Antiseptic use in the neonatal intensive care unit - a dilemma in clinical practice: An evidence based review

Table 2 Studies reporting adverse effects of chlorhexidine use in neonates

Ref.	Design/type	Patient characteristics (n)	Type of antiseptic used	Purpose of antisepsis	Adverse reaction	Systemic effects	Comments
Garland et al[78]	Prospective study	Neonates (n = 111)	0.5% CHG in 70% IPA	PICC insertion	None reported	Not reported	GA not reported
Garland et al[79]	RCT	Neonates (n = 335, including 98 babies < 1000 g)	0.5% CHG and 70% IPA, CHG impregnated dressing after cleansing	PICC insertion	19 cases of contact dermatitis of which 15 are < 1000 g	Not reported	Occlusive dressing could be the cause of contact dermatitis
Bührer et al[102]	Prospective study	Preterm < 27 wk GA (n = 24)	2% phenoxyethanol and 0.1% octenidine	Skin care	Transient erythema in a 23 wk gestation baby	Absorbed systemically but no adverse effects reported
Pezzati et al[57]	RCT	Preterm < 34 wk (n = 101)	4% CHG aqueous solution	Umbilical cord care	None	Not reported	Mostly above 28 wk
Andersen et al[37]	Prospective study	VLBW < 1500 g (n = 36)	2% aqueous CHG	PICC, cannula insertion	Skin erythema and burn	Not reported	Recommended alternative safer agent
Visscher et al[22]	Pilot study	Neonates (n = 40; 14 of which < 30 wk )	2% CHG in 70% IPA	PICC insertion	Erythema and dryness	Not reported	Could be from dressing
Schick et al[98]	Case report	Preterm < 28 wk GA (n = 2)	IPA	Umbilical catheterisation	Skin burn (2nd/3rd degree burn)	Not reported
Harpin et al[95]	Case report	Preterm 27 wk GA (n = 1)	Methylated spirit (95% ethanol and 5% wood naptha)	Umbilical catheterisation	Haemorrhagic skin necrosis	Very high ethanol and methanol levels in blood	Use of alcohol antiseptics in preterm neonates potentially dangerous
Watkins et al[99]	Case report	Extreme LBW babies (n = 2)	Iso propyle alcohol	Umbilical catheterisation	Skin burns	Not reported	Care must be taken in selection of such solutions
Brayer et al[100]	Case report	Preterm at 35 wk (n = 1)	Isopropyl alcohol	Umbilical catheterisation	Severe skin burn	Not reported
Reynolds et al[96]	Case report	Preterm infants 24 wk (n = 2)	0.5% CHG + 70% methanol	Umbilical catheterisation	Extensive abdominal skin burns	Not reported	Avoid pooling of the antiseptic solution and use Saline for cleaning to wash antiseptic
Mannan et al[101]	Case report	Preterm 26 wk GA (n = 1)	0.5% CHG + 70% alcohol	Umbilical catheterisation	Extensive abdominal skin burns	Not reported	Alcohol containing preparations should be avoided in NICUs
Bringué Espuny et al[97]	Case report	Preterm 26 wk (n = 2)	0.5% CHG + methanol	Umbilical catheterisation	Skin burns	Not reported	Use of alcoholic preparations should be avoided in preterm
Lashkari et al[103]	Case report	Preterm 25 wk GA (n = 1)	2% aqueous CHG	Umbilical catheterisation	Skin burn	Not reported	Cleansing with Normal saline could potentially reduce the exposure and burns

CHG: Chlorhexidine; GA: General availability; NICU: Neonatal intensive care unit; IPA: Iso propyle alcohol; PICC: Peripherally inserted central venous catheter; VLBW: Very low birth weight infants; RCT: Randomized controlled trial.