Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labour. The Swedish Chlorhexidine Study Group.
Streptococcus agalactiae transmitted to infants from the vagina during birth is an important cause of invasive neonatal infection. We have done a prospective, randomised, double-blind, placebo-controlled, multi-centre study of chlorhexidine prophylaxis to prevent neonatal disease due to vaginal transmission of S agalactiae. On arrival in the delivery room, swabs were taken for culture from the vaginas of 4483 women who were expecting a full-term single birth. Vaginal flushing was then done with either 60 ml chlorhexidine diacetate (2 g/l) (2238 women) or saline placebo (2245) and this procedure was repeated every 6 h until delivery. The rate of admission of babies to special-care neonatal units within 48 h of delivery was the primary end point. For babies born to placebo-treated women, maternal carriage of S agalactiae was associated with a significant increase in the rate of admission compared with non-colonised mothers (5.4 vs 2.4%; RR 2.31, 95% CI 1.39-3.86; p = 0.002). Chlorhexidine reduced the admission rate for infants born of carrier mothers to 2.8% (RR 1.95, 95% CI 0.94-4.03), and for infants born to all mothers to 2.0% (RR 1.48, 95% CI 1.01-2.16; p = 0.04). Maternal S agalactiae colonisation is associated with excess early neonatal morbidity, apparently related to aspiration of the organism, that can be reduced with chlorhexidine disinfection of the vagina during labour.
National Bacteriological Laboratory, Stockholm, Sweden.
L G
LG
Burman
P
P
Christensen
K
K
Christensen
B
B
Fryklund
A M
AM
Helgesson
N W
NW
Svenningsen
K
K
Tullus
D000282:Administration, Intravaginal; D002353:Carrier State / Q000188:drug therapy* / Q000382:microbiology / Q000635:transmission; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D004203:Disinfection / Q000379:methods* / Q000592:standards; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D009017:Morbidity; D007744:Obstetric Labor Complications / Q000188:drug therapy* / Q000382:microbiology; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000635:transmission; D013292:Streptococcus agalactiae; D013548:Sweden / Q000453:epidemiology; D014623:Vaginal Diseases / Q000188:drug therapy* / Q000382:microbiology
D002710:Chlorhexidine