Chlorhexidine gluconate 2.0% w/v aqueous solution (AquiHex 2%) was used to prepare the skin before umbilical catheter insertion soon after birth in a non-identical preterm twin born at 25+4 weeks gestation. Two hours later, the skin in the right iliac fossa, right flank, the periumbilical area, perineum and groin turned erythematous. Over the subsequent 6 h, the skin became pale (figure 1). The epithelium was lost in the affected areas, and the appearance was consistent with mixed-depth, partial-thickness burns. These injuries completely healed with conservative management over 4 weeks with no residual scarring. Interestingly, the other twin, who also needed umbilical catheter placement, did not develop any burns as the antiseptic solution was entirely wiped off with normal saline immediately after skin sterilisation.

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Figure 1

Partial-thickness burns over the right and left flanks (day 1 of life).

Burns due to alcohol-based chlorhexidine (Chx) solutions have been reported in neonates.1,–,3 To the best of our knowledge, there are no published reports on chemical burns secondary to 2% aqueous Chx solution. The 2011 Hospital Infection Control Practices Advisory Committee recommends >0.5% Chx preparation with alcohol solution for skin sterilisation before the insertion of intravascular catheters in paediatric and adult populations.4 Nevertheless, safety or efficacy of Chx in infants younger than 2 months old remains an unresolved issue.4 5

We believe that had the exposure to aqueous Chx been minimised by immediately wiping the excess Chx with normal saline, the burns may have been avoided. This case highlights the need to be extra vigilant when using any antiseptic solution for skin preparation in extremely preterm infants.