Assessment of the Impact of Sunflower Oil Emollient Therapy on Neonatal Skin Barrier Function and Nutritional Status in Sarlahi, Nepal
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Date
2014-03-31
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Johns Hopkins University
Abstract
Background: Over 3 million neonatal deaths occur annually, mostly in developing countries. Neonatal massage with locally available vegetable oils is a low-cost intervention being explored to reduce neonatal morbidity and mortality. Although millions of infants in South Asia are massaged with mustard oil each year, it is unknown whether substituting sunflower seed oil changes any biological mechanisms that may improve neonatal health.
Methods: This was a nested community-based cluster-randomized controlled trial of 1000 neonates (500 preterm (<37 weeks), 500 full term) randomized to promotion of either mustard seed (traditional) or sunflower (improved) oil for full body massage. Skin integrity was assessed using the following measurements: transepidermal water loss (TEWL), skin pH, skin condition (days 1, 3, 7, 14, and 28), and stratum corneum protein concentration (days 1, 7, 14, and 28). Nutritional status was assessed by weight (days 1, 3, 7, 10, 14, 21, and 28) and length (days 1 and 28) measurements. Risk factors associated with skin integrity were evaluated using longitudinal mixed-effects models. Effects of oil group on skin integrity and nutritional status were assessed using longitudinal mixed-effects models, accounting for the clustered design.
Results: Risk factors associated with skin integrity included: sex, birthweight, ethnicity, socioeconomic status, time between measurement and last (i.e. most frequent) massage, temperature, and humidity. In the sunflower oil group, skin pH and TEWL decreased at a faster rate during the neonatal period (0.006 pH units/day and 0.16 g/m^2/hr per day respectively) than in the mustard oil group. Preterm infants’ TEWL in the sunflower oil group decreased 0.47 g/m^2/hr per day faster than those in the mustard oil group between days 4 and 28. There was no evidence that skin condition scores, protein concentration, or nutritional status was different between groups.
Conclusions: These data indicate neonatal full body massage using sunflower oil may help to improve skin barrier integrity relative to mustard seed oil. Sunflower oil did not show an improved effect on nutritional status when compared to mustard seed oil. Further research on other possible biological mechanisms that may be related to improved health outcomes in infants massaged with emollients should be considered.
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Keywords
emollients, massage, neonatal, nutrition, skin