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

Journal of Perinatology

Volumn 32, Issue 1, 2012, Pages 4-9

  Chapman, A K ^a   Aucott, S W ^a   Milstone, A M ^a,b,c  

^a JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH   (United States)

^c JOHNS HOPKINS HOSPITAL   (United States)

Author keywords

chlorhexidine gluconate; drug safety; drug toxicity; neonates; prematurity

Indexed keywords

2 PROPANOL; ALCOHOL; CHLORHEXIDINE GLUCONATE; HEXACHLOROPHENE; POVIDONE IODINE; ZINC OXIDE;

ABSENCE OF SIDE EFFECTS; ANAPHYLAXIS; ANTIBACTERIAL ACTIVITY; ANTISEPSIS; AQUEOUS SOLUTION; ARTICLE; BATH; BIRTH WEIGHT; BLOOD SAMPLING; BURN; CENTRAL VENOUS CATHETERIZATION; CONTACT DERMATITIS; DRUG ABSORPTION; DRUG ACCUMULATION; DRUG BLOOD LEVEL; DRUG FORMULATION; DRUG HYPERSENSITIVITY; DRUG SAFETY; DRUG STRUCTURE; DRUG TOLERABILITY; ERYTHEMA; GESTATIONAL AGE; HUMAN; NEUROTOXICITY; NEWBORN INTENSIVE CARE; NONHUMAN; PHOTOSENSITIZATION; PREMATURITY; SIDE EFFECT; SKIN; SKIN ABSORPTION; SKIN ANTISEPSIS; SKIN IRRITATION; SKIN TOXICITY; STRATUM CORNEUM; UMBILICAL CORD;

ANTI-INFECTIVE AGENTS, LOCAL; ANTISEPSIS; CHLORHEXIDINE; HUMANS; INFANT, NEWBORN; SKIN CARE;

EID: 84855273524     PISSN: 07438346     EISSN: 14765543     Source Type: Journal    
DOI: 10.1038/jp.2011.148     Document Type: Article

References (45)

1. Milstone AM, Passaretti CL, Perl TM. Chlorhexidine: Expanding the armamentarium for infection control and prevention. Clin Infect Dis 2008; 46(2): 274-281. (Pubitemid 351269170)
2. Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: A meta-analysis. Ann Intern Med 2002; 136(11): 792-801. (Pubitemid 34568649)
3. O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO et al. Summary of recommendations: Guidelines for the prevention of intravascular catheterrelated infections. Clin Infect Dis 2011; 52(9): 1087-1099.
4. Mullany LC, Darmstadt GL, Tielsch JM. Safety and impact of chlorhexidine antisepsis interventions for improving neonatal health in developing countries. Pediatr Infect Dis J 2006; 25(8): 665-675. (Pubitemid 44162121)
5. Case DE. Chlorhexidine: Attemts to detect percutanous absorption in man. Proc Int Congr Chemother 1976; 3: 367-374.
6. Krautheim AB, Jermann TH, Bircher AJ. Chlorhexidine anaphylaxis: Case report and review of the literature. Contact Dermat 2004; 50(3): 113-116. (Pubitemid 38746215)
7. Aggett PJ, Cooper LV, Ellis SH, McAinsh J. Percutaneous absorption of chlorhexidine in neonatal cord care. Arch Dis Child 1981; 56(11): 878-880. (Pubitemid 12229205)
8. Cowen J, Ellis SH, McAinsh J. Absorption of chlorhexidine from the intact skin of newborn infants. Arch Dis Child 1979; 54(5): 379-383. (Pubitemid 9158992)
9. Garland JS, Alex CP, Uhing MR, Peterside IE, Rentz A, Harris MC. Pilot trial to compare tolerance of chlorhexidine gluconate to povidone-iodine antisepsis for central venous catheter placement in neonates. J Perinatol 2009; 29(12): 808-813.
10. Johnsson J, Seeberg S, Kjellmer I. Blood concentrations of chlorhexidine in neonates undergoing routine cord care with 4% chlorhexidine gluconate solution. Acta Paediatr Scand 1987; 76(4): 675-676. (Pubitemid 17127920)
11. Mullany LC, Khatry SK, Sherchand JB, Leclerq SC, Darmstadt GL, Katz J et al. A randomized controlled trial of the impact of chlorhexidine skin cleansing on bacterial colonization of hospital-born infants in Nepal. Pediatr Infect Dis J 2008; 27: 505-511.
12. O'Brien CA, Blumer JL, Speck WT, Carr H. Effect of bathing with a 4 per cent chlorhexidine gluconate solution on neonatal bacterial colonization. J Hosp Infect 1984; 5(Suppl 1): 141.
13. Oneill J HM, Challop R, Driscoll J, Speck W, Sprunt K. Percutaneous absorption potential of chlorhexidine in neonates. Curr Ther Res 1982; 31(3): 485-489. (Pubitemid 12107604)
14. Curley A, Kimbrough RD, Hawk RE, Nathenson G, Finberg L. Dermal absorption of hexochlorophane in infants. Lancet 1971; 2(7719): 296-297.
15. Kopelman AE. Cutaneous absorption of hexachlorophene in low-birth-weight infants. J Pediatr 1973; 82(6): 972-975.
16. Shuman RM, Leech RW, Alvord Jr. EC. Neurotoxicity of hexachlorophene in the human: I. A clinicopathologic study of 248 children. Pediatrics 1974; 54(6): 689-695.
17. Slatter D, editor. Textbook of Small Animal Surgery. 3rd edn: Elsevier Health Sciences 2002.
18. Sebben JE. Surgical antiseptics. J Am Acad Dermatol 1983; 9(5): 759-765. (Pubitemid 14230576)
19. Tamma PD, Aucott SW, Milstone AM. Chlorhexidine use in the neonatal intensive care unit: Results from a national survey. Infect Control Hosp Epidemiol 2010; 31(8): 846-849. PMCID: 2900383.
20. Reynolds PR, Banerjee S, Meek JH. Alcohol burns in extremely low birthweight infants: Still occurring. Arch Dis Child Fetal Neonatal Ed 2005; 90(1): F10. PMCID: 1721832. (Pubitemid 40040197)
21. Garland JS, Alex CP, Mueller CD, Cisler-Kahill LA. Local reactions to a chlorhexidine gluconate-impregnated antimicrobial dressing in very low birth weight infants. Pediatr Infect Dis J 1996; 15(10): 912-914. (Pubitemid 26339606)
22. Garland JS, Alex CP, Mueller CD, Otten D, Shivpuri C, Harris MC et al. A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics 2001; 107(6): 1431-1436.
23. Visscher M, deCastro MV, Combs L, Perkins L, Winer J, Schwegman N et al. Effect of chlorhexidine gluconate on the skin integrity at PICC line sites. J Perinatol 2009; 29(12): 802-807.
24. Watkins AM, Keogh EJ. Alcohol burns in the neonate. J Paediatr Child Health 1992; 28(4): 306-308.
25. Bringue Espuny X, Soria X, Sole E, Garcia J, Marco JJ, Ortega J et al. Chlorhexidinemethanol burns in two extreme preterm newborns. Pediatr Dermatol 2010; 27(6): 676-678.
26. Mannan K, Chow P, Lissauer T, Godambe S. Mistaken identity of skin cleansing solution leading to extensive chemical burns in an extremely preterm infant. Acta Paediatr 2007; 96(10): 1536-1537. (Pubitemid 47416414)
27. Schick JB, Milstein JM. Burn hazard of isopropyl alcohol in the neonate. Pediatrics 1981; 68(4): 587-588. (Pubitemid 11026941)
28. Andersen C, Hart J, Vemgal P, Harrison C. Prospective evaluation of a multi-factorial prevention strategy on the impact of nosocomial infection in very-low-birthweight infants. J Hosp Infect 2005; 61(2): 162-167. (Pubitemid 41283341)
29. Lashkari HP, Chow P, Godambe S. Aqueous 2% chlorhexidine-induced chemical burns in an extremely premature infant. Arch Dis Child Fetal Neonatal Ed 2011; e-pub ahead of print 11 July 2011; doi:10.1136/adc.2011.215145.
30. Kalia YN, Nonato LB, Lund CH, Guy RH. Development of skin barrier function in premature infants. J Invest Dermatol 1998; 111(2): 320-326. (Pubitemid 28354723)
31. Barker N, Hadgraft J, Rutter N. Skin permeability in the newborn. J Invest Dermatol 1987; 88(4): 409-411. (Pubitemid 17053082)
32. de Souza LB, de Aquino SG, de Souza PP, Hebling J, Costa CA. Cytotoxic effects of different concentrations of chlorhexidine. Am J Dent 2007; 20(6): 400-404.
33. Faria G, Cardoso CR, Larson RE, Silva JS, Rossi MA. Chlorhexidine-induced apoptosis or necrosis in L929 fibroblasts: A role for endoplasmic reticulum stress. Toxicol Appl Pharmacol 2009; 234(2): 256-265.
34. Goldschmidt P, Cogen R, Taubman S. Cytopathologic effects of chlorhexidine on human cells. J Periodontol 1977; 48(4): 212-215. (Pubitemid 8087522)
35. Helgeland K, Heyden G, Rolla G. Effect of chlorhexidine on animal cells in vitro. Scand J Dent Res 1971; 79(3): 209-215.
36. Duc Q, Breetveld M, Middelkoop E, Scheper RJ, Ulrich MM, Gibbs S. A cytotoxic analysis of antiseptic medication on skin substitutes and autograft. Br J Dermatol 2007; 157(1): 33-40. (Pubitemid 46934283)
37. Olson L, Bjorklund H, Henschen A, Palmer M, Hoffer B. Some toxic effects of lead, other metals and antibacterial agents on the nervous systemFanimal experiment models. Acta Neurol Scand Suppl 1984; 100: 77-87. (Pubitemid 14060415)
38. Milstone A, Bamford P, Aucott S, Bearer CF, Tang N. Chlorhexidine Reduces L1- Mediated Neurite Outgrowth Annual Meeting of the Pediatric Academic Society; Denver, Colorado; 2011. E-PAS 2011; 4536: 537.
39. Davies GE, Francis J, Martin AR, Rose FL, Swain G. 1:6-Di-40- chlorophenyldiguanidohexane (hibitane); laboratory investigation of a new antibacterial agent of high potency. Br J Pharmacol Chemother 1954; 9(2): 192-196. PMCID: 1509439.
40. Lee A, Harlan R, Breaud AR, Speck K, Perl TM, Clarke W et al. Blood concentrations of chlorhexidine in hospitalized children undergoing daily chlorhexidine bathing. Infect Control Hosp Epidemiol 2011; 32(4): 395-397.
41. Garland JS, Buck RK, Maloney P, Durkin DM, Toth-Lloyd S, Duffy M et al. Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: A prospective trial. Pediatr Infect Dis J 1995; 14(6): 510-516.
42. Pezzati M, Rossi S, Tronchin M, Dani C, Filippi L, Rubaltelli FF. Umbilical cord care in premature infants: The effect of two different cord-care regimens (salicylic sugar powder vs chlorhexidine) on cord separation time and other outcomes. Pediatrics 2003; 112(4): E275.
43. Darmstadt GL, Hossain MM, Choi Y, Shirin M, Mullany LC, Islam M et al. Safety and effect of chlorhexidine skin cleansing on skin flora of neonates in Bangladesh. Pediatr Infect Dis J 2007; 26(6): 492-495. (Pubitemid 46847309)
44. Sankar MJ, Paul VK, Kapil A, Kalaivani M, Agarwal R, Darmstadt GL et al. Does skin cleansing with chlorhexidine affect skin condition, temperature and colonization in hospitalized preterm low birth weight infants?: A randomized clinical trial. J Perinatol 2009; 29(12): 795-801.
45. Pereira L, Chipato T, Mashu A, Mushangwe V, Rusakaniko S, Bangdiwala SI et al. Randomized study of vaginal and neonatal cleansing with 1% chlorhexidine. Int J Gynaecol Obstet 2011; 112(3): 234-238.