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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Darmstadt
Gary L
GL
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA. gdarmsta@jhsph.edu
Saha
Samir K
SK
Ahmed
A S M Nawshad Uddin
AS
Chowdhury
M A K Azad
MA
Law
Paul A
PA
Ahmed
Saifuddin
S
Alam
Muhammad Asif
MA
Black
Robert E
RE
Santosham
Mathuram
M
D000328:Adult; D001459:Bangladesh; D003428:Cross Infection / Q000517:prevention & control*; D003906:Developing Countries; D004643:Emollients / Q000008:administration & dosage*; D005260:Female; D006368:Helianthus; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D008297:Male; D010577:Petrolatum / Q000008:administration & dosage; D010938:Plant Oils / Q000008:administration & dosage; D012867:Skin / Q000382:microbiology*; D017592:Skin Care
D004643:Emollients; D010938:Plant Oils; D010577:Petrolatum