The comparison of two disinfectants commonly used in neonatal intensive care units in terms of efficacy and side effects

In neonatal intensive care units throughout the world, various disinfectants are used frequently in interventional procedures such as venous catheterization, blood and urine culture, and lumbar puncture. For these procedures, providing disinfection with reliable antiseptic solutions is of great importance in preventing infections and contaminations. Povidone iodine solutions or chlorhexidine-based solutions are used for this purpose in neonatal intensive care units worldwide. It is known that povidone iodine solutions might suppress thyroid functions, while chlorhexidine-based solutions might have severe side effects on the skin. Both mentioned side effects are more prominent in the premature babies. The studies demonstrating the safety of chlorhexidine solutions in these babies are inadequate. In this study, the superiority and safety of these two disinfectants on each other was investigated in terms of efficacy and side effects. Two hundred and eight babies born in Bursa Uludağ University, Faculty of Medicine between the dates July 15th, 2018 – March 26th, 2020 and hospitalized for at least seven days in the neonatal intensive care unit without experiencing any major operation were included in the research. These patients were randomized into two equal groups. While 10% povidone iodine solution (10% PI) was used in all interventional procedures of 104 patients, a solution containing 2% chlorhexidine gluconate + 70% isopropyl alcohol (2% CHG + 70% IA) was used in the other 104 patients. The duration of the patients' hospitalization, the number of times antiseptic solution was applied during their hospitalization, thyroid function test results, culture results, and other conditions encountered during hospitalization were recorded. The study was initiated after the approval of Bursa Uludağ University Medical Faculty Clinical Research Ethics Committee on the date June 19th, 2018 with the approval code 2018-11/16. Among 104 babies who belong to povidone iodine group, 77 were premature (74.0%) while the remaining 27 of them were term babies (26.0%). In chlorhexidine gluconate group, 75 out of 104 babies (74%) were premature while the other 29 of them (27.9%) were term. Culture positivity was observed in 31.7% of the infants belonging to 10% PI group, while this ratio was 17.3% in 2% CHG + %70 IA group (OR = 2.22; p = 0.024). When contaminated cultures were excluded and real neonatal sepsis results were obtained, 8.7% of the patients belonging to 10% PI group had neonatal sepsis in contrast to 4.8% of the patients in 2% CHG + 70% IA group p=0.406). The logistic regression analysis performed on proven cases of sepsis reveals that the choice of disinfectant did not alter the rate of neonatal sepsis. The thyroid function test results of the infants belonging to two distinct disinfectant groups is as follows: Ninety-eight povidone iodine utilized infants have a median TSH value of 4.05 mIU/L on contrary to that of chlorhexidine gluconate group, which is computed as 3,09 mIU/L (p=0.016). None of the infants belonging to chlorhexidine gluconate group exhibit any cutaneous or neurological side effects. The solution containing 2% chlorhexidine gluconate + 70% isopropyl alcohol has a comparable effect to 10% povidone iodine solution in terms of protection from the infections. 10% povidone iodine solution may cause transient hypothyroidism, especially in preterm babies, due to the absorption of iodine content. 2% chlorhexidine gluconate + 70% isopropyl alcohol is a solution that can be used safely instead of 10% povidone iodine for the skin disinfection of infants since it provides similar defense against microorganisms with less side effects.