Background: Inadequate skin care may increase morbidity in preterm infants. Skin care practices that support skin maturation have barely been investigated. Objectives: To investigate the effect of sunflower seed oil (SSO) on skin barrier development in low-birth-weight premature infants. Methods: 22 preterm infants (<48 h after birth, 1,500-2,500 g) were randomized into group C (control) and group SSO, receiving daily SSO application during the first 10 postnatal days, followed by no intervention. Transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin pH and sebum were measured <48 h after birth and on postnatal days 5, 11 and 21 on the forehead, abdomen, thigh and buttock. Results: Skin pH decreased, while sebum remained stable in both groups. In group C, TEWL remained stable; in group SSO, TEWL increased significantly on the abdomen, leg and buttock until day 11, followed by a decrease after SSO application had been stopped. Abdomen SCH remained stable in group C, but continuously decreased in group SSO until day 21. Conclusion: SSO application may retard postnatal skin barrier maturation in preterm infants.

1.
Chiou YB, Blume-Peytavi U: Stratum corneum maturation. A review of neonatal skin function. Skin Pharmacol Physiol 2004;17:57-66.
2.
Kanti V, Bonzel A, Stroux A, Proquitté H, Bührer C, Blume-Peytavi U, Garcia Bartels N: Postnatal maturation of skin barrier function in premature infants. Skin Pharmacol Physiol 2014;27:234-241.
3.
Bührer C, Bahr S, Siebert J, Wettstein R, Geffers C, Obladen M: Use of 2% 2-phenoxyethanol and 0.1% octenidine as antiseptic in premature newborn infants of 23-26 weeks gestation. J Hosp Infect 2002;51:305-307.
4.
Cooke A, Cork MJ, Danby S, Lavender T: A national survey of UK maternity and neonatal units regarding the use of oil for baby skincare. Br J Midwifery 2011;19:354-362.
5.
Darmstadt GL, Saha SK, Ahmed AS, Ahmed S, Chowdhury MA, Law PA, Rosenberg RE, Black RE, Santosham M: Effect of skin barrier therapy on neonatal mortality rates in preterm infants in Bangladesh: a randomized, controlled, clinical trial. Pediatrics 2008;121:522-529.
6.
Darmstadt GL, Saha SK, Ahmed AS, Chowdhury MA, Law PA, Ahmed S, Alam MA, Black RE, Santosham M: Effect of topical treatment with skin barrier-enhancing emollients on nosocomial infections in preterm infants in Bangladesh: a randomised controlled trial. Lancet 2005;365:1039-1045.
7.
Darmstadt GL, Badrawi N, Law PA, Ahmed S, Bashir M, Iskander I, Al Said D, El Kholy A, Husein MH, Alam A, Winch PJ, Gipson R, Santosham M: Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infants in Egypt: a randomized, controlled clinical trial. Pediatr Infect Dis J 2004;23:719-725.
8.
Edwards WH, Conner JM, Soll RF: The effect of prophylactic ointment therapy on nosocomial sepsis rates and skin integrity in infants with birth weights of 501 to 1,000 g. Pediatrics 2004;113:1195-1203.
9.
Darmstadt GL, Mao-Qiang M, Chi E, Saha SK, Ziboh VA, Black RE, Santosham M, Elias PM: Impact of topical oils on the skin barrier: possible implications for neonatal health in developing countries. Acta Paediatr 2002;91:546-554.
10.
Vaivre-Douret L, Oriot D, Blossier P, Py A, Kasolter-Pere M, Zwang J: The effect of multimodal stimulation and cutaneous application of vegetable oils on neonatal development in preterm infants: a randomized controlled trial. Child Care Health Dev 2009;35:96-105.
11.
Danby SG, AlEnezi T, Sultan A, Lavender T, Chittock J, Brown K, Cork MJ: Effect of olive and sunflower seed oil on the adult skin barrier: implications for neonatal skin care. Pediatr Dermatol 2013;30:42-50.
12.
Eichenfield LF, McCollum A, Msika P: The benefits of sunflower oleodistillate (SOD) in pediatric dermatology. Pediatr Dermatol 2009;26:669-675.
13.
Hartop PJ, Prottey C: Changes in transepidermal water loss and the composition of epidermal lecithin after applications of pure fatty acid triglycerides to skin of essential fatty acid-deficient rats. Br J Dermatol 1976;95:255-264.
14.
Nopper AJ, Horii KA, Sookdeo-Drost S, Wang TH, Mancini AJ, Lane AT: Topical ointment therapy benefits premature infants. J Pediatr 1996;128:660-669.
15.
Agarwal KN, Gupta A, Pushkarna R, Bhargava SK, Faridi MM, Prabhu MK: Effects of massage and use of oil on growth, blood flow and sleep pattern in infants. Indian J Med Res 2000;112:212-217.
16.
Yosipovitch G, Maayan-Metzger A, Merlob P, Sirota L: Skin barrier properties in different body areas in neonates. Pediatrics 2000;106:105-108.
17.
Garcia Bartels N, Mleczko A, Schink T, Proquitté H, Wauer RR, Blume-Peytavi U: Influence of bathing or washing on skin barrier function in newborns during the first four weeks of life. Skin Pharmacol Physiol 2009;22:248-257.
18.
Garcia Bartels N, Scheufele R, Prosch F, Schink T, Proquitté H, Wauer RR, Blume-Peytavi U: Effect of standardized skin care regimens on neonatal skin barrier function in different body areas. Pediatr Dermatol 2010;27:1-8.
19.
Lund CH, Osborne JW: Validity and reliability of the neonatal skin condition score. J Obstet Gynecol Neonatal Nurs 2004;33:320-327.
20.
Garcia Bartels N, Massoudy L, Scheufele R, Dietz E, Proquitté H, Wauer R, Bertin C, Serrano J, Blume-Peytavi U: Standardized diaper care regimen: a prospective, randomized pilot study on skin barrier function and epidermal interleukin-1alpha in newborns. Pediatr Dermatol 2012;29:270-276.
21.
Blume-Peytavi U, Hauser M, Stamatas GN, Pathirana D, Garcia Bartels N: Skin care practices for newborns and infants: review of the clinical evidence for best practices. Pediatr Dermatol 2012;29:1-14.
22.
Visscher MO, Chatterjee R, Munson KA, Pickens WL, Hoath SB: Changes in diapered and nondiapered infant skin over the first month of life. Pediatr Dermatol 2000;17:45-51.
23.
Agren J, Sjors G, Sedin G: Transepidermal water loss in infants born at 24 and 25 weeks of gestation. Acta Paediatr 1998;87:1185-1190.
24.
Kalia YN, Nonato LB, Lund CH, Guy RH: Development of skin barrier function in premature infants. J Invest Dermatol 1998;111:320-326.
25.
Aungst BJ: Structure/effect studies of fatty acid isomers as skin penetration enhancers and skin irritants. Pharm Res 1989;6:244-247.
26.
Stamatas GN, de Sterke J, Hauser M, von Stetten O, van der Pol A: Lipid uptake and skin occlusion following topical application of oils on adult and infant skin. J Dermatol Sci 2008;50:135-142.
27.
Taljebini M, Warren R, Mao-Oiang M, Lane E, Elias PM, Feingold KR: Cutaneous permeability barrier repair following various types of insults: kinetics and effects of occlusion. Skin Pharmacol 1996;9:111-119.
28.
Stamatas GN, Nikolovski J, Luedtke MA, Kollias N, Wiegand BC: Infant skin microstructure assessed in vivo differs from adult skin in organization and at the cellular level. Pediatr Dermatol 2010;27:125-131.
29.
Agren J, Sjors G, Sedin G: Ambient humidity influences the rate of skin barrier maturation in extremely preterm infants. J Pediatr 2006;148:613-617.
30.
Maayan-Metzger A, Yosipovitch G, Hadad E, Sirota L: Effect of radiant warmer on transepidermal water loss (TEWL) and skin hydration in preterm infants. J Perinatol 2004;24:372-375.
31.
Fox C, Nelson D, Wareham J: The timing of skin acidification in very low birth weight infants. J Perinatol 1998;18:272-275.
32.
Campbell JR, Zaccaria E, Baker CJ: Systemic candidiasis in extremely low birth weight infants receiving topical petrolatum ointment for skin care: a case-control study. Pediatrics 2000;105:1041-1045.
33.
Kulkarni A, Kaushik JS, Gupta P, Sharma H, Agrawal RK: Massage and touch therapy in neonates: the current evidence. Indian Pediatr 2010;47:771-776.
34.
Schachner L, Field T, Hernandez-Reif M, Duarte AM, Krasnegor J: Atopic dermatitis symptoms decreased in children following massage therapy. Pediatr Dermatol 1998;15:390-395.
35.
Voigt M, Schneider KT, Jahrig K: Analysis of a 1992 birth sample in Germany. 1. New percentile values of the body weight of newborn infants. Geburtshilfe Frauenheilkd 1996;56:550-558.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.