Effect of emollient therapy on clinical outcomes in preterm neonates in Pakistan: a randomised controlled trial

Salam, Rehana A; Darmstadt, Gary L.; Bhutta, Zulfiqar A

doi:10.1136/archdischild-2014-307157

Cited by 54 publications

(52 citation statements)

References 24 publications

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“…Interestingly, a more recent study from Germany shows that sunflower seed oil massage can impair skin barrier maturation and increase TEWL . Topical coconut oil application has also shown a benefit in maintaining skin integrity and reducing the risk of bloodstream infections in a Pakistani study . However, not all oils should be used for maintenance of skin barrier integrity.…”

Section: Resultsmentioning

confidence: 99%

Evidence‐based skin care in preterm infants

Kusari

Han

Virgen

et al. 2018

Pediatric Dermatology

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Most guidelines on neonatal skin care emphasize issues pertaining to healthy, term infants. Few address the complex task of skin barrier maintenance in preterm, very preterm, and extremely preterm infants. Here, we provide an evidence‐based review of the literature on skin care of preterm neonates. Interestingly, the stratum corneum does not fully develop until late in the third trimester, and as such, the barrier function of preterm skin is significantly compromised. Numerous interventions are available to augment the weak skin barrier of neonates. Plastic wraps reduce the incidence of hypothermia while semipermeable and transparent adhesive dressings improve skin quality and decrease the incidence of electrolyte abnormalities. Tub bathing causes less body temperature variability than sponge bathing and can be performed as infrequently as once every four days without increasing bacterial colonization of the skin. Topical emollients, particularly sunflower seed oil, appear to reduce the incidence of skin infections in premature neonates—but only in developing countries. In developed countries, studies indicate that topical petrolatum ointment increases the risk of candidemia and coagulase‐negative Staphylococcus infection in the preterm population, perhaps by creating a milieu similar to occlusive dressings. For preterm infants with catheters, povidone‐iodine and chlorhexidine are comparably effective at preventing catheter colonization. Further studies are necessary to examine the safety and efficacy of various skin care interventions in premature infants with an emphasis placed on subclassifying the patient population. In the interim, it may be beneficial to develop guidelines based on the current body of evidence.

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Section: Resultsmentioning

confidence: 99%

Evidence‐based skin care in preterm infants

Kusari

Han

Virgen

et al. 2018

Pediatric Dermatology

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“…In a quasi-experimental study from Pakistan, nurses gave 258 preterm neonates coconut oil massages twice daily that were then continued by their mothers at home for the first month of life (Salam, Darmstadt, & Bhutta, 2015). Data collected by a researcher who was "blind to group assignment" suggested that the mean weight gain was 11.3 grams greater for the massaged newborns as compared to the control group.…”

Section: Preterm Newborn Massage Therapy Effectsmentioning

confidence: 99%

Newborn Massage Therapy

Field¹

2017

IJPN

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Abstract:This review on newborn massage therapy research is based on literature searches of Pubmed, Medline and PsychInfo for studies published during the last six years to update a similar review published in 2010. In that review, massage therapy was noted to lead to greater weight gain and growth in preterm newborns who had received moderate pressure massage. The weight gain was thought to relate to increased vagal activity, gastric motility, insulin and IGF -1 levels resulting from the stimulation of pressure receptors during massage. The current review includes randomized controlled trial studies, systematic reviews and meta-analyses on the effects of massage therapy on both preterm and full -term newborns. Immediate effects have been noted for massage therapy during painful procedures such as the heelstick for preterm newborns and vaccinations for full-term newborns. Although most of the studies have focused on the effects of different oils used in massage therapy to enhance weight gain in preterm newborns, other conditions that have benefited from massage therapy include hyperbilirubinemia, feeding intolerance and brain injury. Mothers of preterm newborns have also experienced less depression, stress and anxiety after massaging their infants. Although very few studies have been conducted with full-term newborns, this review includes research on the effects of massage therapy on sleep patterns in full term newborns and their mothers, on hyperbilirubinemia, pain, colic, cortisol and HIV. Despite the methodological limitations noted for some of these studies including small sample sizes and the need for more randomized controlled trials on a standard moderate pressure massage protocol, the data converge to suggest that newborns benefit both physically and developmentally from being massaged by their mothers during the newborn period and their mothers also benefit when they are providing their newborns massage.

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“…A recent trial of oil massage of preterm infants with coconut oil has produced similar results. 79 While an emollient appears to work by preserving skin integrity and protecting from skin injury, 80,81 this intervention is also hypothesized to work by helping accelerate maturation of skin-barrier function (partially through reducing cutaneous signs of essential fatty acid deficiency), thereby reducing likelihood of transcutaneous acquisition of invasive pathogens. Ongoing randomized community-based trials are addressing these questions in large rural populations in Nepal and India.…”

Section: Topical Emollient Therapymentioning

confidence: 98%