Influence of Sunflower Seed Oil on the Skin Barrier Function of Preterm Infants: A Randomized Controlled Trial

Abstract

Background: Inadequate skin care may increase morbidity in preterm infants. Skin care practices that support skin maturation have barely been investigated. Objectives: To investigate the effect of sunflower seed oil (SSO) on skin barrier development in low-birth-weight premature infants. Methods: 22 preterm infants (<48 h after birth, 1,500-2,500 g) were randomized into group C (control) and group SSO, receiving daily SSO application during the first 10 postnatal days, followed by no intervention. Transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin pH and sebum were measured <48 h after birth and on postnatal days 5, 11 and 21 on the forehead, abdomen, thigh and buttock. Results: Skin pH decreased, while sebum remained stable in both groups. In group C, TEWL remained stable; in group SSO, TEWL increased significantly on the abdomen, leg and buttock until day 11, followed by a decrease after SSO application had been stopped. Abdomen SCH remained stable in group C, but continuously decreased in group SSO until day 21. Conclusion: SSO application may retard postnatal skin barrier maturation in preterm infants.

Evidence‐based skin care in preterm infants

“…Aquaphor ® Healing Ointment (Beiersdorf AG, Hamburg, Germany) appears to have a similarly beneficial effect when used in developing countries, though it may be less readily available in rural settings and has been shown to be not as effective as sunflower seed oil at reducing nosocomial infections in two Bangladeshi studies . 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 .…”

Developmental Changes in Skin Barrier and Structure during the First 5 Years of Life

“…The top layer of the skin, the stratum corneum (SC), is largely responsible for regulating the transport of water and other substances through the skin. Water loss through the skin is a significant health concern in preterm infants, and a better understanding of how skin barrier function evolves and reacts towards external factors is the first step to developing solutions for improved infant skin health [1,2,3]. …”

Use of “natural” oils for moisturization: Review of olive, coconut, and sunflower seed oil

“…In Cooke and colleagues, as described above, no differences in TEWL or erythema or skin scores were seen between the neonatal group treated with SSO twice daily for 4 weeks and the untreated control group . In another prospective randomized trial of 22 preterm infants treated with SSO daily or not treated, Kanti and colleagues found statistically significant higher TEWL than in controls, suggesting disruption of the skin barrier, although the authors noted that all TEWL scores remained within the range of values previously described in healthy preterm and full‐term infants after birth and that their cohort was too small to draw conclusions regarding SSO treatment for premature infants …”

“…Of the three oils discussed in this article, SSO has been most extensively investigated in the treatment of xerosis and AD. 13,[38][39][40][41][42][43] As with other oils, SSO is defined according to the ratios of its fatty acid components: linoleic acid constitutes approximately 60% of the oil, which also contains oleic acid, palmitic acid, stearic acid, and linolenic acid. 9 Linoleic acid has been shown to be a necessary fatty acid to maintain normal barrier function of the epidermis.…”

“…13 In another prospective randomized trial of 22 preterm infants treated with SSO daily or not treated, Kanti and colleagues found statistically significant higher TEWL than in controls, suggesting disruption of the skin barrier, although the authors noted that all TEWL scores remained within the range of values previously described in healthy preterm and full-term infants after birth and that their cohort was too small to draw conclusions regarding SSO treatment for premature infants. 41 For the treatment of AD specifically, Msika and colleagues demonstrated that SSO could potentially be used as a steroid-sparing agent. Eighty-six children with moderate AD were randomized to receive daily topical corticosteroids or every other day corticosteroids alternating with emollient containing 2% SSO.…”