Presented at the Neonatal Society 2010 Autumn Meeting.
Chaban B, Maimaris J, Wallen-Mitchell V, Bhatti T, Chuang S-L, Ogundipe E
Neonatal Unit, Chelsea and Westminster Hospital, Imperial College, London
Background: The survival of very preterm infants has improved over the past three decades but their mortality is highest in the first 7 days. The skin of the preterm infant is immature at birth and unable to serve as an effective epidermal barrier whose major functions include barrier to infection and prevention of transepidermal water loss (TEWL) which impacts directly on their metabolic, fluid and electrolyte balance. Over-hydration may be required to compensate for high TEWL resulting in electrolyte and metabolic upset in the first 7 days. This may further predispose them to other neonatal morbidity e.g. patent ductus arteriosus (PDA), intraventricular haemorrhage (IVH) and chronic lung disease (CLD). The aim of the study is to determine the effect of preservative free topical ointment therapy (Aquaphor) in newborn preterm infants on their TEWL measured using total body water (TBW) as a proxy, fluid intake and metabolic balance in the first week of life. Secondary outcomes of other morbidities i.e. sepsis, CLD, PDA and IVH were noted.
Methods: This is a prospective randomised controlled trial in a single tertiary centre in Central London. Twenty six newborn preterm infants <30 weeks gestation were randomised into 2 groups; treatment with Aquaphor or a control group. The infants TBW was measured using the Body Stat method as described for neonates by Tang that measured total body water content using bioelectric impedance. Ethical approval was obtained from the Riverside Ethics and informed consent was obtained from parents of all infants in the study. The student t test and Mann Whitney tests were used in statistical analyses.
Results: Despite the treated group being sicker at birth with higher CRIB scores (range 1 – 12 vs 0 – 7; p = 0.005), there was no statistically signficant difference in TBW between the 2 groups from day 4 – 7 of life. However, the treated group showed an improved trend in their base deficts from day 1 to 7 when compared to controls (see Table). This finding supports the hypothesis that metabolic balance in extreme preterms may improve with Aquaphor treatment in the first week of life. Secondary outcomes showed that the treated group had more septic screens after 48 hrs of life but there was no difference in culture proven sepsis between the groups.
Conclusion: Despite the treated group being sicker in the perinatal period, there was no increase in sepsis or metabolic derangement. Rather, the trend was for better metabolic balance in the treated group from day 1 – 7 when compared to controls. Larger studies are needed to elucidate the role of Aquaphor in preterm fluid control.
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2. Assessment of total body water using total body water using bioelectrical impedance analysis in neonates receiving intensive care. Tang W, Ridout D, Modi N; Arch Dis Child1997; 77: F123 – 126