Chlorhexidine use in newborn care: a scoping review of evidence across settings and interventions

Neonatal infections remain a critical global health challenge, claiming approximately 2.4 million lives annually and accounting for 25%-45% of all neonatal deaths worldwide. Chlorhexidine, a broad-spectrum antiseptic agent, has emerged as a promising intervention for preventing neonatal infections across various care settings. We conducted a scoping review to systematically map the available evidence on the use of chlorhexidine in newborn care, examining its effects on omphalitis, sepsis, and neonatal mortality, stratified by birth setting. Following PRISMA-ScR and Joanna Briggs Institute methodology, we developed a Population-Concept-Context framework. We systematically searched PubMed and Google Scholar for peer-reviewed literature. Three chlorhexidine intervention types were examined: cord care, skin antisepsis, and bathing policies. Quality assessment employed Cochrane RoB 2, AMSTAR 2, NOS, and AGREE II tools. Sixteen studies were included: 8 RCTs/cluster RCTs, 5 systematic reviews, 2 narrative reviews, and 1 clinical guideline. Chlorhexidine cord care demonstrated substantial benefits in home birth settings, with omphalitis reductions of 68%-75% and mortality reductions of 23%-38%. In facility settings, results were more variable, with benefits primarily in high-risk populations. Chlorhexidine skin antisepsis showed promise for preterm and low birth weight infants, achieving 28% mortality reduction. Evidence for bathing policies remained limited. Chlorhexidine cord care demonstrates robust effectiveness in home birth settings and high-mortality contexts. Implementation strategies should be tailored to local epidemiology, baseline mortality rates, and healthcare infrastructure. Risk-stratified approaches may be optimal for facility-based care.