Anoint Them with Oil: Cheap-and-easy treatment cuts infection rates in premature infants

Christen Brownlee

In developing countries, babies that arrive prematurely with low birthweights have mortality rates that exceed 50 percent. Infections are to blame for many of these deaths. A new study suggests that one way to curb infections and save babies' lives is as close as the grocery store.

Unlike full-term babies, premature infants have skin that isn't fully developed. It also lacks vernix, a creamy, white film with a variety of protective properties, including antibacterial activity. "We thought [their skin] may not function well to guard against pathogens entering the body," says Gary Darmstadt of Johns Hopkins University in Baltimore.

Seeking a barrier against infection as preemies' skin matures, Darmstadt's team worked with 497 low-birthweight infants admitted to a hospital in Bangladesh. To enroll in the study, babies had to be born at less than 33 weeks' gestation and weigh less than 1,500 grams (about 3 pounds).

The infants were randomly divided into three groups. All received normal care, but two of the groups also received massages—one using sunflower-seed oil, the other, Aquaphor, a petroleum-based ointment.

Nurses applied the emollients everywhere except the babies' faces and scalps three times daily during the first 2 weeks of life, then twice a day until the babies were discharged from the hospital. Because the infants were admitted at different times after birth, some infants started treatment on their first day of life and others started it later.

Between 1998 and 2003, Darmstadt and his colleagues tracked bloodborne infection rates in all three groups. Overall, babies treated with sunflower-seed oil were 41 percent less likely to develop infections than were those who received conventional care. The percentage jumped to 56 percent when treatment started within a day of birth. Aquaphor's overall effectiveness was less clear, but when the treatment was started within 24 hours of birth, the infection rate dropped by 61 percent. The researchers report these results in the March 16 Lancet.

Darmstadt notes that massaging babies with oil is a common practice in many cultures. Throughout south Asia, for example, mustard-seed oil is the emollient most commonly used on infants. However, an earlier study in mice suggested that this oil might have toxic effects. Sunflower-seed oil appears to be a culturally acceptable alternative for mothers and nurses in Bangladesh, Darmstadt says.

Massaging preterm infants with sunflower-seed oil "is something that just about anybody can do, and, for a whole course of treatment, it costs about 20 cents," Darmstadt says.

Alfred Lane, a dermatologist at Stanford University calls the study's results "really excellent." The challenge, he says, is to get the sunflower-seed oil into the hands of mothers who might otherwise opt to buy cheaper emollients that may not cut infection rates.

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Letters:

>Regarding the therapeutic effects of sunflower-seed oil on infants, has any research been done as to the health benefits of the oil in any other age group?

Yael Levy
New York, NY

Research to date has focused on newborns, says researcher Gary L. Darmstadt of Johns Hopkins University in Baltimore. However, a few studies have suggested that oil massage enhances wound healing in older children. Oil massage of children of all ages is practiced extensively in south Asia, he adds.—C. Brownlee

References:

Darmstadt, G.L., et al. 2005. Effect of topical treatment with skin barrier-enhancing emollients on nosocomial infections in preterm infants in Bangladesh: A randomised controlled trial. Lancet 365(March 16)1039–1045. Abstract available at http://dx.doi.org/10.1016/S0140-6736(05)71140-5.

Further Readings:

Darmstadt, G.L., et al. 2005. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 365(March 12):977–988. Abstract available at http://dx.doi.org/10.1016/S0140-6736(05)71088-6.

______. 2004. Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infants in Egypt: A randomized, controlled clinical trial. Pediatric Infectious Disease Journal 23(August):719–725. Abstract available at http://www.pidj.com/pt/re/pidj/abstract.00006454-200408000-00005.htm.

______. 2003. The skin as a potential portal of entry for invasive infections in neonates. Perinatology 5:205–212.

Edwards, W., et al. 2004. The effect of prophylactic ointment therapy on nosocomial sepsis rates and skin integrity in infants with birth weight of 501 to 1000 g. Pediatrics 113(May):1195–1203. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/113/5/1195.

Lane, A.T., and S.S. Drost. 1993. Effects of repeated application of emollient cream to premature neonates' skin. Pediatrics 92(September):415–419. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/92/3/415.

Sources:

Gary Darmstadt
Johns Hopkins University
Department of International Health
615 N. Wolfe Street
Baltimore, MD 21205-2179

Al Lane
Department of Dermatology
Stanford University School of Medicine
900 Blake Wilbur, Room W0071
Stanford, CA 94305-5334

From Science News, Volume 167, No. 11, March 12, 2005, p. 165.