Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India.
J Glob Health. 2022 Jul 25;12:12002. doi: 10.7189/jogh.12.12002.
This systematic review of randomized trials assessed the effect of emollient application compared to no emollient application in term or near-term healthy newborns.
We searched MEDLINE via PubMed, Cochrane CENTRAL, Embase, and CINAHL (updated until November 2021), clinical trials databases, and reference lists of retrieved articles. Key outcomes were neonatal mortality, systemic infections, atopic dermatitis, skin condition, and adverse events. Two authors separately evaluated the risk of bias, extracted data, and synthesized effect estimates using relative risks (RR). The GRADE approach was used to assess the certainty of evidence.
We screened 19 243 records and included 16 eligible trials involving 5643 participants. Five trials recruited 3352 healthy newborns (term = 728; gestation ≥35 weeks = 2624); and 11 trials included 2291 term newborns who were 'at risk' for developing atopy but were otherwise healthy. We conducted a separate analysis for these two groups of newborns. Emollient application (creams or nut, seed, and vegetable oils) started in the neonatal period and continued for four weeks to two years across studies. Meta-analysis for term healthy newborns suggests that topical emollient application may have little to no effect on atopic dermatitis (RR = 1.29, 95% CI = 0.96-1.72; two trials, 1408 newborns; low certainty evidence). Effects on food allergy (RR = 0.84; 95% CI = 0.42-1.70; one trial, 233 newborns), allergic sensitization to food allergens (RR 1.31; 95% CI 1.03 to 1.68; one trial, 234 newborns) and inhalational allergens (RR = 0.97; 95% CI = 0.44, 2.14; 1 trial, 234 newborns), skin dryness (RR = 0.74, 95% CI = 0.55-1.00; two trials, 294 newborns), and skin problems (RR = 0.92, 95% CI = 0.81-1.05; two trials, 292 newborns) were uncertain. Meta-analysis for 'at-risk' newborns suggests that intervention probably lowers the risk of atopic dermatitis (RR = 0.74, 95% CI = 0.63-0.86; 11 studies, 1988 infants; moderate certainty evidence), but may have little or no effect on food allergy and allergic sensitization to food or inhalation allergens. The effect on skin dryness and skin rash was uncertain.
Topical emollient application may not prevent atopic dermatitis in term healthy newborns. There is little data for other skin and allergic outcomes.
Priyadarshi M, Balachander B, Rao S, Gupta S, Sankar MJ. Use of emollients in term healthy newborns: A systematic review. PROSPERO 2020 CRD42020177437.
本系统评价纳入了随机试验，评估了与不使用保湿剂相比，在足月或近足月健康新生儿中使用保湿剂的效果。
我们通过 PubMed 中的 MEDLINE、Cochrane 中心、Embase 和 CINAHL（更新至 2021 年 11 月）、临床试验数据库以及检索到的文章的参考文献列表进行检索。主要结局为新生儿死亡率、全身感染、特应性皮炎、皮肤状况和不良事件。两位作者分别评估了偏倚风险、提取数据，并使用相对风险（RR）综合效应估计值。采用 GRADE 方法评估证据的确定性。
我们筛选了 19243 条记录，纳入了 16 项符合条件的试验，涉及 5643 名参与者。其中 5 项试验纳入了 3352 名健康足月新生儿（足月=728；胎龄≥35 周=2624）；11 项试验纳入了 2291 名足月且有特应性发病风险但其他方面健康的新生儿。我们对这两组新生儿分别进行了分析。研究中保湿剂（乳膏或坚果、种子和植物油）从新生儿期开始使用，持续使用 4 周至 2 年。对于足月健康新生儿，荟萃分析表明，局部使用保湿剂可能对特应性皮炎几乎没有影响（RR=1.29，95%CI=0.96-1.72；两项试验，1408 名新生儿；低确定性证据）。对食物过敏（RR=0.84；95%CI=0.42-1.70；一项试验，233 名新生儿）、食物过敏原致敏（RR=1.31；95%CI=1.03-1.68；一项试验，234 名新生儿）和吸入性过敏原致敏（RR=0.97；95%CI=0.44，2.14；一项试验，234 名新生儿）、皮肤干燥（RR=0.74，95%CI=0.55-1.00；两项试验，294 名新生儿）和皮肤问题（RR=0.92，95%CI=0.81-1.05；两项试验，292 名新生儿）的影响仍不确定。对于“有风险”的新生儿，荟萃分析表明，干预可能降低特应性皮炎的风险（RR=0.74，95%CI=0.63-0.86；11 项研究，1988 名婴儿；中等确定性证据），但对食物过敏和食物或吸入性过敏原致敏的影响可能较小或没有。皮肤干燥和皮疹的影响仍不确定。
局部使用保湿剂可能不能预防足月健康新生儿的特应性皮炎。其他皮肤和过敏结局的数据很少。
M Priyadarshi，B Balachander，S Rao，S Gupta，MJ Sankar。在足月健康新生儿中使用保湿剂：系统评价。PROSPERO 2020 CRD42020177437。
