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The beneficial effects of emollients could be through improvements in the skin barrier, resulting in protection from bacteria and reduced water and heat loss, Dr Gary Darmstadt from the Bloomberg School of Public Health, Johns Hopkins University, noted in an e-mail to Reuters Health.
"Perhaps the oil acts not only locally on the skin, but has a systemic effect as well, due to absorption into the bloodstream, even perhaps on the barrier function of the gastrointestinal tract," he speculated.
"I suspect the massage that occurs in the process of applying the oil to the skin is also important," he added.
An important determinant of the high illness and death rates for very preterm infants is a compromised skin barrier, Darmstadt and colleagues explain in the journal Pediatrics.
They evaluated the effects of skin barrier therapy in 497 preterm neonates born very early, at 33 weeks gestation or less, and admitted to the Dhaka Sishu (Children's) Hospital, Bangladesh.
Survival increased notably
In the randomised trial, 159 neonates received topical application of sunflower oil, 157 received topical Aquaphor, an emollient ointment, in addition to routine care, while 181 neonates served as controls. Starting within 72 hours after birth, emollients were applied to the whole body excluding, the face and scalp, three times a day for the first two weeks and twice daily thereafter until hospital discharge.
At the end of the first month, survival rates were 29.4 percent in controls, compared with 34.2 percent in the sunflower seed oil group and 45.8 percent in the Aquaphor group, the researchers report.
The adjusted death rates were 32 percent lower in the Aquaphor and 26 percent lower in sunflower seed oil groups as compared to the controls, they also note.
The investigators observed fewer instances of sepsis and skin infections in the emollient groups as compared to the controls.
Low-cost emollients like sunflower seed oil can be recommended in hospitalised premature neonates in resource-poor settings, Darmstadt advised. "Newborns in the community may also benefit - however, this has not yet been studied," he concluded. – (C. Vidya Shankar, MD/Reuters Health)
SOURCE: Pediatrics, March 2008.
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