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Intervention Review

Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection

  1. Brenda C Stade1,*,
  2. Vibhuti S Shah2,
  3. Arne Ohlsson2

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 19 JUL 2004

Assessed as up-to-date: 31 AUG 2007

DOI: 10.1002/14651858.CD003520.pub2


How to Cite

Stade BC, Shah VS, Ohlsson A. Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003520. DOI: 10.1002/14651858.CD003520.pub2.

Author Information

  1. 1

    St. Michael's Hospital, Pediatrics, Toronto, Ontario, Canada

  2. 2

    Mount Sinai Hospital, Department of Paediatrics, Toronto, Ontario, Canada

*Brenda C Stade, Pediatrics, St. Michael's Hospital, 30 Bond Street, 61 Queen Street East, 2nd Floor, Toronto, Ontario, M5C 2T2, Canada. stadeb@smh.toronto.on.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2004

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Early-onset group B β-hemolytic streptococcus (GBS) infection accounts for approximately 30% of neonatal infections, has a high mortality rate, and is acquired through vertical transmission from colonized mothers. Several trials have demonstrated the efficacy of intrapartum chemoprophylaxis (IPC) for preventing early-onset disease (EOD). Vaginal disinfection with chlorhexidine during labour has been proposed as another strategy for preventing GBS EOD in the preterm and term neonate. Chlorhexidine has been found to have no impact on antibiotic resistance, is inexpensive, and applicable to poorly equipped delivery sites.

Objectives

To determine the effectiveness of vaginal disinfection with chlorhexidine during labour for preventing early-onset GBS infection in preterm and term neonates.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3), MEDLINE (1966 to September 2007), EMBASE (1980 to September 2007), CINAHL (1982 to September 2007), and LILACS (1982 to September 2007).

Selection criteria

Randomized and quasi-randomized trials comparing vaginal disinfection with chlorhexidine to placebo, or no treatment.

Data collection and analysis

Two review authors independently assessed the trials for inclusion and extracted the data.

Main results

We identified no new trials eligible for inclusion in our update of this review. Five studies, including approximately 2190 term and preterm infants, met the inclusion criteria and reported on at least one of the outcomes of interest for this systematic review. When all studies were combined, there was a statistically significant (P = 0.005) reduction in colonisation (typical RR 0.72; 95% CI 0.56 to 0.91; typical RD -0.16; 95% CI -0.26 to -0.05; NNT 6; 95% CI 4 to 20). There was no statistically significant between-study heterogeneity both for RR (chi² = 3.21 (P = 0.2), I² = 37.8%) and for RD (chi² = 1.66 (P = 0.44), I² = 0%). There was no statistically significant reduction in EOD including GBS sepsis, GBS pneumonia, GBS meningitis, or mortality.

Authors' conclusions

Vaginal chlorhexidine resulted in a statistically significant reduction in GBS colonization of neonates, but was not associated with reductions in other outcomes. The review currently does not support the use of vaginal disinfection with chlorhexidine in labour for preventing EOD. Results should be interpreted with caution as the methodological quality of the studies was poor.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection

Not enough evidence to show that washing the vagina with chlorhexidine during labour reduces group B streptococcal infections in babies.

A woman's vagina normally contains numerous bacteria that generally pose no problems to her or to her baby. However, very occasionally a baby picks up an infection during birth. GBS infection can cause severe illness in babies, and very occasionally a baby may die. Washing the vagina with chlorhexidine, or applying chlorhexidine gel, during labour was studied as a possible means of reducing infections. The review of five trials (including approximately 2190 term and preterm infants) showed that although chlorhexidine reduced the number of bacteria that passed to the babies, the studies were not large enough to say whether it reduced GBS infections or not.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

分娩時使用陰道chlorhexidine來預防早發性新生兒乙型鏈球菌感染

早發性乙型鏈球菌(GBS)感染,約佔新生兒感染的30% ,有很高的死亡率,並且是從受感染的母親所垂直傳染而得到。 數個臨床試驗證明生產期間的預防性用藥(IPC),在預防早發性疾病(EOD)的功效。 在分娩過程時利用chlorhexidine消毒陰道已被提出是另一種預防早產兒或足月生產的新生兒發生早發性乙型鏈球菌感染的策略。 Chlorhexidine不會引起抗藥性、價格便宜、而且很適合那些設備缺乏的接生場所

目標

確認在分娩過程中使用chlorhexidine進行陰道消毒來預防早產或足月生產新生兒早期發生乙型鏈球菌感染的有效性

搜尋策略

我們搜尋了Cochrane Pregnancy and Childbirth Group's Trials Register(2007年9月)、Cochrane Central Register of Controlled Trials(The Cochrane Library 2007, Issue 3)、MEDLINE(從1966到2007年9月)、EMBASE(1980到2007年9月)、CINAHL(1982到2007年9月),以及LILAC (從1982到2007年9月)等資料庫

選擇標準

隨機或準隨機抽樣臨床試驗比較以chlorhexidine或安慰劑進行陰道消毒,或不做處理的差異

資料收集與分析

2位評論作者獨立地評估應該納入哪些試驗並摘錄其數據

主要結論

我們發現沒有新的試驗符合資格被納入這篇回顧性文章的更新之中。 個研究,包含約2190個足月和早產的新生兒,符合收納的標準同時記錄了至少一個本系統性文獻回顧有興趣的預後(outcomes)。 當所有的研究合併之後,菌集移生(colonisation)程度出現具統計顯著性的降低(0.005)(typical RR 0.72; 95% CI 0.56 to 0.91; typical RD −0.16 5% CI −0.26 to −0.05; NNT 6; 95% CI 4 to 20)。 而研究異質性(study heterogeneity)包含RR (chi(2) 3.21 [p = 0.2], I(2) = 37.8%)和R (chi(2) = 1.66 [p = 0.44], I(2) = 0%)兩者皆沒有統計顯著性。 BS敗血症、GBS肺炎、GBS腦膜炎,或死亡率等早發性疾病的降低則沒有統計顯著性

作者結論

陰道的chlorhexidine可使新生兒的GBS菌集移生減少,但對於改善其它預後則沒有關聯性。 現在這篇回顧性文章並不主張在分娩時合併使用陰道消毒劑和chlorhexidine來預防早發性疾病。 由於此研究的品管方法不理想,因此這些結果必須審慎評估

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

沒有足夠的證據顯示在分娩時使用chlorhexidine清洗陰道會降低嬰兒B群鏈球菌感染。 婦女的陰道通常會帶有許多細菌,一般而言並不會對母體及嬰兒造成任何問題。 然而,嬰兒在生產時偶而會被感染。 BS感染會讓嬰兒發生嚴重的疾病,甚至死亡。 在分娩時以chlorhexidine清洗陰道,或施以chlorhexidine凝膠,或許是一種降低感染的可能方法,並加以研究。 本文蒐集了5個試驗數據(納入大約2190個足月和早產的新生兒)做分析,結果顯示雖然chlorhexidine減低嬰兒身上的菌落數量,但這個研究的樣本數量不足以做出它是否能減低GBS感染率的推論