Chlorhexidine for prevention of neonatal colonization with group B streptococci. II. Chlorhexidine concentrations and recovery of group B streptococci following vaginal washing in pregnant women

Dykes, Anna-Karin; Christensen, Karen Kvist; Christensen, Poul; Kahlmeter, Gunnar

doi:10.1016/0028-2243(83)90096-5

Cited by 27 publications

(13 citation statements)

References 12 publications

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“…This agent has been used successfully in developed countries for prophylaxis against newborn colonization and infection with group B streptococcus. [420][421][422][423][424][425][426] community-based evidence. A study of the impact of chlorhexidine cleansing was undertaken in Malawi at an urban hospital, at a cost of $0.10 for each maternal-infant pair treated (Table 25).…”

Section: )mentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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ABSTRACT. Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developingcountry communities has not been reported.Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in communitybased neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning.Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies.Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care.Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy...

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Section: )mentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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“…5 It can suppress growth of bacteria for up to 24 h and its effectiveness is not reduced by the presence of blood or amniotic fluid. 1 Chlorhexidine has also been used as a skin and mucous membrane disinfectant in nurseries for many years. 1 Chlorhexidine has also been used as a skin and mucous membrane disinfectant in nurseries for many years.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Chlorhexidine disinfection during labor is a simple, cheap, and safe method of reducing GBS colonization without risk for development of bacterial resistance. [1][2][3] Chlorhexidine disinfection during labor is a simple, cheap, and safe method of reducing GBS colonization without risk for development of bacterial resistance.…”

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confidence: 99%

Chlorhexidine vs. sterile vaginal wash during labor to prevent neonatal infection

Eriksen

Sweeten

Blanco

1997

Infect. Dis. Obstet. Gynecol.

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Objective The purpose of this study was to determine if a dilute solution of chlorhexidine used as a one‐time vaginal wash intrapartum can reduce the use of postnatal antibiotics and neonatal infection. Methods Term pregnant women in labor were prospectively randomized to receive either 20 cc of 0.4% chlorhexidine (n = 481) or 20 cc of sterile water (n = 466) placebo. Exclusion criteria included fetal distress, clinical infection, cervical dilatation >6 cm, and known allergy to chlorhexidine. Outcome variables included the incidence of neonatal pneumonia, culture proven neonatal sepsis, and use of the antibiotics in the neonate. Continuous variables were compared using the Mann‐Whitney U‐test and discrete variables were compared with the chi‐square test. Results The length of ruptured membranes (mean ± S.D.) between the chlorhexidine group (408 ± 589 min) and control group (352 ± 318 min) was not significantly different (P = 0.85, 95% confidence interval 354–462). Fifteen neonates (3.2%) in the chlorhexidine group and 9 (1.9%) in the control group received antibiotics in the postnatal period (P = 0.32, 95% confidence interval 0.72–3.72). There was one case of pneumonia in the control group and no cases of sepsis in either group. Conclusions A one‐time chlorhexidine vaginal wash does not decrease the use of antibiotics or incidence of neonatal infection in our population. Infect. Dis. Obstet. Gynecol. 5:286–290, 1997. © 1998 Wiley‐Liss, Inc.

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“…The Swedish Chlorhexidine Study Group explored the minimum inhibitory and bactericidal concentrations of chlorhexidine, 39 described postcleansing vaginal concentrations of chlorhexidine and its residual effect on GBS carriage, 40,41 and demonstrated that trace levels of chlorhexidine could be absorbed through the vaginal mucosa. 42 Pilot studies showed that vaginal washing with chlorhexidine reduced newborn colonization with GBS compared with those born to nonwashed controls.…”

Section: Vaginal Cleansingmentioning

confidence: 99%

Safety and Impact of Chlorhexidine Antisepsis Interventions for Improving Neonatal Health in Developing Countries

Mullany

Darmstadt

Tielsch

2006

The Pediatric Infectious Disease Journal

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Affordable, efficacious, and safe interventions to prevent infections and improve neonatal survival in low-resource settings are needed. Chlorhexidine is a broad-spectrum antiseptic that has been used extensively for many decades in hospital and other clinical settings. It has also been given as maternal vaginal lavage, full-body newborn skin cleansing, and/or umbilical cord cleansing to prevent infection in neonates. Recent evidence suggests that these chlorhexidine interventions may have significant public health impact on the burden of neonatal infection and mortality in developing countries. This review examines the available data from randomized and nonrandomized studies of chlorhexidine cleansing, with a primary focus on potential uses in low-resource settings. Safety issues related to chlorhexidine use in newborns are reviewed, and future research priorities for chlorhexidine interventions for neonatal health in developing countries are discussed. We conclude that maternal vaginal cleansing combined with newborn skin cleansing could reduce neonatal infections and mortality in hospitals of sub-Saharan Africa, but the individual impact of these interventions must be determined, particularly in community settings. There is evidence for a protective benefit of newborn skin and umbilical cord cleansing with chlorhexidine in the community in south Asia. Effectiveness trials in that region are required to address the feasibility of community-based delivery methods such as incorporating these interventions into clean birth kits or training programs for minimally skilled delivery assistants or family members. Efficacy trials for all chlorhexidine interventions are needed in low-resource settings in Africa, and the benefit of maternal vaginal cleansing beyond that provided by newborn skin cleansing needs to be determined.

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Chlorhexidine for prevention of neonatal colonization with group B streptococci. II. Chlorhexidine concentrations and recovery of group B streptococci following vaginal washing in pregnant women

Cited by 27 publications

References 12 publications

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

Chlorhexidine vs. sterile vaginal wash during labor to prevent neonatal infection

Safety and Impact of Chlorhexidine Antisepsis Interventions for Improving Neonatal Health in Developing Countries

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