Vanzi Valentina, Pitaro Rosanna
University Department of Pediatrics, IRCCS Bambino Gesù Children's Hospital, Rome, Italy (Ms Vanzi); and Neonatal Intensive Care Unit (NICU), S. Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy (Ms Pitaro).
J Perinat Neonatal Nurs. 2018 Oct/Dec;32(4):341-350. doi: 10.1097/JPN.0000000000000334.
Early premature infants are subjected to many invasive procedures in neonatal intensive care units, and effective skin antisepsis is an essential step in caring for these vulnerable patients. Nevertheless, preterm infants have an anatomically and physiologically immature skin and preserving their skin integrity is essential to avoid the risk of local and systemic complications. Skin particularities of newborns reduce the list of available antiseptics in neonatology. Chlorhexidine gluconate (CHG) has excellent antiseptic properties and its antimicrobial efficacy cannot be understated, but there is great concern about its use for premature infants, referring to the risk of development skin injuries, such as skin erythema, burns, and blisters. Current guidelines do not recommend the use of CHG as antiseptic in the neonatal population, but despite the lack of safety data in premature infants, CHG is commonly used worldwide for off-label indications in neonatal intensive care units. A clinical case of an infant born at 26 weeks of gestation who sustained a CHG-related chemical burn after skin antisepsis was reported. A review of the literature was undertaken to evaluate the skin safety of CHG in infants born less than 32 weeks of gestation, to summarize clinical practice' recommendations, and to discuss the wound treatment options available.
早期早产儿在新生儿重症监护病房会接受许多侵入性操作，有效的皮肤消毒是护理这些脆弱患儿的关键步骤。然而，早产儿的皮肤在解剖学和生理学上尚未发育成熟，保护其皮肤完整性对于避免局部和全身并发症的风险至关重要。新生儿的皮肤特殊性减少了新生儿科可用防腐剂的种类。葡萄糖酸氯己定（CHG）具有出色的防腐性能，其抗菌效果不容小觑，但由于存在发生皮肤损伤（如皮肤红斑、烧伤和水泡）的风险，人们对其用于早产儿极为担忧。当前指南不建议在新生儿群体中使用CHG作为消毒剂，尽管缺乏早产儿的安全性数据，但CHG在全球范围内仍普遍用于新生儿重症监护病房的超说明书用药指征。有报道称，一名孕26周出生的婴儿在皮肤消毒后发生了与CHG相关的化学烧伤。本文进行了文献综述，以评估CHG在孕周小于32周婴儿中的皮肤安全性，总结临床实践建议，并讨论可用的伤口治疗方案。
