skin cleansing might substantially reduce neonatal infection
and mortality in developing countries. Few data exist on the impact of chlorhexidine
cleansing on skin colonization of infants during the first day of life or on the absorption
potential of chlorhexidine
during newborn skin cleansing.
Hospital-born newborns in Kathmandu, Nepal
were randomly allocated to full-body skin cleansing with 0.25%, 0.50%, or 1.00% chlorhexidine
solution. Skin swabs were collected from the axilla, inguinal, and peri-umbilical areas before cleansing (baseline), and at 2 and 24 hours after treatment. Skin flora
was quantified and organisms identified. In a subsample, heel prick blood was collected 24 hours after the cleansing and percutaneous absorption
Among 286 enrolled newborns, no adverse effects on skin were reported and body temperature was minimally reduced (mean reduction, 0.33°C). In all groups, positive skin culture rates were significantly reduced at 2 hours but generally not at 24 hours; greater reductions were observed with higher concentrations of chlorhexidine
. Effect at 24 hours was highest in the 1.00% group (37% lower positive skin culture rate). For 15 of 75 infants with heel pricks, chlorhexidine
was detected at trace concentrations (<8 ng/mL, n = 14; 25.8 ng/mL, n = 1).
skin cleansing seemed safe and reduced skin flora
in newborns in a dose-dependent manner 2 hours after treatment. Greater residual effect at the highest concentration (1%) might provide broader benefit and may simplify combined maternal and neonatal regimens by matching the concentration used for vaginal cleansing during labor.