Absorption of chlorhexidine from the intact skin of newborn infants.

Abstract

SUMMARY 34 newborn infants who had been bathed in a standard manner with Hibiscrub* were studied to find out whether it was absorbed percutaneously. Low levels of chlorhexidine were found in the blood of all 10 babies sampled by heel prick, and 5 of 24 from whom venous blood was taken. The detection of chlorhexidine varied greatly with the method and timing of sampling, and no correlation was found between gestational or postnatal age and chlorhexidine levels.

Pilot trial to compare tolerance of chlorhexidine gluconate to povidone-iodine antisepsis for central venous catheter placement in neonates

“…Others have also shown cutaneous absorption of CHG in neonates. [27][28][29] The concentration of CHG found in the blood of enrolled neonates was similar to what others report. 29 Although the study was not designed to evaluate the pharmacokinetics of cutaneously absorbed CHG, at least two infant appeared to have increasing concentrations following each application suggesting accumulation through increased absorption or reduced metabolism and excretion of CHG.…”

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

“…23 Contact dermatitis has not been reported in infants receiving full-body CHG skin cleansing when occlusive dressings were not necessary, even for very low birth weight infants and neonates as young as 28 weeks gestational age. 8 Alcohol-based CHG preparations have been reported to cause burns in infants 24 to 26 weeks gestational age. 20,24 -26 Alcohol alone is a known cause of skin burns in preterm infants, 27 therefore the impact of CHG as the trigger of skin breakdown in alcohol-based CHG preparations is unknown.…”

“…There are limited data addressing the potential for chlorhexidine absorption following topical application in preterm infants, especially in those <32 weeks gestation in the first 2 weeks of life. Three studies have reported detectable chlorhexidine concentrations in the blood of preterm infants <32 weeks gestation after skin exposure to CHG. [7][8][9] In a study by Cowen et al in 1979, blood samples were taken from 34 infants after whole body bathing with Hibiscrub (Mölnlycke Health Care, Gothenburg, Sweeden), a 4% CHG aqueous solution not marketed in the United States, to determine if chlorhexidine was absorbed percutaneously. 8 Infants were bathed once daily by applying Hibiscrub to the whole body except the face and then washing the Hibiscrub off with plain water.…”

“…6 Trace amounts of CHG can be absorbed through the skin after a single bath in adults and term neonates. [7][8][9][10][11][12][13] There are no reports of adverse consequences as a result of trace chlorhexidine absorption in studies of term newborns or adults, and no data to suggest that trace levels have clinical importance. 4 There are limited data available in premature infants, however.…”

Effective use of transdermal drug delivery in children

“…Blood and tissue levels indicated that little systemic absorption had occurred, with only one blood sample having the minimum detectable concentration (11 ng.mL -1 ) at the time. Heel prick and venipuncture were then used to assess the potential systemic exposure to CHG in 34 (28-39 wk GA) newborn infants [80].…”