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Skin care and Candidiasis
Systemic Candidiasis in Extremely Low Birth Weight Infants Receiving Topical Petrolatum Ointment (TPO) for Skin Care: A Case-Control Study. Campbell JR, Zaccaria E, and Baker CJ. Pediatrics 2000; 105:1041-50.
This study was done to determine whether an observed increase in the incidence in systemic Candida infections in a Houston NICU was associated with a change in skin care to the use of TPO, Data was analyzed on ten ELBW infants with systemic Candidiasis (SC) and 30 control infants. Each case infant was matched with 3 control infants for birth weight, admission date, and survival to the age of SC onset for the case. Eight of ten infants with SC received TPO for skin care, whereas only 8 of 30 (27%) of control infants received TPO (p < 0.01). The odds ratio for the development of SC in TPO treated versus control infants was 11 (95% conficence interval: 1.9-63). Skin care with TPO was discontinued, and the incidence of SC decreased to baseline.
Comments. It seems likely that the risk of Candida infections is increased with the use of petrolatum-based skin care products in ELBW babies. The TPO used in these patients was White Petrolatum United States Pharmacopeia, Sherwood Medical. Aquaphor ointment (Beiersdorf Inc) is also petrolatum-based. An earlier study by Nopper (J Peds 1996;128:660-9) showed that Aquaphor use actually decreased the incidence of nosocomial infections during the first 14 days of life in ELBW babies. It is unclear whether the increased risk of SC is limited to the skin ointment used in this NICU, or whether it will also be seen with other pertolatum-based products such as Aquaphor. While we await further studies to answer this question, we should probably minimize the use of TPOs for skin care in ELBW babies, and rely on a high-humidity environment to decrease insensible water loss and to prevent skin dryness and breakdown.
Andrew B. Kairalla MD