Intervention Review

Topical ointment for preventing infection in preterm infants

  1. Jeanette M. Conner1,*,
  2. Roger Soll2,
  3. William H Edwards3

Editorial Group: Cochrane Neonatal Group

Published Online: 20 OCT 2003

Assessed as up-to-date: 23 JUL 2003

DOI: 10.1002/14651858.CD001150.pub2


How to Cite

Conner JM, Soll R, Edwards WH. Topical ointment for preventing infection in preterm infants. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD001150. DOI: 10.1002/14651858.CD001150.pub2.

Author Information

  1. 1

    Vermont Oxford Network, Neonatal, Burlington, Vermont, USA

  2. 2

    University of Vermont, Division of Neonatal-Perinatal Medicine, Burlington, Vermont, USA

  3. 3

    Dartmouth-Hitchcock Medical Center, Department of Pediatrics, Lebanon, NH, USA

*Jeanette M. Conner, Neonatal, Vermont Oxford Network, 33 Kilburn St., Burlington, Vermont, 05401, USA. jconner@mayaintegratedmedicine.org.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 OCT 2003

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Nosocomial sepsis is a frequent and serious complication of premature infants. The increased susceptibility of ELBW infants to infection has been attributed to less effective immune function compared to mature newborns and the invasive nature of necessary supportive care. Breakdown of the barrier function of the skin may be an additional risk factor for nosocomial sepsis.

Objectives

To assess the effect of prophylactic application of topical ointment on nosocomial sepsis rates and other complications of prematurity in preterm infants.

Search methods

Searches were made of the Cochrane Central Registry of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2003), Ovid DC MEDLINE through June 2003, previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, and journal hand searching in the English language.

Selection criteria

Randomized controlled trials which compared the effect of prophylactic application of topical ointment to routine (standard) skin care or as needed topical therapy in preterm infants are included in this review.

Data collection and analysis

Data regarding clinical outcomes including infection [including any bacterial infection, bacterial infection with a known pathogen, coagulase negative staphylococcal infection, fungal infection, and any nosocomial infection (bacterial or fungal)], patent ductus arteriosus, oxygen requirement at 28 days, chronic lung disease and mortality were excerpted from the reports of the clinical trials by the reviewers. Data analysis was done in accordance with the standards of the Cochrane Neonatal Review Group.

Main results

Four randomized controlled trials were identified. All four studies reported improved skin condition in infants treated with prophylactic topical ointment (results not reported here).

All four studies reported on the incidence of any nosocomial infection, fungal infection and coagulase negative staphylococcal infection. Infants treated with prophylactic topical ointment are at increased risk of coagulase negative staphylococcal infection (typical relative risk 1.31, 95% CI 1.02, 1.70; typical risk difference 0.04, 95% CI 0.00, 0.08); and any nosocomial infection (typical relative risk 1.20, 95% CI 1.00, 1.43; typical risk difference 0.05, 95% CI 0.00, 0.09). A trend toward increased risk of any bacterial infection was found in infants treated with prophylactic topical ointment (typical relative risk 1.19, 95% CI 0.97, 1.46; typical risk difference 0.04, 95% CI -0.01, 0.08). There was no significant difference found in the risk of bacterial infection with a known pathogen, fungal infection, or other complications related to prematurity.

Authors' conclusions

Prophylactic application of topical ointment increases the risk of coagulase negative staphylococcal infection and any nosocomial infection. A trend toward increased risk of any bacterial infection was noted in infants prophylactically treated. Topical ointment should not be used routinely in preterm infants.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Topical ointment for preventing infection in preterm infants

It is common for preterm babies to develop infections while in hospital. The ability of preterm babies to fight infection is compromised and their skin is not fully formed and may be an ineffective barrier to infection. Applying ointment to the skin may protect against skin breakdown and thereby prevent germs from spreading into the blood stream and causing serious infection. Four trials included 1304 preterm infants (range 19 to 1191 in each trial) compared infants who received routine application of ointment to infants who received routine skin care, including ointment application if needed for skin breakdown. In infants who received routine application of ointment, their skin conditions improved but they experienced more infections, particularly with a bacteria of the skin know as coagulase negative staphylococcus. The reason for this increase in infection is unclear. Perhaps there was contamination of the ointment with bacteria or perhaps the ointment created a favorable environment for the spread of germs.

The practice of regularly applying ointment (as opposed to only using ointment when there is evidence of skin breakdown) may not be beneficial to premature infants in decreasing their risk of infection. Limitations to this review included the wide range of gestational ages of the preterm infants (26 to 36 weeks) and the different ways ointment was applied, from individual tubes or sterile syringes.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

早產兒使用局部藥膏以避免感染

院內感染對於早產兒來說是一個頻繁和嚴重的併發症。由於相對於比較成熟的新生兒,其免疫功能較差,且較需要侵入性的支持治療,因此,更增加了感染的易感受性。被破壞屏障功能的皮膚可能是一種額外的風險會造成院內敗血症。

目標

評估預防性使用局部藥膏來預防早產兒發生院內敗血症率及其他併發症。

搜尋策略

搜查從2003年6月開始的Cochrane中央登記處的對照試驗(CENTRAL, The Cochrane Library, Issue 2, 2003),Ovid DC MEDLINE ,前人的review,包括交叉引用,摘要,會議和專題討論會程序,專家訊息和英文雜誌搜索。

選擇標準

本試驗採取隨機對照試驗,比較早產兒中預防性地例行使用局部軟膏理或視需要局部治療的效果。

資料收集與分析

審查者收錄集了臨床試驗報告中的結果,包括感染[包括任何細菌感染,已知病原體的細菌感染,凝固?陰性葡萄球菌感染,真菌感染,任何院內感染(細菌或真菌) ,開放性動脈導管,在28天時仍需氧氣,慢性肺病疾病和死亡率。數據分析是根據科克倫新生兒審查小組所訂定的標準完成。

主要結論

本審查中包含了4個隨機對照試驗。所有4個研究報告認為嬰幼兒預防性使用局部軟膏改善皮膚狀況(此處沒有報告結果)。所有研究報告了任何院內感染,真菌感染和凝固?陰性葡萄球菌感染的發病率。使用預防性局部軟膏的嬰幼兒可能面臨更大的風險感染凝固?陰性葡萄球菌(typical relative risk: 1.31,95 % CI為1.02, 1.70; typical risk difference: 0.04, 95 % CI為0.00, 0.08); 和任何院內感染(typical relative risk 1.20, 95 % CI為1.00, 1.43; typical risk difference 0.05,95 % CI為0.00, 0.09)。在使用預防性局部軟膏的嬰兒中發現,任何細菌感染的風險有增加的趨勢(typical relative risk: 1.19,95 % CI為0.97, 1.46; typical risk difference: 0.04,95 % CI為−0.01,0.08)。而已知病原體的細菌感染、真菌感染,或其他相關的早產併發症並無顯著差異。

作者結論

預防性使用局部軟膏增加了凝固脢陰性葡萄球菌感染與任何院內感染的危險性。而預防性使的嬰兒對於任何細菌感染也有危險性增加的趨勢。外用軟膏不應常規使用於早產兒。

翻譯人

本摘要由高雄醫學大學附設醫院吳佩玲翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

等待摘要