The randomized control trial aims to determine the effect of twice daily application of a commonly used coconut oil to the skin of neonates in the neonatal intensive care setting on the rate of late onset sepsis versus a no treatment control.
Purpose and Specific Aims The purpose is to determine the effect of twice daily topical coconut oil application on late onset sepsis in neonates admitted to the Neonatal Intensive Care Units of Indira Gandhi Institute of Child Health, Cloudnine Hospital at Old Airport Road, and Cloudnine Hospital at Jayanagar in Bangalore, India. The aim is to determine the effect of topical coconut oil application on: * The incidence of neonatal late onset culture positive sepsis * Neonatal skin integrity versus a no treatment control using standard skin evaluation methods * Biomarkers of neonatal innate immune function * Temperature instability, weight gain, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, chronic lung disease, and mortality. The investigators hypothesize that twice daily topical coconut oil application will reduce the incidence of late onset sepsis (LOS) in premature and full-term infants versus the current standard of care, i.e., no treatment. The oil treatment will increase the neonatal skin barrier integrity measured by validated clinical and instrumental methods. Skin surface biomarkers of innate immune function collected from coconut oil treated skin will indicate less inflammation (lower proinflammatory cytokine levels) than in untreated control skin.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
420
Coconut oil, Parachute oil composition: 92% lauric (C12) fatty acid, 6% oleic fatty acid, 2% linoleic fatty acid
Cloudnine Hospital
Bangalore, India
RECRUITINGIndira Gandhi Institute of Child Health
Bangalore, India
WITHDRAWNLate-onset sepsis rate for intervention versus control
Incidence of late-onset sepsis is defined as an infection that occurs on or after day 3 of life
Time frame: Day 3 of life until discharge or day of life 28, whichever occurs first
Skin erythema
The skin erythema (redness) of the outer thigh and perianal region will be quantified from visual inspection of high resolution digital photographs that will be collected with standard positioning and lighting and color corrected. The area of coverage and severity of erythema will be judged using published, validated grading scales.
Time frame: Day 3 of life until discharge or day of life 28, whichever comes first
Skin rash
The skin rash of the outer thigh and perianal region will be quantified from visual inspection of high resolution digital photographs that will be collected with standard positioning and lighting and color corrected. The area of coverage and severity of rash will be judged using published, validated grading scales.
Time frame: Day 3 of life until discharge or day of life 28, whichever comes first
Skin dryness
The skin dryness of the outer thigh and perianal region will be quantified from visual inspection of high resolution digital photographs that will be collected with standard positioning and lighting and color corrected. The area of coverage and severity of dryness/scaling will be judged using published, validated grading scales.
Time frame: Day 3 of life until discharge or day of life 28, whichever comes first
Skin transepidermal water loss
The rate of transepidermal water loss of a site on the outer thigh will be measured as grams/meter2/hour using a standard, closed-chamber instrument known as the Vapometer. This instrument will provide the transepidermal water loss value once the system reaches equilibrium. This method has previously been validated and is used routinely for skin measurements.
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Time frame: Day 3 of life until discharge or day of life 28, whichever comes first
Skin surface acidity (pH)
The skin surface acidity of a site on the outer thigh and a site on the buttocks covered by the diaper will be measured using a flat surface electrode device that is calibrated daily to buffers of pH 4 and pH 7. The surface acidity is given in pH units which are the negative log to the base 10 of the hydrogen ion concentration of water placed on the skin by the instrument probe. The instrument is designed for use on the skin and has been validated.
Time frame: Day 3 of life until discharge or day of life 28, whichever comes first
Set of skin surface proteins of known innate immune function
There are proteins in the skin surface layers known to be biomarkers of innate immune function. Each protein will be quantified and reported as picograms of protein per microgram of total protein. The specific proteins are: filaggrin, filaggrin 2, transglutaminase 3, S100A8 (antimicrobial, calcium binding protein), S100A7 (antimicrobial, calcium binding protein), SERPINB3 (cysteine protease inhibitor), SERPINB4 (protease inhibitor), elafin (protease inhibitor) keratins 1, 6A and 6B (structural proteins) and fatty acid elongase 1 (lipid). Levels of each protein will be evaluated together to compare effect of the intervention versus control. Samples from skin surface will be collected using two sequential adhesive tapes (gentle adhesive) placed on the skin sites (thigh, buttocks covered by diaper) for one minute each, removed and stored at -80 deg C until analysis. The proteins will be extracted and analyzed for using standard techniques of tandem mass spectrometry.
Time frame: Day 3 of life until discharge or day of life 28, whichever comes first
Skin Microbiome
Microbiome analyses of neonatal skin and stool to determine the effect of coconut oil versus no treatment on microflora
Time frame: Day 3 of life until discharge or day of life 28, whichever comes first
Chronic lung disease
The incidence of chronic lung disease among the subjects in the intervention (coconut oil) will be compared to the incidence in the no treatment control during the study period. Chronic lung disease will be diagnosed based on the subject's oxygen requirement at 36 weeks corrected age.
Time frame: Day 3 of life until discharge or day of life 28, whichever comes first
Causative Organisms of Sepsis
Sepsis diagnosis includes determination of the organisms to which sepsis was attributed
Time frame: Day 3 of life until discharge or day of life 28, whichever comes first
Necrotizing enterocolitis
The impact of coconut oil versus no treatment on the incidence of necrotizing enterocolitis during the study period
Time frame: Day 3 of life until discharge or day of life 28, whichever comes first.