Michel Odent, M.D.

It is exceptionally rare that a baby born at term with a normal birth weight dies from a B strep infection. Those who are more vulnerable are premature babies and small-for-date babies. Three studies published in authoritative medical journals suggest that the use of a vaginal spray of chlorhexidine is as effective as antibiotics. For mysterious reasons these studies are not well known. I include the abstract of the most recent one. It is better not to give eyes dro ps to the baby at birth and to rely on the results of an antibiogram (in the unlikely occurence of an eye infection).

Abstract

Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term.

Objective

To investigate the efficacy of intrapartum vaginal flushings with chlorhexidine compared with ampicillin in preventing group B streptococcus transmission to neonates.

Methods

This was a randomized controlled study, including singleton pregnancies delivering vaginally. Rupture of membranes, when present, must not have occurred more than 6 h previously. Women with any gestational complication, with a newborn previously affected by group B streptococcus se ps is or whose cervical dilatation was greater than 5 cm were excluded. A total of 244 group B streptococcus-colonized mothers at term (screened at 36-38 weeks) were randomized to receive either 140 ml chlorhexidine 0.2% by vaginal flushings every 6 h or ampicillin 2 g intravenously every 6 h until delivery. Neonatal swabs were taken at birth, at three different sites (nose, ear andgastric juice).

Results

A total of 108 women were treated with ampicillin and 109 with chlorhexidine. Their ages and gestational weeks at delivery were similar in the two grou ps . Nulliparous women were equally distributed between the two grou ps (ampicillin, 87%; chlorhexidine, 89%). Clinical data such as birth weight (ampicillin, 3,365 +/- 390 g;chlorhexidine, 3,440 +/- 452 g), Apgar scores at 1 min (ampicillin, 8.4 +/- 0.9;chlorhexidine, 8.2 +/- 1.4) and at 5 min (ampicillin, 9.7 +/- 0.6; chlorhexidine,9.6 +/- 1.1) were similar for the two grou ps , as was the rate of neonatal group B streptococcus colonization (chlorhexidine, 15.6%; ampicillin, 12%). Escherichia coli, on the other hand, was significantly more prevalent in the ampicillin (7.4%) than in the chlorhexidine group (1.8%, p < 0.05).Six neonates were transferred to the neonatal intensive care unit, including two cases of early-onset se ps is (one in each group).

Conclusions

In this carefully screened target population, intrapartum vaginal flushings with chlorhexidine in colonized mothers display the same efficacy as ampicillin in preventing vertical transmission of group B streptococcus. Moreover, the rate of neonatal E. colicolonization was reduced by chlorhexidine.