title: A pilot study of Biotene OralBalance® gel for oral care in mechanically ventilated preterm neonates.
abstract: BACKGROUND
  Neonatal ventilator-associated pneumonia (VAP) is associated with increased morbidity and mortality. In adults on mechanical ventilation, timed oral care decreases the frequency of VAP, but this approach has not been studied in neonates.
  
  
  OBJECTIVE
  To evaluate the feasibility of a randomized trial of timed oral care with Biotene OralBalance® gel and estimate the required sample size for such a trial.
  
  
  METHODS
  Infants were eligible for enrollment if they were born before 28 weeks of gestation, and were mechanically ventilated between 7 and 10 postnatal days. Infants were randomized to receive timed oral care with Biotene OralBalance® gel or sterile water. All subjects were treated with a standard bundle of procedures to reduce the risk of VAP.
  
  
  RESULTS
  We enrolled 41 of 46 eligible infants (89%). Compliance with timed oral care protocol was 97%. No local oral side effects of Biotene OralBalance® gel were observed. There were no significant group differences in mortality or short-term outcomes, except length of hospital stay which was significantly shorter in the Sterile water group (p = 0.02). A lower rate of VAP was found in the Biotene group, although the difference was not statistically significant (9/1000 ventilator-days versus 17/1000 ventilator-days in the Sterile water group, respectively; p = 0.16).
  
  
  CONCLUSIONS
  The results of this pilot study support the feasibility of a randomized trial of timed oral care with Biotene OralBalance® gel for prevention of VAP in mechanically ventilated neonates.
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA. beatrice.stefanescu@Vanderbilt.edu
authors.forename: Beatrice M
authors.initials: BM
authors.lastname: Stefanescu
authors.forename: Caroline
authors.initials: C
authors.lastname: Hétu
authors.forename: James C
authors.initials: JC
authors.lastname: Slaughter
authors.forename: T Michael
authors.initials: TM
authors.lastname: O'Shea
authors.forename: Avinash K
authors.initials: AK
authors.lastname: Shetty
mesh_terms: D000287:Administration, Topical; D004338:Drug Combinations; D005240:Feasibility Studies; D005260:Female; D005949:Glucose Oxidase / Q000627:therapeutic use*; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007784:Lactoperoxidase / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D009113:Muramidase / Q000627:therapeutic use*; D009910:Oral Hygiene / Q000379:methods*; D010865:Pilot Projects; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: C111669:Biotene; D004338:Drug Combinations; D005949:Glucose Oxidase; D007784:Lactoperoxidase; D009113:Muramidase
keywords: CDC; Center of Diseases Control and Prevention; ELBW; Mechanical ventilation; NHSN; National Healthcare Safety Network; Pilot study; Preterm infants; VAP; VAP (ventilator-associated pneumonia); extremely low birth weight; ventilator-associated pneumonia