Abstract
# Background Natural oils are applied daily to newborn infant skin during massage in certain cultures. In hospitalized premature infants, topical oils reduced infection and improved skin condition. A community study among neonates in rural Nepal compared sunflower and mustard oils for effects on skin integrity. Particularly notable was the rapid increase in skin rash that peaked at day 14 and lessened by day 28 for both oils, a finding not previously reported. # Methods To investigate the rash physiology, high-resolution digital images were collected for a subset of 216 premature and full-term infants. Image features were characterized for type and severity, quantified for color and surface texture and compared to measures of skin barrier integrity. # Results Skin features were observed in 403 of 811 images, including localized erythema, discrete papules and an occasional pustule. Miliaria crystallina was noted in 32.2%. A second texture, with raised, “pebble” features, characterized 26%. Of 216 subjects, 61% had “pebble” on at least one visit. Miliaria severity increased and day 14 was higher than 1 and 7 (P<0.05). Pebble texture severity increased. Day 28 was higher than 1, 3 and 7 (P<0.05). Skin pH was lower and erythema, rash and massage numbers were higher for miliaria than without it (P<0.05). Subjects with and without pebble texture did not differ for skin integrity measures. # Conclusions An understanding of the maturational changes in qualitative and quantitative skin color and texture with routine neonatal oil massage provides the basis for leveraging this commonly practiced ritual to optimize skin care.
Highlights
Natural oils are applied daily to newborn infant skin during massage in certain cultures
Skin pH was lower and erythema, rash and massage numbers were higher for miliaria than without it (P
Efforts to develop the evidence base for low-cost efficacious interventions that can reduce neonatal mortality in these settings have demonstrated the critical role of neonatal skin, which provides robust innate immunity, antibacterial defense and protection
Summary
To investigate the rash physiology, high-resolution digital images were collected for a subset of 216 premature and full-term infants. Image features were characterized for type and severity, quantified for color and surface texture and compared to measures of skin barrier integrity. Images were collected from approximately 20% infants enrolled in a 1000 subject cluster-randomized study nested within a larger trial (ClinicalTrials.gov, NCT01177111) to determine the impact of topical skin emollient application on neonatal mortality and morbidity in Sarlahi District, Nepal.[7] Communities in the larger trial were randomized to promotion of full-body topical treatment (“newborn massage”) with either SSO (intervention) or MO (comparison), the nearly universal traditional practice in Nepal.[6] For communities with prior neonatal death statistics, randomization was restricted to ensure risk balance. Quasi-randomization was performed for districts without death data (LCM). Ltd (Jitpur, Nepal) every 4-6 weeks and stored at site headquarters at room tempera-
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