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Chlorhexidine baths in preterm infants — are we there yet?

Journal of Perinatology volume 39, pages 1014–1015 (2019)Cite this article

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We enjoyed reading the article by Johnson et al. [1] presenting the efficacy of chlorhexidine (CHG) baths in preterm neonates. A key finding was the temporary reduction in skin bacterial burden in 18 preterm neonates, which returned to baseline by ~72 h with no reported healthcare-acquired infections (HAI) or adverse skin events. Although the study demonstrated efficacy, it does not highlight the safety concerns perceived by many neonatologists regarding CHG use for central line insertions and dressing changes, let alone for routine baths. The results of this study may potentially increase CHG use in this at-risk population without convincing evidence of long-term safety.

The epidermis in preterm infants is immature with thin stratum corneum that does not fully mature until about 34 weeks, leading to higher risk of local complications of CHG such as contact dermatitis, and chemical burns. Furthermore, detectable serum levels from systemic absorption have been shown after topical CHG exposure in preterm infants ≥1500 grams (≥7 days old), and at low concentrations [2, 3]. The risk is higher in smaller infants with poor skin integrity. The blood–brain barrier permeability to CHG and its neurological impact on the immature preterm brain are unknown. Fears of CHG-related neurodevelopmental complications stem from previous experience using Hexachlorophene (a phenol derivative similar to CHG) to decrease HAIs in the 1970 s, which later was found to be associated with vacuolar encephalopathy [4]. CHG also had a clear toxic effect on the vestibular and cochlear function in sand rats. Milstone et al. showed that in vitro CHG use decreased neuronal growth at concentrations similar to blood levels found in preterm infants exposed to CHG [5].

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References

  1. Johnson J, Suwantarat N, Colantuoni E, Ross TL, Aucott SW, Carroll KC, et al. The impact of chlorhexidine gluconate bathing on skin bacterial burden of neonates admitted to the Neonatal Intensive Care Unit. J Perinatol. 2019;39:63–71.

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  1. Division of Neonatology, Department of Pediatrics, NYU Winthrop Hospital, Mineola, NY, USA

    Ranjith Kamity & Nazeeh Hanna

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  1. Ranjith Kamity
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  2. Nazeeh Hanna
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Correspondence to Ranjith Kamity.

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Kamity, R., Hanna, N. Chlorhexidine baths in preterm infants — are we there yet?. J Perinatol 39, 1014–1015 (2019). https://doi.org/10.1038/s41372-019-0378-x

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