Nopper A J, Horii K A, Sookdeo-Drost S, Wang T H, Mancini A J, Lane A T
Department of Dermatology, Stanford University School of Medicine, California 94305-5334, USA.
J Pediatr. 1996 May;128(5 Pt 1):660-9. doi: 10.1016/s0022-3476(96)80132-6.
Premature infants have an ineffective epidermal barrier. The aim of this study was to investigate the cutaneous and systemic effects of preservative-free topical ointment therapy in premature infants.
We conducted a prospective, randomized study of 60 infants less than 33 weeks' estimated gestational age. The treated infants received therapy for 2 weeks with twice-daily preservative-free topical ointment therapy while the control group received no topical treatment or as-needed therapy with a water-in-oil emollient. Data collection included transepidermal water loss (TEWL) measurement, skin condition evaluations, fungal and quantitative bacterial skin cultures, analysis of fluid requirements, patterns of weight low or gain, and the incidence of blood and cerebrospinal fluid cultures positive for microorganisms.
We found that topical ointment therapy significantly decreased TEWL during the first 6 hours after the initial application. TEWL was decreased by 67% (p = 0.0001) when measured 30 minutes after application and 34% (p = 0.001) when measured 4 to 6 hours after application. We also observed significantly superior skin condition scores in the treated group on study days 7 and 14 (p = 0.001) and 0.0004, respectively). Quantitative bacterial cultures revealed significantly less colonization of the axilla on day 2, 3, or 4 and on day 14 (p = 0.008 and 0.04, respectively). The incidence of positive findings in blood and/or cerebrospinal fluid cultures was 3.3% in the treated group of infants versus 26.7% in the control group (p = 0.02). There was no statistical difference in the fluid requirements or patterns of weight gain or loss during the 2 weeks of the study.
Preservative-free topical ointment therapy decreased TEWL for 6 hours after application, decreased the severity of dermatitis, and decreased bacterial colonization of axillary skin. Infants treated with ointment had fewer blood and cerebrospinal fluid cultures positive for microorganisms. These data support the use of topical ointment therapy in very premature infants during the first weeks after birth.
早产儿的表皮屏障功能不完善。本研究旨在探讨无防腐剂外用软膏疗法对早产儿皮肤及全身的影响。
我们对60名估计孕周小于33周的婴儿进行了一项前瞻性随机研究。治疗组婴儿接受为期2周的无防腐剂外用软膏治疗，每日两次，而对照组不接受外用治疗或根据需要使用油包水润肤剂治疗。数据收集包括经表皮水分流失（TEWL）测量、皮肤状况评估、真菌和定量细菌皮肤培养、液体需求量分析、体重增减模式以及血液和脑脊液培养物中微生物阳性的发生率。
我们发现，外用软膏治疗在首次应用后的最初6小时内显著降低了TEWL。用药后30分钟测量时TEWL降低了67%（p = 0.0001），用药后4至6小时测量时降低了34%（p = 0.001）。我们还观察到，治疗组在研究第7天和第14天的皮肤状况评分显著更高（分别为p = 0.001和0.0004）。定量细菌培养显示，在第2、3或4天以及第14天，腋窝的定植菌明显减少（分别为p = 0.008和0.04）。治疗组婴儿血液和/或脑脊液培养物阳性结果的发生率为3.3%，而对照组为26.7%（p = 0.02）。在研究的2周内，液体需求量或体重增减模式没有统计学差异。
无防腐剂外用软膏治疗在用药后6小时内降低了TEWL，减轻了皮炎的严重程度，并减少了腋窝皮肤的细菌定植。接受软膏治疗的婴儿血液和脑脊液培养物中微生物阳性的情况较少。这些数据支持在出生后的头几周对极早产儿使用外用软膏治疗。
