by Crystal Lauer
Health Impact News
Most of us who have reached maturity take our body’s largest organ at face value, spending a staggering $300 billion on anti-aging globally and approximately $400 million U.S. dollars yearly on over-the counter acne solutions to put on a pretty face.
But for the newest and most vulnerable among us, preterm and full-term infants, healthy skin is critical to their very survival, and here is where researchers think virgin coconut oil may be a major contributor in the fight to lower preterm infant mortality.
Complications arising from preterm births are the leading cause of death globally for children under the age of five, according to the World Health Organization.
A preterm birth is defined as an infant born alive under 37 weeks of gestation. Preterm newborns have an underdeveloped skin barrier, which puts them at high risk for infection, as well as transdermal moisture loss resulting in electrolyte abnormalities and hypothermia, amongst other threats.
Infants born between 23 and 24 weeks have little to no outer layer or stratum corneum, which is formed during the final trimester of pregnancy. This layer of the skin has anti-microbials such as lysozymes and lactoferrin, etc., and it creates a tough physical barrier to irritants and water loss and allows for the necessary acid mantle formation in the newly born child.
A fully functioning acid mantle will then protect the body from bacteria and pollutants found in our environment through a combination of our own natural oils (sebum), sweat and dead skin cells.
In the premature infant, the stratum corneum is underdeveloped or missing, the epidermis is thin, and the dermis is structurally compromised.
Because of the fragility of the preterm skin, something as simple as diapering can cause damage to the protein structures because urine, fecal matter, friction, and over-hydration can degrade the skin the diaper is held in contact with, leading to an increase in infection and inflammation.
When the sixteen-layer stratum corneum is damaged or non-existent, water loss is already higher than normal, and in preterm infants under 36 weeks gestation, the ability to sweat is not present, contributing to a greater vulnerability to infection as well as decreased thermoregulation.
The vernix, which is a whitish film covering the skin of a full-term infant at birth, is composed of a mixture of water, protein and lipids which moisturizes, cleanses, heals, disinfects and repairs the skin of the newborn. This film facilitates the continued development and integrity of the epidermis of a full-term infant.
When the protective film of the vernix is missing, which is typical in neonates, it is one more issue contributing to the vulnerable state of the child and eliciting the need for a practical safe exogenous substitute to this film in the care of premature babies in the NICU.
Decreasing infant mortality rates is dependent, in a large part, on the safety and effectiveness of the practices used to maintain the developing skin barrier.
Emollients Linked to a Decrease in Preterm Deaths
Emollients have been shown to improve the condition of the vulnerable skin of the neonates, as well as that of infants and children with compromised skin. Emollients are linked to a decrease in preterm deaths and an increase in hydration in neonates, since healthy well-hydrated skin is in first line of defense in preventing dangerous infections.
Few published studies have been done on the topic of which type of emollients are most beneficial, and many more studies are certainly warranted. Amongst the research that has been done are studies on various vegetable oils and traditional methods that have shown hopeful results.
Mustard oil, which is commonly used across Asia as a topical skin barrier in the treatment of preterm infants, is being called into question for safety reasons.
A mouse study done in 2002, meant to evaluate the impact of topical oils on epidermal water loss in compromised skin, applied mustard oil to the mouse ‘pups’ twice daily for seven days.
They found even a single application not only delayed skin barrier repair, but also caused damage at a cellular level to the integrity and function of the skin. It was concluded by researchers that this widely-used oil was toxic to the skin of the newborn and presented a threat to the health of the neonate.
It’s long been agreed that not everything natural is safe for a child, and even more so with a premature infant. Vegetable oils, no matter how traditional or natural, are no exception to this rule.
Discovering the composition and effect of the individual vegetable oils on the neonate’s skin is an important step in the prevention of toxicity in their use in neonatal massage and for skin barrier purposes. This does not, however, negate the benefits of neonatal massage with vegetable oils, a practice which goes back as far as the 2nd century B.C. in China and is used traditionally throughout India and the Mediterranean area.
Studies have shown significant improvement in thermoregulation, weight gain, improved skin status, improved sympathetic nervous system development, a decrease in stress levels, improved respiration and heartrate, increased bone density, and lower mortality rates, with the use of various vegetable oils for neonatal massage. Recent studies have even correlated neonatal massage with higher levels of IGF-1 in the cortex resulting in observable increase in brain function as well as maturation of visual function.
Despite all the above-mentioned benefits that are received with neonatal massage, researchers are quick to assert that the types of oils used are of vital importance to consider, since many can have an adverse effect on the health and integrity of the preterm infant’s skin and overall health, and in some cases, do more harm than good.
While research has confirmed a significant delay in the skin barrier function with the use of vegetable oils such as olive oil, soybean oil and mustard oil, this is not so with the use of coconut oil boasting medium chain triglycerides.
The oil absorption through the fragile skin of the preterm infant has been proven, and is thought to contribute, to the resultant weight gains made by infants massaged with MCT-containing coconut oil. A noticeable increase in height was also observed in groups who were massaged with virgin coconut oil, nature’s richest source of MCTs.
The use of oil for massage was also observed to overcome inadequate fatty acids and to improve lipid profiles in infants who were regularly massaged with coconut oil.
Research into the use of topically applied virgin coconut oil (VCO) gives hope to preterm infants and those who suffer from atopic dermatitis and eczema, as it alters the expression of genes which are connected to the inflammatory response, and it improves hydration.
Interestingly, a recent study also showed a more positive outcome in neurodevelopment for premature infants who were massaged with virgin coconut oil.
This is important because studies into late preterm infants and reduced neurodevelopment indicate that there is an increased probability of learning disabilities, developmental delays, behavior problems, medical needs and even death.
In the same study, it was noted that there was less apnea, hypothermia and better overall skin maturation in the preterm infant group that was massaged with coconut oil topically twice a day as compared to the group which was massaged without oil.
In a randomized controlled study done at the intensive care unit at Aga Khan University Hospital in Pakistan, coconut oil was used as a topical emollient and applied to infants twice daily.
The study, which concluded on the twenty-eighth day of the infant’s life, showed a reduction in bloodstream infections and showed improvement in skin integrity, with no adverse effects detected.
Another trial, which was open label, randomized and controlled, was done to look at the effects of using coconut oil on very preterm babies <30 weeks gestation.
The study enrolled 73 infants total with thirty-six in each arm. The neonates were randomized and received either routine care or coconut oil twice daily starting at birth and lasting until their twenty-first day of life.
The collected data showed that coconut oil maintained superior skin integrity than the control group, again with no adverse effects.
These trials and others like them are shining the light on the safety and benefits of the topical use of coconut oil on both the very youngest and most vulnerable among us, as well as on those who are older and wiser.
Skin barrier function at some level or another can be a problem which affects both the preterm infant and the elderly, not to mention those who suffer with atopic dermatitis and eczema thrown in for good measure.
Because in many cases inflammation can be present, virgin coconut oil used topically can often bring fast relief in a safe and effective manner.
In some cases, the loss of hydration and skin thinning, cracking and splitting can easily become a very real problem for the elderly as well as those who suffer with skin barrier dysfunction.
With the anti-microbial benefits of virgin coconut oil and the low potential for side effects it presents, virgin coconut oil may be an excellent solution for young and old alike.
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References
GL Darmstadt, M Mao‐Qiang, E Chi, SK Saha, VA Ziboh, RE Black, M Santosham, and PM Elias. “Impact of Topical Oils on the Skin Barrier: Possible Implications for Neonatal Health in Developing Countries.” Acta Paediatrica 91, no. 5 (January 2, 2007): 546–54. https://doi.org/10.1111/j.1651-2227.2002.tb03275.x.
Guzzetta A1, Baldini S, Bancale A, Baroncelli L, Ciucci F, Ghirri P, Putignano E, et al. “Massage Accelerates Brain Development and the Maturation of Visual Function.” J Neurosci. 29, no. 18 (May 2009): 6042–51. https://doi.org/10.1523/JNEUROSCI.5548-08.2009.
Harpin VA, and Rutter N. “Sweating in Preterm Babies.” J Pediatr. 100, no. 4 (April 1982): 614–19. https://doi.org/10.1016/s0022-3476(82)80768-3.
Lindsey K. Elmore, PharmD, BCPS, Gwen Nance, Samantha Singleton, and Luke Lorenz. “Treatment of Dermal Infections With Topical Coconut Oil.” Natural Medicine Journal 6, no. 5 (May 2014). https://www.naturalmedicinejournal.com/journal/2014-05/treatment-dermal-infections-topical-coconut-oil.
MelissaWoythalerMS, DO. “Neurodevelopmental Outcomes of the Late Preterm Infant.” Seminars in Fetal and Neonatal Medicine 24, no. 1 (February 2019): 54–59.
Mithun Chandra Konar, Kamirul Islam, Atanu Roy, and Taraknath Ghosh. “Effect of Virgin Coconut Oil Application on the Skin of Preterm Newborns: A Randomized Controlled Trial.” Journal of Tropical Pediatrics, June 29, 2019. https://doi.org/10.1093/tropej/fmz041.
“Preterms.” World Health Organization, n.d.
Reza Saeidi, Zahra Ghorbani, and Abbas Shapouri Moghadam. “The Effect of Massage with Medium-Chain Triglyceride Oil on Weight Gain in Premature Neonates.” Acta Medica Iranica 53, no. 2 (July 8, 2013): 134–38.
Salam RA, Darmstadt GL, and Bhutta ZA. “Effect of Emollient Therapy on Clinical Outcomes in Preterm Neonates in Pakistan: A Randomised Controlled Trial.” Arch Dis Child Fetal Neonatal Ed. 100, no. 3 (May 2015): F210-5.
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