Infections account for about
33% of all newborn deaths worldwide. Although neonatal
death rates are much higher in developing countries, these
numbers are still significant in developed nations considering
that we have access to superior healthcare. The most common
pathogens blamed for neonatal nosocomial infections are
those that normally inhabit the skin. Premature babies
are the most vulnerable as they lack vernix — a protective
cutaneous biofilm with antimicrobial properties.
Despite significant research, few
options are available to treat or prevent these killer
infections. Although antibiotics are used in developed
countries, the constant threat of drug resistance has
driven some researchers to test the validity of simple,
traditional treatment alternatives. A study in the March
5 issue of The Lancet lends support to the practice
of bathing preemies in sunflower oil to prevent infection.
DERMAL
BARRIER
"Evidence is emerging that the skin is much more important
as a barrier to infection than previously recognized,
particularly in preterm infants whose skin is underdeveloped,"
noted lead author Dr Gary Darmstadt of the Johns Hopkins
School of Public Health. "The good news is that treatment
is available to strengthen the function of the skin
as a barrier in these vulnerable newborns," he added
in the Lancet study.
One way to protect preemies may
be to rub sunflower oil on them. The Greek doctor Soranus
of Ephesus recommended such a treatment and some mothers
in Mediterranean countries still follow his tip to bathe
newborns in oil. The right oils, like sunflower, contain
lipids that can be metabolized by skin keratinocytes
to form a barrier against infection. However, certain
oils like mustard oil — the choice of most Bangladeshi
mothers — can be toxic as they damage the integrity
of the skin barrier.
MAGIC
OINTMENT
In order to test the benefits of using the right kind
of oil in preterm infants, researchers randomized 497
Bangladeshi infants born at less than 33 weeks' gestation
to receive either daily massage with sunflower oil or
Aquaphor — a mixture of petrolatum, mineral oil,
mineral wax and lanolin alcohol — or to receive
no prophylactic treatment.
Infections were 41% less likely
in the sunflower oil group and 40% lower in the Aquaphor
group. The benefit was most dramatic in the most vulnerable
infants — those weighing less than 1.25kg —
and in those treated in the first 24 hours of life.
More research needs to be done
to nail down whether this kind of preventative treatment
could work in more developed nations. Methicillin-sensitive
Staphylococcus aureus — a gram-positive
organism — is the most common bug behind neonatal
infections in developed countries, although the methicillin-resistant
form has also been reported. The infants in this latest
study were mostly infected with the gram-negative variety.
Testing is needed to determine if sunflower oil is as
effective against gram-positive bugs. The authors suggest
that new emollients based on the composition of neonatal
skin might be beneficial for preemies in developed countries.
Lancet published online March
3, 2005
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