Safety of neonatal skin cleansing in rural Nepal

Abstract

Objective: A high proportion of deaths during the neonatal period are attributed to infections. Neonatal skin plays an important role in protecting the newborn from invasive pathogens. In preparation for a study of newborn skin cleansing with chlorhexidine in Nepal, we evaluated the feasibility, acceptability, and safety of the newborn cleansing procedure.

Study design/setting: Observational pilot study of full-body cleansing of newborns in rural Nepal.

Methods: Thirty two newborn infants were wiped with commercially available non-antiseptic baby wipes. Pre and post-procedure axillary temperatures were recorded to estimate the impact of cleansing on body temperature. Skin aggravation, residual moisture, removal of vernix, and maternal satisfaction were assessed qualitatively.

Results: Body temperature of newborns decreased an average of 0.40 C (95% CI: 0.31 to 0.49 C, p < 0.0001) during the procedure. There was no evidence of skin aggravation, injury or removal of vernix, and mothers expressed satisfaction with the procedure. The procedure was simple and project workers were easily trained.

Conclusion: Care must be taken to promptly wrap infants after skin cleansing procedures as slight temperature decrease was noted after the procedure. These pilot data indicate, however, that gentle cleansing of newborn skin poses minimal risk to infants. This procedure is safe and appropriate precautions can be taken to deliver safe skin antisepsis with chlorhexidine to infants in the community.