Premature Infants With Pulmonary Complications Exhibit Decreased Skin Maturity Early After Birth: A Cross‐Sectional Study

INTRODUCTION: Early identification of respiratory risk in preterm newborns (PTNB) remains challenging, as direct assessment of pulmonary maturity is often unavailable or requires invasive or resource-intensive methods. Non-invasive biomarkers capable of indicating physiological maturity shortly after birth could improve early clinical decision-making in neonatal care. Because skin and lung development share common biological pathways, skin maturity assessed by optical reflectance may serve as an indirect marker of pulmonary development. OBJECTIVE: This study evaluated the association between skin maturity estimated by skin reflectance and respiratory outcomes in PTNB during the first 48 hours of life. METHODS: A cross-sectional study was conducted with PTNB born admitted within 48?h. Exclusion criteria included cutaneous malformations, or conditions interfering with dermal assessment. Skin maturity was measured using the non-invasive Preemie-Test® device. Respiratory outcomes, such as chest radiographic abnormalities, pneumothorax, atelectasis, and pulmonary hemorrhage, were defined by clinical and radiological criteria. RESULTS: A total of 82 PTNB were included, 54.9% male. Skin reflectance ranged from 0.9 to 2.1?nm. Lower skin maturity was significantly associated with radiographic abnormalities (p = 0.01), pneumothorax (p = 0.01), pulmonary hemorrhage (p = 0.01), atelectasis (p = 0.01), and need for invasive ventilation (p = 0.01). CONCLUSIONS: These findings suggest skin reflectance may serve as a rapid, objective, and non?invasive screening tool for neonatal respiratory risk.