Topical application of emollients to maintain skin integrity in preterm neonates: a systematic review and meta-analysis

This systematic review and meta-analysis compared the efficacy and safety of topical emollient application in preterm neonates for maintaining skin integrity. The available evidence related to the effects of topical emollients vs. routine skin care was identified, appraised, and synthesized. The outcome measures were assessment of skin integrity, objectively defined by a skin condition score (SCS), incidence of culture-positive neonatal sepsis, mortality, trans-epidermal water loss, skin colonization, and adverse events. Data were pooled using RevMan Web. Certainty of evidence (CoE) was analyzed by GRADE. Nineteen trials comprising 5586 neonates were included for meta-analysis. A significant decrease in SCS was observed, favoring topical emollients [SMD (95% CI), − 1.11 (− 1.57, − 0.65), I² = 85%, 6 studies, n = 2807, high RoB, low CoE]. Although there was no overall difference in the incidence of culture-positive neonatal sepsis with topical emollients [RR (95% CI), 0.82 (0.61, 1.09), I² = 56%, 15 studies, n = 5297, high RoB, low CoE], a sensitivity analysis including studies comparing topical oil vs. routine care showed significant benefits favoring topical oil [RR (95% CI) 0.66 (0.47, 0.92), I² = 30%, 8 studies, n = 3392], whereas pooled data from studies including topical ointment/cream vs. routine care did not show any benefit [RR (95% CI) 1.03 (0.72, 1.48), I² = 26%, 8 studies, n = 2046]. There was no difference in mortality, and no major adverse events were reported. Data for other outcomes could not be pooled.

Conclusion: Low-CoE evidence suggested better skin integrity with topical emollients, and a lower incidence of culture-positive neonatal sepsis with topical oil application. High heterogeneity limits the generalizability of results.