Anitha, M (2014) Effect of multiple applications of chlorhexidine on skin colonisation in preterm neonates - A Double Blinded RCT. Masters thesis, Madras Medical College, Chennai.
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Abstract
Preterm birth is truly a global problem. Countries with highest numbers include Brazil, India, Nigeria and the United States of America. In the poorest countries on an average, 12% of babies are born too soon compared with 9% in higher income countries. Preterm infants due to their immaturity of various organ systems are more likely to be admitted to the neonatal intensive care units (NICU) than their term counterparts who are likely to be by their mother side. During the process of birth, transport to NICU and various procedures of treatment and care, infant’s skin gets colonized by flora derived from the body of the mother, other human contacts and various inanimate objects. The mechanisms leading to colonization of the skin involve a complex interplay among rapid growth of commensal organisms, the development of the acid mantle, local micro environmental factors such as occlusion and humidity and the choice of exogenous soaps and skin care practices.4 Initial colonization depends on the initial organism that colonize at a particular site as well as factors such as type of delivery, the amount of vernix present at birth, the type of nourishment received and the degree of exposure in the hospital environment. Though microbial colonization begins immediately after birth, it is low initially and the rate increases after 12 hours. 1) Multiple applications of 0.5% chlorhexidine reduced the risk of skin colonisation in the axilla and groin by 50% and 38% respectively during the first week (NNT = 2). 2) A single application of 0.5% chlorhexidine at 48 hours reduces the risk of skin colonisation by 33% and 28% in the axilla and groin respectively. 3) The results of quantitative reductions in the bacterial colony counts in the axilla and the groin at different time points were also similar. 4) There was no difference in mortality on the 28 – day of life between the two groups. 5) There was no significant difference in the incidence of sepsis during the first week of life between the groups. But the incidence of sepsis in the 28-31 weeks GA infants was lower in the chlorhexidine group. 6) Rate of repeat hospitalisation and the proportion remaining sick on day – 28 of life were significantly lower in the intervention group. 7) Multiple applications of 0.5% chlorhexidine in the aqueous form was well tolerated by the preterm infants without skin toxicity and thermal instability. The aqueous preparation did not predispose to skin colonisation with gram negative organisms.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | chlorhexidine; multiple applications; skin colonisation; preterm neonates; A Double Blinded RCT. |
| Subjects: | MEDICAL > Neonatology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 23 Jun 2017 03:12 |
| Last Modified: | 23 Jun 2017 05:55 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/285 |
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