Position Statements Taken From Peer Reviewed Article for Publication in Advances in Skin and Wound
Neonate Skin Products Used in Oxygen-Enriched Environments May Pose Risks Associated with Flammability and Skin Breakdown
By: Darlene McCord, Ph.D., FAPWCA, Barry E. Newton, BSME, PE, Gwenael Chiffoleau, Ph.D
Neonatal health care has continued to advance over a period spanning three decades. However, the treatment of preterm and term infant skin has lagged behind. Current AWHONN and NANN guidelines call for the use of a petrolatum-based product in the neonate setting. Petrolatum may pose significant risks associated with NICU fire hazards, barrier occlusion, microbial contamination and toxin absorption. In order to reduce infant mortality and improve neonatal skin care, advanced emollient technologies should be considered. Semipermeable silicone derivatives have demonstrated a reduced rate of combustion as compared to petrolatum. Silicone derivatives also sustain transcutaneous respiration while preventing e-TEWL. Certain silicone-based emollients have further demonstrated a reduced rate of microbial contamination and toxin absorption. The purpose of this report is to review the risks associated with current highly-flammable and occlusive infant skin care products and discuss the benefits of oxygen-compatible, silicone-based neonatal emollients.
Flammability of Petrolatum
Petrolatum-based skin care emollients such as Aquaphor are composed of highly flammable hydrocarbons. Petrolatum itself is a semisolid mixture of hydrocarbons obtained by the fractional distillation of petroleum10. Paraffin and liquid paraffin are lower grades of petrolatum; both are composed of highly flammable hydrocarbons11. Lizhong et al. noted that hydrocarbon-oxygen mixtures are extremely explosive, especially in confined spaces. Each year numerous medical centers report fires caused by ignition in an oxygen-enriched environment. Sheffield et al. confirmed that enclosed fires occur in enriched oxygen atmospheres and in the presence of abundant, flammable substances. Furthermore, fires ignited in enclosed areas enriched with greater than 28% oxygen were associated with the highest rates of mortality. Victims exposed to hydrocarbon-oxygen fires frequently die from extreme heat before carbon monoxide inhalation becomes a significant factor. The severe heat is intensified by the water vapor created during hydrocarbon combustion. In summary, the application of petrolatum based emollients to preterm infants in oxygen-enriched systems may endanger neonate survival.
Risks of Mineral Oil
Mineral oil is yet another popular ingredient derived from petroleum that is found in recommended neonatal emollients. The petroleum-derivative is used industrially in machine shops as a cutting fluid and lubricating oil. Similar to petrolatum, mineral oil is highly flammable and imposes the risk of occluding the skin, thus trapping microorganisms and toxins between the stratum corneum and the applied barrier. Consequently, the skin becomes irritated, infected and incapable of performing proper barrier functions. Moreover, the FDA requires infant skin care products such as Johnsonâ€™s baby oil to print the following label warning.
Do not apply to irritated skin. If rash occurs discontinue use.
Numerous reports have found that mineral oils contain strong concentrations of potent carcinogens, namely polycyclic aromatic compounds. Roy et al. compared the mutagenicity, polynuclear aromatic compound content and skin carcinogenicity of a series of petroleum-derived mineral oil mixtures. The study found that mineral oil carcinogens are strongly linked to mutagenic and dermal carcinogenic activities. Therefore, mineral oil application to underdeveloped neonatal skin may contribute to barrier breakdown and dysfunction.
Petrolatum is a fraction of petroleum, which consists of hydrocarbon molecules, including oxygen, nitrogen and sulfur atoms. The hydrocarbon constituents of petroleum form paraffins, olefins, and cycloparaffins, which are used to produce gasoline, kerosene, diesel fuel, asphalt, tar and petrolatum. The processing of petroleum to petrolatum removes various toxins via sulphuric acid treatment and earth filtering. However, petroleum contamination during the poorly regulated purification process remains a considerable risk. In sum, the toxic impurities of petrolatum provide strong evidence against the application of petrolatum-based products to sensitive neonatal skin.