Topical ointment for preventing infection in preterm infants

Conner JM., Soll R, Edwards WH

Published Online:

January 21, 2009

It is common for preterm babies to develop infections while in hospital. The ability of preterm babies to fight infection is compromised and their skin is not fully formed and may be an ineffective barrier to infection. Applying ointment to the skin may protect against skin breakdown and thereby prevent germs from spreading into the blood stream and causing serious infection. Four trials included 1304 preterm infants (range 19 to 1191 in each trial) compared infants who received routine application of ointment to infants who received routine skin care, including ointment application if needed for skin breakdown. In infants who received routine application of ointment, their skin conditions improved but they experienced more infections, particularly with a bacteria of the skin know as coagulase negative staphylococcus. The reason for this increase in infection is unclear. Perhaps there was contamination of the ointment with bacteria or perhaps the ointment created a favorable environment for the spread of germs.

The practice of regularly applying ointment (as opposed to only using ointment when there is evidence of skin breakdown) may not be beneficial to premature infants in decreasing their risk of infection. Limitations to this review included the wide range of gestational ages of the preterm infants (26 to 36 weeks) and the different ways ointment was applied, from individual tubes or sterile syringes.

Abstract (click to read)

Background:

Nosocomial sepsis is a frequent and serious complication of premature infants. The increased susceptibility of ELBW infants to infection has been attributed to less effective immune function compared to mature newborns and the invasive nature of necessary supportive care. Breakdown of the barrier function of the skin may be an additional risk factor for nosocomial sepsis.

Objectives:

To assess the effect of prophylactic application of topical ointment on nosocomial sepsis rates and other complications of prematurity in preterm infants.

Search strategy:

Searches were made of the Cochrane Central Registry of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2003), Ovid DC MEDLINE through June 2003, previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, and journal hand searching in the English language.

Selection criteria:

Randomized controlled trials which compared the effect of prophylactic application of topical ointment to routine (standard) skin care or as needed topical therapy in preterm infants are included in this review.

Data collection and analysis:

Data regarding clinical outcomes including infection [including any bacterial infection, bacterial infection with a known pathogen, coagulase negative staphylococcal infection, fungal infection, and any nosocomial infection (bacterial or fungal)], patent ductus arteriosus, oxygen requirement at 28 days, chronic lung disease and mortality were excerpted from the reports of the clinical trials by the reviewers. Data analysis was done in accordance with the standards of the Cochrane Neonatal Review Group.

Main results:

Four randomized controlled trials were identified. All four studies reported improved skin condition in infants treated with prophylactic topical ointment (results not reported here).

All four studies reported on the incidence of any nosocomial infection, fungal infection and coagulase negative staphylococcal infection. Infants treated with prophylactic topical ointment are at increased risk of coagulase negative staphylococcal infection (typical relative risk 1.31, 95% CI 1.02, 1.70; typical risk difference 0.04, 95% CI 0.00, 0.08); and any nosocomial infection (typical relative risk 1.20, 95% CI 1.00, 1.43; typical risk difference 0.05, 95% CI 0.00, 0.09). A trend toward increased risk of any bacterial infection was found in infants treated with prophylactic topical ointment (typical relative risk 1.19, 95% CI 0.97, 1.46; typical risk difference 0.04, 95% CI -0.01, 0.08). There was no significant difference found in the risk of bacterial infection with a known pathogen, fungal infection, or other complications related to prematurity.

Authors' conclusions:

Prophylactic application of topical ointment increases the risk of coagulase negative staphylococcal infection and any nosocomial infection. A trend toward increased risk of any bacterial infection was noted in infants prophylactically treated. Topical ointment should not be used routinely in preterm infants.

This record should be cited as:

Conner JM., Soll R, Edwards WH. Topical ointment for preventing infection in preterm infants. Cochrane Database of Systematic Reviews 1998, Issue 3. Art. No.: CD001150. DOI: 10.1002/14651858.CD001150.pub2

Assessed as up to date:

July 24, 2003

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Primary Review Group:

Neonatal Group

Health topics:

Infectious disease > Neonatal infections > Nosocomial sepsis

Neonatal care > Neonatal infections > Nosocomial sepsis

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Topical ointment for preventing infection in preterm infants

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