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Published on: December 31, 2015
Topical application of emollients to maintain skin integrity in preterm neonates: a systematic review and
Saurodeep Basu1, Poonam Singh2, Mayank Priyadarshi2
1Department of Dermatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Insights
Topical emollients improve skin integrity in preterm neonates. Topical oils, specifically, may reduce the incidence of neonatal sepsis, though evidence certainty is low and results vary.
Area of Science:
- Neonatal care
- Dermatology
- Evidence-based medicine
Background:
- Maintaining skin integrity is crucial for preterm neonates.
- Routine skin care practices vary, and their efficacy in preventing complications is debated.
- Topical emollients are increasingly considered for neonatal skin management.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of topical emollient application versus routine skin care in preterm neonates.
- To assess the impact of emollients on skin integrity, neonatal sepsis, mortality, and adverse events.
- To synthesize current evidence regarding the use of topical emollients in preterm infant care.
Main Methods:
- Systematic review and meta-analysis of 19 randomized controlled trials involving 5586 preterm neonates.
- Data synthesis using RevMan Web and assessment of evidence certainty using GRADE methodology.
- Outcome measures included skin condition score (SCS), culture-positive neonatal sepsis, mortality, and adverse events.
Main Results:
- Topical emollients significantly decreased the skin condition score (SMD -1.11), indicating improved skin integrity (low certainty of evidence).
- No overall difference in culture-positive neonatal sepsis incidence was found with emollients, but topical oils showed a significant reduction (RR 0.66) compared to routine care (low certainty of evidence).
- No significant difference in mortality or major adverse events was reported.
Conclusions:
- Low-certainty evidence suggests topical emollients improve skin integrity in preterm neonates.
- Topical oil application may reduce the incidence of culture-positive neonatal sepsis.
- High heterogeneity among studies limits the generalizability of findings, necessitating further research.
Abstract:
This systematic review and meta-analysis compared the efficacy and safety of topical emollient application in preterm neonates for maintaining skin integrity. The available evidence related to the effects of topical emollients vs. routine skin care was identified, appraised, and synthesized. The outcome measures were assessment of skin integrity, objectively defined by a skin condition score (SCS), incidence of culture-positive neonatal sepsis, mortality, trans-epidermal water loss, skin colonization, and adverse events. Data were pooled using RevMan Web. Certainty of evidence (CoE) was analyzed by GRADE. Nineteen trials comprising 5586 neonates were included for meta-analysis. A significant decrease in SCS was observed, favoring topical emollients [SMD (95% CI), - 1.11 (- 1.57, - 0.65), I2 = 85%, 6 studies, n = 2807, high RoB, low CoE]. Although there was no overall difference in the incidence of culture-positive neonatal sepsis with topical emollients [RR (95% CI), 0.82 (0.61, 1.09), I2 = 56%, 15 studies, n = 5297, high RoB, low CoE], a sensitivity analysis including studies comparing topical oil vs. routine care showed significant benefits favoring topical oil [RR (95% CI) 0.66 (0.47, 0.92), I2 = 30%, 8 studies, n = 3392], whereas pooled data from studies including topical ointment/cream vs. routine care did not show any benefit [RR (95% CI) 1.03 (0.72, 1.48), I2 = 26%, 8 studies, n = 2046]. There was no difference in mortality, and no major adverse events were reported. Data for other outcomes could not be pooled.
Conclusion:
Low-CoE evidence suggested better skin integrity with topical emollients, and a lower incidence of culture-positive neonatal sepsis with topical oil application. High heterogeneity limits the generalizability of results.
What Is Known:
• Compared to routine skin care, application of topical oils may reduce the incidence of sepsis in preterm infants. • There is no difference in mortality with the use of topical emollients.
What Is New:
• Low-certainty evidence documented an improvement in skin integrity with the use of topical emollients and a reduction in the incidence of culture-positive neonatal sepsis with topical oil application. • No major adverse effects of topical emollients were observed.
