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Efficacy and Safety of Whole Body Skin Cleansing With Chlorhexidine in Neonates—A Systemic Review

Sankar, M. Jeeva MD, DM; Paul, Vinod K. MD, PhD

The Pediatric Infectious Disease Journal: June 2013 - Volume 32 - Issue 6 - p e227–e234
doi: 10.1097/INF.0b013e31828693f6
Original Studies

Background: Cord cleansing with chlorhexidine has been shown to reduce the risk of neonatal mortality in low-resource settings. The effect of whole body skin cleansing with chlorhexidine in neonates is, however, not clear.

Methods: We searched MEDLINE and other databases and included all studies that evaluated the effect of chlorhexidine cleansing on neonatal mortality rate (NMR) and/or the incidence of neonatal sepsis. We estimated the pooled relative risks by fixed effect and random-effects models and also explored the sources of heterogeneity by subgroup meta-analysis.

Results: Seven randomized trials and 2 before-and-after studies that evaluated single cleansing with chlorhexidine were included in the review. Pooled analysis showed no significant effect on NMR in either the fixed effect (5 studies; relative risk: 0.91; 95% confidence interval: 0.80 to 1.04) or random-effects model (0.83; 0.63 to 1.08). On subgroup analysis, the before-and-after study conducted in high-NMR setting showed significant reduction in mortality (0.68; 0.50 to 0.93) but the randomized controlled trials from low-NMR settings did not show any benefit (0.97; 0.84 to 1.13). Pooled analysis of 5 studies that reported the rates of sepsis revealed substantial heterogeneity (I2 = 80.2%). Pooled result by random-effects model as well as the sensitivity analysis including only the randomized trials found no significant effect (0.65; 0.40 to 1.05 and 0.97; 0.80 to 1.18, respectively).

Conclusions: There is no conclusive evidence for any beneficial effect after single skin cleansing with chlorhexidine. However, given the heterogeneity in the major outcomes it seems prudent to generate more evidence from randomized trials in high-NMR settings. Until such time, this intervention cannot be recommended in any settings.

From the Department of Pediatrics, WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India.

Accepted for publication January 07, 2013.

M.J.S. prepared the protocol, applied the search strategy, retrieved the articles, extracted the data and did the statistical analysis. V.K.P. finalized the protocol and extracted the data. Both authors wrote the final version of the article and are guarantors.

The authors are intending to conduct randomized trials on chlorhexidine application in neonates. The authors have no funding or conflicts of interest to disclose.

Address for correspondence: M. Jeeva Sankar, MD, DM, Newborn Health Knowledge Center, WHO Collaborating Centre for Training & Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India -110029. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.