The skin of a preterm baby is immature and lacks vernix, a protective cutaneous film with antimicrobial properties. Infections and complications resulting from premature birth are responsible for more than half of all neonatal deaths. Preterm very low birth weight babies (weighing less than 1500g) are particularly vulnerable; they have mortality rates of 50% upwards in both hospital and community settings in developing countries.

Gary Darmstadt (John Hopkins University, USA) and colleagues recruited 497 newborn (72 hours old or less) and preterm babies (less than 33 weeks gestation) between 1998 and 2003 in Bangladesh. The babies were randomly assigned to receive sunflower seed oil, an ointment called Aquaphor (petrolatum, mineral oil, mineral wax, and lanolin) or no intervention. The treatment was applied to the entire body of the babies apart from scalp and face three times daily for the first fourteen days then two times daily until discharge. The babies were assessed daily for signs of infection. Infants treated with sunflower oil had around 7.0 infections per 100 days in hospital, while controls had around 10.8 infections per 100 days. Overall, infants treated with sunflower seed oil were 41% less likely to develop infections than controls. The effect was even greater when treatment was started within 24 hours of birth in these babies, bloodstream infections were reduced 56%. Aquaphor did not significantly reduce the risk of infection overall (7.2 infections per 100 days), but when treatment was started on the first day of life, it reduced infection by 61%.

Dr Darmstadt comments: "Evidence is emerging that the skin is much more important as a barrier to infection than previously recognised, particularly in preterm infants whose skin is underdeveloped. The good new
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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
3-Mar-2005