Effect of topical treatment with skin barrier-enhancing emollients on nosocomial infections in preterm infants in Bangladesh: A randomised controlled trial

Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
The Lancet (Impact Factor: 45.22). 03/2005; 365(9464):1039-45. DOI: 10.1016/S0140-6736(05)71140-5
Source: PubMed


Infections and complications of prematurity are main causes of neonatal mortality. Very low birthweight premature infants have compromised skin barrier function, and are at especially high risk for serious infections and mortality. Our aim was to ascertain whether topical application of emollients to enhance skin barrier function would prevent nosocomial infections in this population.
We randomly assigned infants born before week 33 of gestation after admission to Dhaka Shishu Hospital, Bangladesh, to daily massage with sunflower seed oil (n=159) or Aquaphor (petrolatum, mineral oil, mineral wax, lanolin alcohol; n=157). We then compared incidence of nosocomial infections among infants in these two groups with an untreated control group (n=181) by an intention-to-treat analysis.
20 patients in the control group, and 22 in each of the treatment groups left the hospital early, but were included in the final analysis. Overall, infants treated with sunflower seed oil were 41% less likely to develop nosocomial infections than controls (adjusted incidence rate ratio [IRR] 0.59, 95% CI 0.37-0.96, p=0.032). Aquaphor did not significantly reduce the risk of infection (0.60, 0.35-1.03, p=0.065). No adverse events were seen.
Our findings confirm that skin application of sunflower seed oil provides protection against nosocomial infections in preterm very low birthweight infants. The low cost, availability, simplicity, and effect of treatment make it an important intervention for very low birthweight infants admitted to hospital in developing countries.

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    • "The oil has many health benefit effects when either ingested orally or applied topically (skin and hair)[2]. Due to its emollient (moisturizing) property, it helps maintaining skin moisture content[3]. The nutritional, antioxidant properties and long shelf-life makes it an ideal component to develop oral and cosmetic preparations[4]. "
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    ABSTRACT: Bigels of sunflower oil, span 40 and water soluble synthetic polymers (e.g. polyvinyl alcohol and polyvinyl pyrrolidone) were prepared and explored as controlled delivery vehicle for metronidazole. Fluorescence microscope was used to characterize the microstructure of the bigels. Static mechanical tester and a viscometer were used to study the mechanical properties properties of the bigels. The efficiency of these bigels as delivery vehicle for antimicrobial agents was evaluated in vitro using E. coli. The cytotoxicity studies were conducted in vitro using HaCaT cell lines. The microstructure of the bigels showed the presence of hydrogel as continuous phase and oleogels as dispersed form. The bigels were viscoelastic in nature with pseudoplastic flow behavior. The drug release was reduced with the increase in the polymer concentration in the bigels. All the bigels showed a high cell proliferation index. The drug loaded bigels showed equivalent inhibitory zones against E. coli as compared to commercially available formulations.
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    • "Included studies used sunflower, coconut, soybean or mineral oil as emollients and all were conducted in developing countries. Two studies [11,21] included neonates < 33 weeks gestation, two studies [20,23] included neonates < 34 weeks gestation, three studies [14,22,25] included neonates <37 weeks gestation while one study [24] included neonates <35 weeks gestation. Three studies [11,20,21] identified gestational age according to the Dubowitz and Ballard, and on the basis of maternal dates while one study [25] estimated from ultrasound records and Ballard scores at admission, whereas the other studies have not reported on the method (Table 1). "
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    ABSTRACT: Application of emollients is a widespread traditional newborn care practice in many low and middle-income countries (LMICs) and may have the potential to decrease infection and consequent mortality in preterm neonates. We systematically reviewed literature published up to December 2012 to identify studies describing the effectiveness of emollient therapy. We used a standardized abstraction and grading format to estimate the effect of emollient therapy by applying the standard Child Health Epidemiology Reference Group (CHERG) rules. We included seven studies and one unpublished trial in this review. Topical emollient therapy significantly reduced neonatal mortality by 27% (RR: 0.73, 95% CI: 0.56, 0.94) and hospital acquired infection by 50% (RR: 0.50, 95% CI: 0.36, 0.71). There were significant increases in weight (g) (MD: 98.04, 95% CI: 42.64, 153.45) and weight gain (g/kg/day) (MD: 1.57, 95% CI: 0.79, 2.36), whereas the impacts were non-significant for length and head circumference. Emollient therapy is associated with improved weight gain, reduced risk of infection and associated newborn mortality in preterm neonates and is a potentially promising intervention for use in low resource settings. Large scale effectiveness trials are required to further assess the impact of this intervention.
    Full-text · Article · Dec 2013 · BMC Public Health
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    • "Because mothers are not likely to be accurate regarding dates and regularity of their cycle, obstetric USS may be a better alternative in assessing the GA of foetuses early in pregnancy. Many investigators had found that, combining NR and DS to assess the GA of babies may be more reliable than obstetric USS [1] [6] [7]. In this light, this study aimed at: 1) to determine the GA of babies using obstetric USS, DS and NR; 2) to compare the mean GA of the babies obtained by obstetric USS, DS and NR; 3) to provide relevant public health information on the importance of obstetric USS in the 21st century. "
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    ABSTRACT: Background: Some researchers have suggested that when Naegle's rule (NR) and Dubowitz score (DS) are combined, it could out-perform obstetric ultrasound scan (USS). Others still believe that obstetric USS alone is still effective relative to the combination of NR rule and DS in assessing the gestational age (GA) of babies. Objectives: To determine and compare the GA of babies using obstetric USS, NR and DS; and to provide relevant public health information on obstetric USS in the 21st century. Methods: Subjects were selected using systematic ran-dom sampling and the GA of babies was deter-mined using obstetric USS, NR, and DS. Statis-tical package for social science (SPSS) statisti-cal software version 16, Illinois, Chicago USA was used for all data analysis. Results: Eighty-five mother-baby pairs were studied. Forty-four babies (52%) were males and 41 (48%) females. Sixty four (75%) were term with a mean (SD) BW of 3.02 (0.59) at 95%CI (2.89 -3.14) kg. The over-all mean GA of the babies was 38.49 (2.89) at 95%CI (38.14 -38.85) weeks. The mean GA using obstetric USS, NR and DS were 38., but comparison of these means was not significant (p = 0.256). Combined mean GA by NR and DS was 38.46 (3.26) at 95%CI (37.96 -38.95). Comparing this mean with mean GA ob-tained by obstetric USS was also not significant (p = 0.885). Conclusion: The GA assessments by Obstetric USS, NR and DS were all reliable, and Obstetric USS performed effectively relative to combined NR and DS.
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