Topical chlorhexidine 1% reduces maternal, neonatal bacterial colonization

Topical application of chlorhexidine 1% proves effective at reducing bacterial load in both mothers and neonates, according to the results of a randomized controlled trial.

The trial was conducted at Zomba Central Hospital in Malawi and included 149 labouring women (mean age at enrolment 25.7 years) and 147 facility-born neonates (mean age at enrolment 10.3 hours, 56 percent male, mean birth weight 2,729 g).

Mothers and neonates were individually randomized to receive chlorhexidine 1% (1% CHG), chlorhexidine 2% (2% CHG), octenidine 0.1% with phenoxyethanol 2% (OHP), or to standard of care (SOC). Each topical antiseptic agent was applied either once or multiple times (every 4 h during working hours for up to 6 applications in mothers; every 24 h for up to 3 applications in neonates). Standard of care involved application of sterile water for mothers and no cleansing for neonates.

The primary outcome of change in total skin bacterial load (log10 colony-forming units [log10CFU]) from baseline at each follow-up was analysed separately in the maternal and neonatal populations. Secondary outcomes were skin condition score (range, 0–12 for neonates and 0–16 for women; lower scores indicated better condition), serious adverse events (SAEs), and neonatal temperature.

In mothers, bacterial load was higher with OHP (adjusted log10CFU difference, 1.7, 95 percent CI, 0.9–2.5) and SOC (adjusted log10CFU difference, 3.5, 95 percent CI, 2.4–4.6) compared with 1% CHG. There was no clear difference between 1% CHG and 2% CHG. Efficacy in terms or reducing bacterial load was not modified by the frequency of application (multiple vs single application: adjusted log10CFU difference, −0.4, 95 percent CI, −1.1 to 0.2).

In neonates, 1% CHG similarly showed better efficacy than SOC at reducing bacterial load (adjusted log10CFU difference, 1.3, 95 percent CI, 0.2–2.4). No significant differences were observed between 1% CHG and 2% CHG (adjusted log10CFU difference, −0.2, 95 percent CI, −1.1 to 0.7) and between 1% CHG and OHP (adjusted log10CFU difference, 0.7, 95 percent CI, −0.2 to 1.6). Multiple applications showed increasing benefits over time.

Skin scores were low in both mothers and neonates (almost all had scores of 0–1, and none had ≥3).

SAE rates were similar across the treatment groups, and there no signal of post-antiseptic neonatal hypothermia identified.