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Published on: December 31, 2015
Mechanism for prevention of infection in preterm neonates by topical emollients: a randomized, controlled clinical
Gary L Darmstadt1, Saifuddin Ahmed, A S M Nawshad Uddin Ahmed
1From the *Global Development Division, Bill and Melinda Gates Foundation, Seattle, WA; †Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; ‡Department of Neonatology; and §Department of Microbiology,Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh.
Insights
Topical emollients like sunflower seed oil and Aquaphor protect preterm infants from bloodstream infections by maintaining skin integrity. Early application after birth is crucial for preventing infection when the skin is intact.
Area of Science:
- Neonatal research
- Dermatology
- Infectious disease prevention
Background:
- Topical emollients, including sunflower seed oil and Aquaphor, reduce bloodstream infections and mortality in preterm infants in resource-limited settings.
- The exact mechanism by which emollients prevent infection via the skin barrier is not fully understood.
Purpose of the Study:
- To investigate the link between skin barrier integrity, measured by skin condition score, and the risk of bloodstream infection in preterm infants.
- To evaluate the impact of emollients on this relationship.
Main Methods:
- A randomized controlled trial involving 491 preterm infants (<33 weeks gestational age) in Bangladesh.
- Utilized latent growth trajectory modeling and multivariable logistic regression to analyze data.
Main Results:
- Emollient application significantly slowed skin condition deterioration compared to controls (P < 0.05).
- A compromised skin score increased infection risk (OR 1.32).
- Emollients reduced infection incidence only when applied to intact skin (Aquaphor IRR: 0.43, sunflower seed oil IRR: 0.46).
Conclusions:
- Skin integrity declines post-birth, increasing infection susceptibility.
- Emollients preserve skin integrity, thereby preventing infections in preterm neonates.
- For optimal bloodstream infection prevention, emollient use should commence immediately after birth on intact skin.
Background:
Topical applications of emollients such as sunflower seed oil and Aquaphor have been shown to reduce the incidence of bloodstream infections and mortality of preterm infants in resource-poor settings. The causal mechanism for prevention of infection through cutaneous portals of entry is not well understood.
Methods:
We examined the relationship between skin condition score as a measure of skin barrier integrity and risk for bloodstream infection, and the effect of emollients on that relationship. Data for this study come from a randomized controlled trial of the impact of topical emollient therapy on nosocomial infections in 491 preterm infants <33 weeks gestational age at Dhaka Shishu Hospital, Bangladesh. Latent growth trajectory model with random-coefficient and multivariable logistic regression were utilized.
Results:
Rate of deterioration of skin condition was significantly lower (P < 0.05) in both emollient arms compared with the untreated control group. Adjusted odds ratio of skin score for infection was 1.32 (95% confidence interval: 1.06-1.65). Emollients reduced the incidence of infection only when the skin had no signs of deterioration [Aquaphor incidence rate ratio: 0.43 (95% confidence interval: 0.19-0.97) and sunflower seed oil incidence rate ratio: 0.46 (95% confidence interval: 0.21-0.99)].
Conclusion:
Skin condition deteriorated progressively after birth and compromised skin condition increased the risk of infection. Emollients preserved skin integrity and thus prevented infection in preterm neonates. To optimize benefits of emollients for the prevention of bloodstream infection, use of emollients should begin immediately after birth when the skin is still intact.
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