Delivery of an extremely premature infant presents a number of challenging issues, and placement of central lines is an important part of the early management of these vulnerable babies. Alcohol based skin cleansers such as chlorhexidine gluconate 0.5% in 70% methanol are widely used before insertion of umbilical and percutaneous central lines and are effective at achieving skin sterilisation in neonates.¹ Despite previous reports,² we have recently seen two cases of infants born at 24 weeks gestation who sustained extensive abdominal burns from chlorhexidine/alcohol applied during the insertion of umbilical catheters before transfer to our unit.

Hypothermia, excessive water loss, sepsis, and renal failure are all recognised consequences of severe burns in the neonate.³ Additionally pain and stress may adversely affect neuronal maturation in the brain,⁴ and skin scarring and depigmentation are common.

In summary, the use of alcohol based skin cleansers in babies with immature skin (<28 weeks) is inappropriate, and we remind paediatricians who may be inserting (usually umbilical) lines that skin cleansers should be chosen that are suitable for the skin maturity. We take great care to avoid pooling of cleanser under the infant, and use saline for immature skin.

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Figure 1

 This 644 g baby sustained extensive burns over the abdomen and upper thighs. He became hypothermic (32.6°C), hypernatraemic, and subsequently developed systemic fungal sepsis with extensive skin breakdown. After two weeks the skin had healed without apparent cosmetic damage, but he died from renal failure 25 days later. This figure is published with parental consent.