Percutaneous absorption of chlorhexidine in neonatal cord care.

Abstract

MacclesfieldSUMMARY The percutaneous absorption of chlorhexidine during its routine use in topical antiseptic preparations used in umbilical cord care was investigated by determining plasma chlorhexidine concentrations at ages 5 and 9 days. These showed that percutaneous absorption of chlorhexidine occurred in preterm neonates treated with a 1 % solution of chlorhexidine in ethanol, but not in term infants similarly treated, or in preterm infants treated only with a dusting powder containing 1 % chlorhexidine and 3 % zinc oxide.

Effective use of transdermal drug delivery in children

“…Further work confirmed the potential absorption of CHD in neonates, particularly in the preterm population, and illustrated the key role of the formulation used [81]. Infants treated with 1% CHD in ethanol had increased plasma levels, whereas the antiseptic was not found in those bathed with 1% CHD and 3% zinc oxide dusting powder.…”

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

“…Two of the studies used chlorhexidine in an alcohol-based solution and one used an aqueous formulation. Alcohol is known to potentiate the absorption of topically applied solutions 7 and it is possible that alcohol increased the absorption of CHG in those patients, however, this does not explain the notable CHG concentrations in the patients only exposed to an aqueous formulation. From all three studies reporting CHG absorption in preterm infants, there were no reports of severe adverse reactions in the patients, including no neurological complications or skin toxicity.…”

“…In 1981, Aggett et al 7 assessed CHG absorption in 25-term infants and 23-preterm infants with gestational ages between 31 to 36 weeks. After birth, the infants had repeated treatments of a 1% CHG in ethanol solution and a 1% CHG with 3% zinc oxide powder placed on their umbilical cord stumps every 4 h for at least 9 days.…”

“…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.…”

“…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.…”