TOP 7 - Effect of Topical Coconut Oil Application on the Skin Barrier Maturation of Very Low Birth Weight (VLBW) Preterm Infants

Publication Number: 2823.TOP 7

Salony Dighamber, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Vivek Narendran, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Marty O. Visscher, University of Cincinnati, Cincinnati, OH, United States; Victor Burklow, University of Cincinnati College of Medicine, Erlanger, KY, United States; Andrew N. Carr, Procter & Gamble, Cincinnati, OH, United States; Likitha A C, Vydehi institute of medical sciences and research center, Bangalore, Karnataka, India; Kishore RAJAGOPAL. Kumar, Cloudnine Hospitals India, BENGALURU, Karnataka, India

Background: The full-term neonatal epidermal barrier is well-formed while the premature skin barrier is underdeveloped, increasing their risk for transepidermal water loss (TEWL), increased permeability, irritant exposure, injury, delayed maturation, and infection. Randomized controlled trials of whole body (below neck) virgin coconut oil (VCO) versus controls in preterm infants, showed improved skin condition and decreased infection rates. VCO has antimicrobial and anti-inflammatory properties due to its high concentration of lauric fatty acid.

Objective: We hypothesized that topical VCO would increase the skin barrier maturation rate and integrity, assessed by biophysical measurements, skin surface proteomic biomarkers and skin microbiome. By hypothesis, epidermal structural barrier proteins, transglutaminase 3, filaggrin, filaggrin 2, cystatin A, S100 calcium-binding protein A8, arginase 1, Cathepsin A, tissue specific transplantation antigen P35B, Elafin, keratin 5 and serpin family B member 3 will be higher in VCO treated skin, indicative of faster barrier maturation. Decreased pathogenic skin bacteria and improved diversity of commensal bacteria are suggestive of barrier maturation. Reduced skin pH and decreased TEWL are indicative of improved barrier integrity.

Design/Methods: Premature infants (24 - 37 weeks) in a level 3 NICU in India were randomized to whole body treatment with VCO (5 ml/kg) twice daily for 14 days and compared to no treatment. Lateral aspects of leg and buttocks were evaluated using biophysical measurements (TEWL, Skin pH, Digital imaging), skin surface targeted proteomics using D-Squame tapes and skin microbiome with 16S V1-V2 sequencing methods. Premature infants (24 - 37 weeks) in a level 3 NICU in India were randomized to whole body treatment with VCO (5 ml/kg) twice daily for 14 days and compared to no treatment. Lateral aspects of leg and buttocks were evaluated using biophysical measurements (TEWL, Skin pH, Digital imaging), skin surface targeted proteomics using D-Squame tapes and skin microbiome with 16S V1-V2 sequencing methods.

Sixty-one infants were enrolled, average gestation age of 32.5 and 31.1 weeks for VCO and no treatment, respectively. There were no baseline demographic group differences. Culture positive sepsis, clinical sepsis, antibiotics use, leukopenia, and invasive catheter use was similar between groups. TEWL decreased over 14 days for both groups (p < 0.05 day 7 versus day 1). Skin pH was lower for VCO on day 14 for leg and buttocks skin (Figure 1). Microbiome and proteomic analyses are in progress.

Graphs for Figure 1
Figure 1 shows the leg skin pH (A) and the buttocks skin pH (B) values over time for subjects who participated for fourteen days. Skin pH was ~6.0-0.615 at birth. The pH of both coconut oil sites decreased over time relative to the starting values. In contrast, the pH values for no treatment were relatively constant.