Chlorhexidine-methanol burns in two extreme preterm newborns

Area of Science:

• Neonatal care
• Dermatology
• Infectious disease prevention

Background:

• Safe antiseptic use is critical in neonatal intensive care units (NICUs).
• Chlorhexidine offers high efficacy with fewer side effects than mercurials or iodine derivatives.
• Methanol-containing antiseptics pose risks, particularly for extremely preterm infants.

Observation:

• Two cases of chemical burns occurred after skin cleansing with alcoholic chlorhexidine (0.5%) in extremely premature infants.
• The burns resulted from antiseptic use during umbilical catheter insertion procedures.
• These incidents highlight a potential risk associated with specific chlorhexidine formulations in vulnerable neonates.

Findings:

• Alcoholic chlorhexidine formulations can cause chemical burns in extremely premature infants.
• The risk appears associated with the alcohol content in the antiseptic preparation.
• While safe for full-term infants, alcoholic chlorhexidine may be detrimental to extremely preterm neonates.

Implications:

• Nonalcoholic antiseptic preparations are preferable for skin cleansing in extremely preterm newborns.
• Clinical guidelines for antiseptic use in NICUs may need revision to specify nonalcoholic options for preterm infants.
• Further research into the safety and efficacy of various antiseptic formulations in preterm neonates is warranted.