Effects of Topical Emollient Therapy on Infants at or Less than 27 Weeks’ Gestation
Preterm infants incur high losses of heat and insensible water due to a ratio of large surface area to body weight. Extreme preterm infants may have insensible water losses in excess of 100 cc/kg/day due to immature skin, larger exposed surface area and lack of subcutaneous tissue. Often by two weeks of life, there is a rapid maturation of the epidermis postnatally. This makes the first two weeks of life very critical in this group of preterm infants. It is estimated that at 23-28 weeks’ gestational age (GA), the epidermis is poorly developed, only 2-3 cell layers thick, with little development of the stratum corneum. As a result of the skin’s immaturity, there are high transepidermal water losses that lead to hypothermia and problems with fluid balance, as well as skin trauma leading to infection.
Preterm infants require a stable thermal environment to minimize heat and insensible water losses. Current nursery care provides an adequate environment using plastic shields or blankets, incubators, headcaps and topical emollients. Different methods of preventing insensible water losses have been investigated in the past 10-20 years. This research has ranged from topical emollients (Aquaphor® Eucerin®, petrolatum mixtures) and thermal blankets to Tega-derm® placed directly on the infant’s skin. Get the medication you need. Buy celecoxib 200 mg online
In 1981, Rutter et al. showed that skin water losses were reduced by 40-60% after one application of a petrolatum topical agent. In 1996, Nopper et al. concluded that topical therapy with Aquaphor ointment decreased skin water losses for six hours after one application and reduced incidence of bacterial colonization of axillary skin. The limitations of this study were that: 1) the study group included infants <33 weeks’ gestation and birthweight <1,500 g, rather than target the group of infants <28 weeks’ gestation, when lack of epidermal development is more of a problem; 2) clinical aspects of electrolyte balance were not part of the study. Going without your pills? Buy cheap atomoxetine hydrochloride online
After reviewing an article by Nopper et al., the neonatal intensive care unit (NICU) at our institution began the practice of applying Aquaphor topical emollient in January 1997 to all of our preterm, very-low-birth weight infants. To evaluate the effects of Aquaphor therapy on fluid requirements, serum electrolytes and other outcome measures in neonates <27 weeks’ gestation, we conducted the following study. omnicef medication