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Topical ointment for preventing infection in preterm infants
J M Conner1, R F Soll, W H Edwards
1Vermont Oxford Network, 33 Kilburn St., Burlington, Vermont 05401, USA.
Insights
Prophylactic topical ointment use in preterm infants increases risks for coagulase-negative staphylococcal and other nosocomial infections. Routine application is not recommended for these vulnerable newborns.
Area of Science:
- Neonatal care
- Infectious disease epidemiology
- Dermatology
Background:
- Nosocomial sepsis is a significant threat to premature infants, particularly those with extremely low birth weight (ELBW).
- Immature immune systems and invasive medical procedures increase infection risk in preterm infants.
- Compromised skin barrier function may further elevate the susceptibility to nosocomial infections.
Purpose of the Study:
- To evaluate the impact of prophylactic topical ointment application on nosocomial sepsis rates in preterm infants.
- To assess the effect on other complications associated with prematurity.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) comparing prophylactic topical ointment with standard skin care.
- Searches included major databases (CENTRAL, MEDLINE) and hand-searching of relevant literature.
- Data extraction focused on infection rates (bacterial, fungal, coagulase-negative staphylococcal, nosocomial), patent ductus arteriosus, oxygen dependency, chronic lung disease, and mortality.
Main Results:
- Four RCTs were included, all showing improved skin condition with prophylactic ointments.
- Prophylactic topical ointment use was associated with an increased risk of coagulase-negative staphylococcal infections (RR 1.31) and any nosocomial infection (RR 1.20).
- A trend towards increased bacterial infections was observed (RR 1.19), with no significant differences in other prematurity-related complications.
Conclusions:
- Routine prophylactic topical ointment application in preterm infants is linked to higher rates of coagulase-negative staphylococcal and overall nosocomial infections.
- A potential increase in bacterial infections warrants caution.
- Current evidence does not support routine use of topical ointments for infection prevention in preterm infants.
Background:
Nosocomial sepsis is a frequent and serious complication of premature infants. The increased susceptibility of ELBW infants to infection has been attributed to less effective immune function compared to mature newborns and the invasive nature of necessary supportive care. Breakdown of the barrier function of the skin may be an additional risk factor for nosocomial sepsis.
Objectives:
To assess the effect of prophylactic application of topical ointment on nosocomial sepsis rates and other complications of prematurity in preterm infants.
Search Strategy:
Searches were made of the Cochrane Central Registry of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2003), Ovid DC MEDLINE through June 2003, previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, and journal hand searching in the English language.
Selection Criteria:
Randomized controlled trials which compared the effect of prophylactic application of topical ointment to routine (standard) skin care or as needed topical therapy in preterm infants are included in this review.
Data Collection And Analysis:
Data regarding clinical outcomes including infection [including any bacterial infection, bacterial infection with a known pathogen, coagulase negative staphylococcal infection, fungal infection, and any nosocomial infection (bacterial or fungal)], patent ductus arteriosus, oxygen requirement at 28 days, chronic lung disease and mortality were excerpted from the reports of the clinical trials by the reviewers. Data analysis was done in accordance with the standards of the Cochrane Neonatal Review Group.
Main Results:
Four randomized controlled trials were identified. All four studies reported improved skin condition in infants treated with prophylactic topical ointment (results not reported here). All four studies reported on the incidence of any nosocomial infection, fungal infection and coagulase negative staphylococcal infection. Infants treated with prophylactic topical ointment are at increased risk of coagulase negative staphylococcal infection (typical relative risk 1.31, 95% CI 1.02, 1.70; typical risk difference 0.04, 95% CI 0.00, 0.08); and any nosocomial infection (typical relative risk 1.20, 95% CI 1.00, 1.43; typical risk difference 0.05, 95% CI 0.00, 0.09). A trend toward increased risk of any bacterial infection was found in infants treated with prophylactic topical ointment (typical relative risk 1.19, 95% CI 0.97, 1.46; typical risk difference 0.04, 95% CI -0.01, 0.08). There was no significant difference found in the risk of bacterial infection with a known pathogen, fungal infection, or other complications related to prematurity.
Reviewer'S Conclusions:
Prophylactic application of topical ointment increases the risk of coagulase negative staphylococcal infection and any nosocomial infection. A trend toward increased risk of any bacterial infection was noted in infants prophylactically treated. Topical ointment should not be used routinely in preterm infants.
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