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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. May 8, 2016; 5(2): 159-171
Published online May 8, 2016. doi: 10.5409/wjcp.v5.i2.159
Antiseptic use in the neonatal intensive care unit - a dilemma in clinical practice: An evidence based review
Sundar Sathiyamurthy, Jayanta Banerjee, Sunit V Godambe
Sundar Sathiyamurthy, Jayanta Banerjee, Sunit V Godambe, Children’s Directorate, Department of Neonatal Medicine, Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Sunit V Godambe, MBBS, MD, FRCPCH, Consultant Neonatologist, Head of Specialty for Neonatology, Children’s Directorate, Department of Neonatal Medicine, Imperial College Healthcare NHS Trust, Hammersmith House, 5th Floor, Queen Charlotte’s and Chelsea Hospital, Du Cane Road, London W12 0HS, United Kingdom. sunit.godambe@imperial.nhs.uk
Telephone: +44-20-33133270 Fax: +44-20-33131122
Received: September 30, 2015
Peer-review started: October 1, 2015
First decision: November 4, 2015
Revised: December 18, 2015
Accepted: January 16, 2016
Article in press: January 19, 2016
Published online: May 8, 2016
Processing time: 278 Days and 21.7 Hours
Abstract

Infants in the neonatal intensive care unit are highly susceptible to healthcare associated infections (HAI), with a substantial impact on mortality, morbidity and healthcare costs. Effective skin disinfection with topical antiseptic agents is an important intervention in the prevention or reduction of HAI. A wide array of antiseptic preparations in varying concentrations and combinations has been used in neonatal units worldwide. In this article we have reviewed the current evidence of a preferred antiseptic of choice over other agents for topical skin disinfection in neonates. Chlorhexidine (CHG) appears to be a promising antiseptic agent; however there exists a significant concern regarding the safety of all agents used including CHG especially in preterm and very low birth weight infants. There is substantial evidence to support the use of CHG for umbilical cord cleansing and some evidence to support the use of topical emollients in reducing the mortality in infants born in developing countries. Well-designed large multicentre randomized clinical trials are urgently needed to guide us on the most appropriate and safe antiseptic to use in neonates undergoing intensive care, especially preterm infants.

Keywords: Antiseptics; Disinfectants; Topical; Neonate; Preterm; Very low birth weight infant; Chlorhexidine; Povidone-iodine; Alcohol

Core tip: Topical antiseptic agents play a crucial role in the prevention of nosocomial infections in infants admitted to neonatal intensive care unit. There is a paucity of good quality studies to guide us on the most effective and safe antiseptic preparation, concentration and combination for use in neonatal skin disinfection. Further research is urgently needed to identify the most appropriate and safe antiseptic use in neonates including preterm and very low birth weight infants.