Skin-Microbiome Assembly in Preterm Infants during the First Three Weeks of Life and Impact of Topical Coconut Oil Application.

Plain Language Summary

The human skin hosts a diverse community of bacteria and fungi, known as the commensal skin microbiome, which plays a vital role in maintaining skin integrity, regulating barrier function, and contributing to the development of the infant's immune system. The external epidermal layer of the skin is not fully developed until week 34 of pregnancy. Consequently, the immaturity of the skin layers in preterm babies provides limited protection against infection and water loss and results in increased susceptibility to late-onset sepsis (LOS), typically associated with Staphylococcus spp. Antibiotic therapy, intravenous feeding and long hospitalisation times are additional contributors to preterm infants being more prone to healthcare-associated infections, commonly with such skin commensals. Skin emollients, including mineral oil-derived and natural oils, are commonly used in preterm infant care to mitigate water loss and enhance skin integrity, although their precise impact on further skin development is not fully understood. Recent research has suggested that topical coconut oil could improve preterm infant skin integrity and potentially reduce the risk of LOS, possibly due to its antimicrobial properties attributed to monolaurin and limited side effects. This study investigated the impact of topical coconut oil on the skin microbiome of preterm infants born before 30 weeks of pregnancy, compared to standard neonatal care as per NICU guidelines without topical coconut oil. A three week series of skin-microbiome samples were analysed from 72 preterm infants gathered as part of a previous randomised clinical trial (Novel antibacterial activity of monolaurin compared with conventional antibiotics by Carpo et al.- 2007). The findings showed that the skin microbiome diversity was highest on day 1 after birth, followed by a decline and the emergence of Staphylococcus genus dominance from day 7. Moreover, infants receiving coconut oil had lower microbiome diversity compared to those receiving standard skin care. The study sheds light on the rapid changes in the skin microbiome during the first week of life and the potential modifying effects of topical coconut oil therapy. Understanding how emollient therapies, such as coconut oil, can affect the skin microbiome in preterm infants is crucial for clinical practice and the development of appropriate skin care protocols for neonates.