The skin of a preterm baby is immature and lacks vernix, a protective cutaneous film with antimicrobial properties. Infections and complications resulting from premature birth are responsible for more than half of all neonatal deaths. Preterm very low birth weight babies (weighing less than 1500g) are particularly vulnerable; they have mortality rates of 50% upwards in both hospital and community settings in developing countries.
Gary Darmstadt (John Hopkins University, USA) and colleagues recruited 497 newborn (72 hours old or less) and preterm babies (less than 33 weeks gestation) between 1998 and 2003 in Bangladesh. The babies were randomly assigned to receive sunflower seed oil, an ointment called Aquaphor (petrolatum, mineral oil, mineral wax, and lanolin) or no intervention. The treatment was applied to the entire body of the babies apart from scalp and face three times daily for the first fourteen days then two times daily until discharge. The babies were assessed daily for signs of infection. Infants treated with sunflower oil had around 7.0 infections per 100 days in hospital, while controls had around 10.8 infections per 100 days. Overall, infants treated with sunflower seed oil were 41% less likely to develop infections than controls. The effect was even greater when treatment was started within 24 hours of birth – in these babies, bloodstream infections were reduced 56%. Aquaphor did not significantly reduce the risk of infection overall (7.2 infections per 100 days), but when treatment was started on the first day of life, it reduced infection by 61%.
Dr Darmstadt comments: "Evidence is emerging that the skin is much more important as a barrier to infection than previously recognised, particularly in preterm infants whose skin is underdeveloped. The good news is that treatment is available to strengthen the function of the skin as a barrier in these vulnerable newborns. More than 90% of babies in Bangladesh, Nepal, and much of South Asia are massaged with mustard oil as part of routine practice. The challenge now is to discourage use of mustard oil, which can delay recovery of the skin barrier and have a toxic effect on the skin, and persuade people to use alternative proven, available and low-cost products such as sunflower seed oil." (Quote by e-mail; does not appear in published paper)
Contact: Dr Gary L Darmstadt, Dept of International Health, Room E-8153, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, E8132, Baltimore, MD 21205-2103, USA.
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