Safety of chlorhexidine gluconate used for skin antisepsis in the preterm infant

Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on Central Line–Associated Bloodstream Infections

“…25 Chlorhexidine, a chlorinated cationic biguanide, is not related to hexachlorophene and is commonly used in North American NICUs; 61% of 90 NICUs in the United States reported using CHG, most commonly for CVC skin preparation, without age or birth restrictions. 7 A recent survey of Canadian tertiary care pediatric hospitals and US freestanding children's hospitals also showed that 5 of 50 NICUs (10%) used CHG for bathing. 26 CHG has been detected in the blood of some preterm and term infants after whole body washing: in 95% of 10 infants when the sample was a capillary blood and in 5% of 17 infants when the sample was a venous blood taken 12 hours after bathing, with levels ranging from 91 to 460 /*g/L.…”

“…1 ' 2 Moreover, HAIs have documented major impacts to prevent infections. 7,8 Daily bathing with 2% CHG can preon premature infants outcomes. They have been associated vent CLABSI and other HAIs in adult settings 9 " 13 and in pewith a 2-fold increase in the risk of death.…”

Effective use of transdermal drug delivery in children

“…Elsewhere, it was reported that 10 of 20 neonates (24-31 wk GA), who were treated with 2% aqueous CHG prior to catheter insertion, had detectable plasma levels (1.6-206 ng.mL -1 ) of the compound, and the highest concentration was observed 2-3 days after exposure [84]. Overall, while the evidence suggests that CHG can be absorbed across the skin of preterm and term infants of less than 2 months of age, the clinical significance of the exposure is unknown [78]. Most of the reported adverse effects are local, such as erythema and contact dermatitis.…”

“…Chlorhexidine (CHD) was subsequently proposed as a safer alternative for antisepsis in the neonate population as it was, apparently, less well absorbed through intact human skin [78].…”

“…Other factors determining accumulation are the area of application considered (whole body bath or umbilical cord application) and the exposure frequency. The safety of CHG in preterm infants has been recently reviewed [78] and further investigated [78,84] given that the FDA has now approved a labelling change which allows the cautious use of CHG products in preterm infants [84].…”