Comparison of the effect of human milk and topical hydrocortisone 1% on diaper dermatitis

Effectiveness of breast milk in the healing of medical adhesive-related skin injuries in peripheral intravenous catheter securement: A randomized controlled trial

BACKGROUND

Skin injuries, which are more prevalent among premature infants, can prolong the hospital stay of preterms in neonatal intensive care units.

AIM

This study aimed to assess the effectiveness of breast milk in reducing the healing time of skin injuries caused using medical adhesive for securing peripheral intravenous catheters (PIVCs) in late preterm infants, which was evaluated using the Neonatal Skin Condition Scale (NSCS). A randomized controlled trial was conducted with two parallel groups in a 1:1 allocation ratio.

STUDY DESIGN

It was conducted in the Neonatal Intensive Care Unit of a hospital in Karaman, Turkey between August and November 2022 with 72 preterm infants born at 35-36 weeks with stable health status and having intravenous catheter securement to the skin with medical adhesive tapes, with the tapes remaining on the skin for a minimum of 24 h and a maximum of 32 h. Preterm infants were randomly assigned to breast milk or routine care groups. The site of the skin injuries was evaluated by two independent observers using the NSCS once every 60 min until the injury was completely healed. A one-way ANOVA and repeated measures analysis of variance was used to analyse the data.

RESULTS

The average postnatal age was 3.32 ± 0.99 days, and the total duration of medical adhesive tape on the skin was 28.21 ± 2.59 h. A significant difference was found between the mean skin condition scale scores of the infants in the breast milk group (F = 117.219, p < .001) and the routine care group (F = 122.247, p < .001) according to time within the group. The skin injuries of preterm infants in the breast milk group decreased significantly in the first 3 h after the procedure.

CONCLUSION

Breast milk application was more effective than routine care in reducing the healing time of skin injuries.

RELEVANCE TO CLINICAL PRACTICE

It can be recommended to use breast milk to heal skin injuries in preterm infants.

The Effect of Breast Milk from Different Lactation Stages on in Vitro Wound Healing

Objective: Wound healing is a complex and dynamic process essential for restoring tissue integrity and homeostasis. It is thought that breast milk contributes positively to the wound healing process, thanks to the components it contains. The aim of this study is to compare the effects of breast milk on the wound healing process at different lactation stages and to evaluate the underlying mechanism(s). Materials and Methods: The effects of breast milk from different lactation stages (colostrum, transitional, and mature milk) on wound healing were determined by in vitro scratch assay in L929 fibroblast cells. 2,2-Diphenyl-1-picrylhydrazyl (DPPH), total oxidant, and antioxidant capacity were used to confirm antioxidant effects. The effect of breast milk on netrin-1 levels in L929 cells was elucidated by ELISA. Results: Breast milk at different lactation stages promoted wound healing. While the wound closure percentage was determined as 48.7% in the control group, this rate was determined to be the highest at 81.6% in the mature milk group (p:0.0002). The free radical scavenging capacity of colostrum, transitional, and mature milk with DPPH was determined as 49.69%, 60.64%, and 80.85%, respectively, depending on the lactation stages. Netrin-1 levels detected by ELISA were determined as 490.1 ± 6.5 pg/mL in the control group, while the lowest level was determined as 376.6 ± 4.5 pg/mL in mature milk (p:0.0003). Conclusions: Breast milk, especially mature milk, promoted wound healing on L929 cells by suppressing netrin-1 levels and scavenging free radicals.

The effect of topical application of breast milk and education on preventing diaper dermatitis in children in rural areas

PURPOSE

This study aimed to ascertain the impact of topical breast milk and diaper-area care instruction on the prevention of diaper dermatitis in rural settings.

DESIGN AND METHODS

This was a pre-test-post-test experimental study with forty-eight 6-18-month-old children and their mothers. Participants were randomly assigned to three groups: two experimental groups (Group A: breast milk, Group B: education) and one control group (Group C). Data were collected face-to-face through home-visits. A sociodemographic data and diaper-area care practices form and The Scale for Assessing the Severity of Uncomplicated Diaper Dermatitis in Infants were used for data collection.

RESULTS

There was a statistically significant difference between children who used breast milk application to prevent dermatitis compared to children whose parents received diaper-area care education and a control group (p = 0.002).

CONCLUSIONS

It was determined that topical breast milk application and diaper-area care education given to mothers were effective in preventing diaper dermatitis, and the application of breast milk was found to be safe and more effective than education.

PRACTICE IMPLICATIONS

These findings highlight the need for education, information and practical solutions to prevent and appropriately treat diaper dermatitis.

Topical Use of Human Milk in the Neonatal Intensive Care Unit: An Integrative Review

BACKGROUND

Research has shown that the bioactive components in human milk could demonstrate efficacy when applied topically. One common neonatal skin issue is diaper dermatitis (DD). DD treatment and prevention guidelines often lack the inclusion of topical human milk as a viable option.

PURPOSE

To analyze the safety and efficacy of topical human milk application as a means to support future research of human milk as a topical treatment for DD.

DATA SOURCES

Google Scholar, CINAHL, PubMed, and Cochrane.

STUDY SELECTION

The search was limited to articles published between 2011 and 2023 in the English language. Disqualifying characteristics included nonhuman subjects, literature reviews, inability to obtain articles, and non-peer-reviewed articles.

DATA EXTRACTION

For Google Scholar, the search terms "human milk OR breast milk" and "topical" were used. For CINAHL, PubMed, and Cochrane, the search terms "human milk OR chest milk OR breast milk OR donor milk" and "topical" were used. Quantitative significance was defined by a P value of less than .05.

RESULTS

The search yielded 20 articles. The results of the review demonstrate that topical human milk application is a safe and effective topical treatment to skin integrity/inflammatory issues such as DD. It also identified that caregivers will likely show positive regard to the treatment, promoting its acceptance.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The results provide evidence to support methodologic development for human milk application for the prevention and treatment of DD. Further studies can use the results to develop protocols that investigate the effects of human milk application.

An Integrative Review of Clinical Characteristics of Infants With Diaper Dermatitis

BACKGROUND

Diaper dermatitis (DD) severity is demonstrated by the degree of erythema and skin breakdown. Many studies describe diaper dermatitis, but lack a full description of clinical characteristic (CC) involvement.

PURPOSE

The purpose of this literature review is to explore the descriptions of CC of infants with DD provided within infant DD literature.

SEARCH STRATEGY

PubMed and Web of Science were searched using the keywords: diaper dermatitis, diaper rash, infant, and neonate. The inclusion criteria for this project are as follows: published after 1990, English language, include skin assessment or evaluation, and infant/children < two years of age. Review and opinion articles were excluded.

RESULTS

A total of 454 studies were retrieved, 27 remained after review for duplicates and relevance. The CC described most often were: type of feeds, stool frequency, history of DD, use of antibiotics, and delivery mode.

SYNTHESIS OF EVIDENCE

The studies reported inconsistent CC and a lack of correlation between these characteristics and the condition of diapered skin. Many studies focused solely on the efficacy of interventions lacking description of possible relationships between DD and CC.

IMPLICATIONS FOR PRACTICE

Skin condition outcome variables can be improved with the acknowledgment of the impact CC have on the development of DD. The combination of assessment measures and CC may ultimately demonstrate more merit or rigor for describing DD severity and skin condition.

IMPLICATIONS FOR RESEARCH

Future research should expand this exploration to include environmental or contributing factors to continue to identify additional risk factors for DD.

Milk lactoperoxidase decreases ID1 and ID3 expression in human oral squamous cell carcinoma cell lines

Milk consumption may modify the risk of squamous cell carcinoma. The role of milk to modulate the gene expression in oral squamous cell carcinoma cells has not been investigated so far. Here, HSC2 oral squamous carcinoma cells were exposed to an aqueous fraction of human milk and a whole-genome array was performed. Among the genes that were significantly reduced by human and cow milk were the DNA-binding protein inhibitor 1 (ID1), ID3 and Distal-Less Homeobox 2 (DLX2) in HSC2 cells. Also, in TR146 oral squamous carcinoma cells, there was a tendency towards a decreased gene expression. Upon size fractionation, lactoperoxidase but not lactoferrin and osteopontin was identified to reduce ID1 and ID3 in HSC2 cells. Dairy products and hypoallergenic infant formula failed to decrease the respective genes. These data suggest that milk can reduce the expression of transcription factors in oral squamous carcinoma cells.

Milk Therapy: Unexpected Uses for Human Breast Milk

BACKGROUND

Human breast milk provides a child with complete nutrition but is also a popular therapeutic remedy that has been used in traditional, natural pharmacopeia, and ethnomedicine for many years. The aim of this current review is to summarize studies of non-nutritional uses of mothers' milk.

METHODS

Two databases (PubMed and Google Scholar) were searched with a combination of twelve search terms. We selected articles that were published between 1 January 2010, and 1 January 2019. The language of publication was limited to English.

RESULTS

Fifteen studies were included in the systematic review. Ten of these were randomized controlled trials, one was a quasi-experimental study, two were in vitro studies, and four employed an animal research model.

CONCLUSIONS

Many human milk components have shown promise in preclinical studies and are undergoing active clinical evaluation. The protective and treatment role of fresh breast milk is particularly important in areas where mothers and infants do not have ready access to medicine.

Prevention and Management of Incontinence-Associated Dermatitis in the Pediatric Population: An Integrative Review

An integrative review was conducted to synthesize evidence on prevention and management of incontinence-associated dermatitis (IAD) in the pediatric population. A 5-step integrative process was used to guide the review. Articles published from January 2000 to April 6, 2017, were identified and retrieved from CINAHL, PubMed, ProQuest (MEDLINE), and Scopus; key terms were associated with IAD, pediatric, prevention, and management. Supplemental and manual searches were carried out to identify other relevant studies. The studies' findings were extracted and summarized in a table of evidence, with their quality evaluated using the Joanna Briggs Institute's Critical Appraisal Checklist. Sixteen articles were included in the review. Articles explored prevention and management strategies including skin cleansing technique, diaper selection, and the application of topical skin care products. Inconsistent and limited evidence was found regarding the benefits of using disposable wipes in preference to water-moistened washcloths in the cleansing process and on the use of superabsorbent polymer diapers with breathable outer lining in IAD prevention. Findings were inconclusive with regard to the best topical skin care product for IAD care. However, the application of skin protectants was encouraged by the authors, as well as promoted in various clinical guidelines. The development of a structured skin care regimen supplemented by a comprehensive patient education program was advised to enhance the prevention and management of IAD.

Systematic Review of the Effect of Topical Application of Human Breast Milk on Early Umbilical Cord Separation

OBJECTIVE

To evaluate the efficacy of topical application of human breast milk to reduce umbilical cord separation time.

DATA SOURCES

We used a three-step search strategy. First, we searched six electronic databases from inception through July 16, 2018: PubMed, Cochrane, CINAHL, Embase, Scopus, and ProQuest Dissertations and Theses Global. We used the following search terms: infant, newborn, baby, babies, colostrum, breast milk expression, breast milk, breastmilk, mother milk, human milk, umbilical cord, and umbilicus. We included published trials in English without any time limit to optimize the search. Second, we searched for ongoing clinical trials and grey literature. Last, we conducted a manual review of the reference lists of the identified articles.

STUDY SELECTION

From 1,303 articles initially screened, eight articles reporting seven randomized controlled trials (RCTs) were included in the systematic review and meta-analysis.

DATA EXTRACTION

Two independent reviewers used a standardized extraction form to extract data from eligible articles. We evaluated the quality of individual and overall evidence according to risk of bias and the Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) system.

DATA SYNTHESIS

Allocation concealment was not clearly identified in any of the studies. In only two trials were participants and personnel blinded to the intervention group, and in none was the assessment of outcomes blinded. The overall quality of evidence was very low for RCTs according to the GRADE criteria. We found a significant reduction in time to cord separation with the topical application of human breast milk (z = 6.22, p < .001), with a mean difference of -1.01 day (95% confidence interval [-1.3,-0.690]) compared with dry cord care. Incidence of omphalitis was not significantly different (risk ratio = 0.82, 95% confidence interval [0.57, 1.18], z = 1.06, p = .29) between human breast milk and dry cord care groups.

CONCLUSION

Topical application of human breast milk is an effective and safe way to reduce cord separation time. Given that the overall quality of the included RCTs was very low, further well-designed trials are needed.

TGF-β activity in cow milk and fermented milk products: An in vitro bioassay with oral fibroblasts

OBJECTIVE

Milk is a rich source of transforming growth factor (TGF)-β which supports intestinal mucosal homeostasis of infants. Milk may also have beneficial effects on the integrity of the oral cavity, its being part of the gastrointestinal tract. However, it is unclear if milk and fermented milk products provoke a TGF-β response in oral cells.

MATERIAL AND METHODS

Human gingival fibroblasts were exposed to pasteurized cow milk, yoghurt, sour milk, buttermilk and whey, followed by a reverse transcriptase polymerase chain reaction of the TGF-β target genes interleukin11 (IL11), proteoglycan4 (PRG4), and NADPH oxidase 4 (NOX4). Immunoassays were performed for IL11 and TGF-β in cell culture supernatant and milk products, respectively. Signaling was investigated with the TGF-β receptor type I kinase inhibitor SB431542.

RESULTS

We report here that pasteurized cow milk and the aqueous fractions of yoghurt, sour milk, buttermilk and whey enhanced the expression of IL11, NOX4 and PRG4 in gingival fibroblasts. Moreover, IL11 protein levels in the respective supernatant were significantly increased. Cow milk, yoghurt, sour milk and buttermilk contain approximately 1-2 ng TGF-β1, whereas active TGF-β1 is hardly detectable in whey. SB431542 reduced the response of gingival fibroblasts to pasteurized cow milk and fermented milk products based on IL11 release into the supernatant.

CONCLUSIONS

These results demonstrate that gingival fibroblasts respond to pasteurized cow milk and to fermented milk products with an increased expression of TGF-β target genes.

Cells of human breast milk

Human milk is a complex fluid that has developed to satisfy the nutritional requirements of infants. In addition to proteins, lipids, carbohydrates and other biologically active components, breast milk contains a diverse microbiome that is presumed to colonize the infant gastrointestinal tract and a heterogeneous population of cells with unclear physiological roles and health implications. Noteworthy cellular components of breast milk include progenitor/stem cells. This review summarizes the current state of knowledge of breast milk cells, including leukocytes, epithelial cells, stem cells and potentially probiotic bacteria.

Assessment Effect of Breast Milk on Diaper Dermatitis

Diaper dermatitis is the most common dermatological disease of infancy, which occurs and caused by the combined effect of irritants such as diaper, urine and faces. In this study, we intend to evaluate the effect of breast milk on the healing of diaper dermatitis. This study was a clinical trial of 30 infants between 0-12 months of age that were suffering from diaper dermatitis and referred to the Health Centers in Tehran, Iran. The subjects were selected by open study. Infants were divided into two matched groups: case and control. Data-gathering tools were the questionnaire that contained two parts: the demographic characteristics of infants and the status of care and condition of the lesion. Data analysis was performed using SPSS/18 software and Mann-Whitney and Chi-Square tests were used. The findings revealed a significant difference between the case and control groups in the number and lesion score of the rashes at the first and third day (P=0.013, P=0.005), these differences were more significant at the fifth day (P=0.004, P=0.001). Because of positive effects of breast milk on healing of diaper dermatitis, it is proposed that educational programs in health centers should be considered by health officials, and the managers would play a key role in increasing knowledge behavior changes in mothers.

Efficacy of Traditional Medicine Product Henna and Hydrocortisone on Diaper Dermatitis in Infants

Background

Diaper dermatitis (DD) is a common inflammatory disorder in infants, including newborns.

Objectives

This study aimed to compare the effects of a traditional medicine product (containing natural henna oil 25%) and hydrocortisone 1% cream on DD in infants.

Patients and Methods

In a triple-blind, randomized trial, 82 children aged two years or less were randomly divided into two groups of 41 children each to receive either hydrocortisone ointment or henna medicinal product. Infants were treated 3 times a day for 5 days. The severity of dermatitis was assessed on the first, third, and fifth days using a six-point scale. The study was conducted in 2013 in a children teaching hospital in Qazvin, Iran.

Results

Both groups showed an improvement in the severity of DD (mean DD severity on the first, third and fifth days, respectively, was 3.20, 1.39, and 1.20 in the henna group versus 3.20, 2.05, and 1.90 in the hydrocortisone group; P < 0.001). The henna group showed a better response when compared with the hydrocortisone group: the rate of improvement on the fifth day of treatment was 90.2% (37 of 41 children without erythema) in the former versus 61% (25 of 41 patients) in the latter (P = 0.042). No significant side effects were observed in both the groups.

Conclusions

Henna, a traditional medicine product, can be considered an effective and appropriate treatment for DD in infants and children.

[What's new in paediatric dermatology?]

Regular analysis of the major journals in dermatology and paediatrics has been used to select forty articles which are representative of the past year in paediatric dermatology. This selection is not exhaustive but rather reflects the interests of the author and also the dominant topics in paediatric dermatology in 2013-2014.

Topical treatment with fresh human milk versus emollient on atopic eczema spots in young children: a small, randomized, split body, controlled, blinded pilot study

Background

Public health nurses report on effects of fresh human milk as treatment for conjunctivitis, rhinitis and atopic eczema (AE), the latter being highly prevalent in early childhood. Emollients and topical corticosteroids are first line treatment of AE. As many caregivers have steroid phobia, alternative treatment options for mild AE are of interest. The aim of this small pilot study was to assess the potential effects and risks of applying fresh human milk locally on eczema spots in children with AE.

Methods

This was a split body, controlled, randomized and physician blinded pilot study, of children with AE with two similar contralateral eczema spots having a mother breastfeeding the child or a sibling. Fresh expressed milk and emollient was applied on the intervention spot and emollient alone on the control area, three times a day for four weeks. The severity and area of the eczema spots was evaluated weekly, and samples from milk and the spots were analysed weekly with respect to bacterial colonisation.

Results

Of nine patients included, six completed the study. Mean age at inclusion was 18.5 months. The spots examined were localized on the arms, legs or cheeks. The spots were similar in severity, but differed in area. In one patient the eczema ceased after inclusion. In four patients both control and intervention areas increased during the intervention. The relative change in eczema area compared to baseline showed less increase in the intervention spots in two patients, whereas the opposite was observed in three. In four children Staphylococcus aureus was found in their eczema once or more. In three of the 28 human milk samples, Staphylococcus aureus, alfa haemolytic streptococci or coagulase negative staphylococci were detected. Staphylococcus aureus was found once both in human milk and in the eczema spots, no clinical signs of infection were however observed. No secondary infection due to milk application was detected.

Conclusion

In this small pilot study, no effect was found on eczema spots treated with topical application of fresh human milk. (ClinicalTrials.gov Identifier, NCT02381028).