aspiration Syndrome.[2]

Other speciesEdit

Vernix is thought to be unique to human fetal development; in 2018, vernix-like material was reportedly obtained from pups of Zalophus californianus.[14]

Additional imagesEdit

  • Vernix on a newborn's legs and feet.

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  • Traces of vernix caseosa on a full term newborn.

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  • Closeup of baby's face right after birth, skin covered in vernix and some blood.