title: Effect of skin barrier therapy on neonatal mortality rates in preterm infants in Bangladesh: a randomized, controlled, clinical trial.
abstract: OBJECTIVE
  Skin barrier therapy during the neonatal period, when the skin barrier is most highly compromised and the risk of death is greatest, has been shown to have a number of potential benefits, including reduced risk of nosocomial sepsis. Topical application of emollients that augment skin barrier function was evaluated as a strategy for improving survival rates among hospitalized preterm infants in Bangladesh.
  
  
  METHODS
  A prospective, randomized, controlled, clinical trial was conducted in the special care nursery at Dhaka Shishu (Children) Hospital, the largest tertiary care children's hospital in Bangladesh. Preterm infants (gestational age: < or = 33 weeks; N = 497) received daily topical applications of sunflower seed oil or Aquaphor ointment. Neonatal mortality rates were compared in an intent-to-treat analysis with a control group that did not receive emollient therapy.
  
  
  RESULTS
  Treatment with sunflower seed oil resulted in a statistically significant 26% reduction in mortality rates, compared with infants not receiving topical emollient therapy. Aquaphor therapy also significantly reduced mortality rates, by 32%.
  
  
  CONCLUSIONS
  Topical therapy with skin barrier-enhancing emollients improved survival rates among preterm hospitalized infants in Bangladesh. This study provides strong evidence for the implementation of topical therapy for high-risk preterm neonates in developing countries.
authors.affiliation: Department of International Health E8153, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe St, Baltimore, MD 21205, USA. gdarmsta@jhsph.edu
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: A S M Nawshad Uddin
authors.initials: AS
authors.lastname: Ahmed
authors.forename: Saifuddin
authors.initials: S
authors.lastname: Ahmed
authors.forename: M A K Azad
authors.initials: MA
authors.lastname: Chowdhury
authors.forename: Paul A
authors.initials: PA
authors.lastname: Law
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Rosenberg
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
mesh_terms: D000287:Administration, Topical; D003428:Cross Infection / Q000401:mortality / Q000517:prevention & control*; D003906:Developing Countries; D004643:Emollients / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality* / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D010577:Petrolatum / Q000008:administration & dosage; D010938:Plant Oils / Q000008:administration & dosage; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012869:Skin Absorption; D000074242:Sunflower Oil; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D004643:Emollients; D010938:Plant Oils; D000074242:Sunflower Oil; D010577:Petrolatum