povidone-iodine and Infant--Premature--Diseases

Nosocomial infections are among the leading causes of mortality and morbidity in neonatal intensive care units. Prevention of healthcare-associated infections is based on strategies that aim to limit susceptibility to infections by enhancing host defences, interrupting trasmission of organisms by healthcare workers and by promoting the judicious use of antimicrobials. Strategies for the prevention of nosocomial infections include hand hygiene practices, prevention of central venous (cvc)-related bloodstream infections, judicious use of antimicrobials for therapy, enhancement of host defences, skin care and early enteral feeding with human milk. Major concerns about the use of alcoholic chlorhexidine are for the high risk of skin burns in extremely premature infants during the first days of life, when the skin is thin and not fully keratinesed. Aqueous chlorhexidine could be less irritant when used in very low birthweigth infants and thus could represent a good option. A recent prospective trial of adult patients showed similar effectiveness of alcoholic and aqueos solutions of chlorexidine. However, to date no study evaluated whether the aqueos formulation is less harmful and as effective as the alcoholic formulation in neonatal infants. The lack of evidence for neonatal patients prompts urgent need for large randomised controlled trials comparing effectiveness and safety of different skin disinfectants before CVC placement in neonates and particulary in very low birth-weight infants. Nosocomial infections are still of the most serious problems for the neonatal intensive care unit. Therefore every effort must be implemented to reduce the incidence of these infections, can not be considered a toll required hospitalization, as it may not be acceptable for a place of shelter and care as the hospital may itself be a source of disease.

Topics: Adult; Alcohols; Anti-Infective Agents, Local; Bacterial Infections; Catheter-Related Infections; Chlorhexidine; Contraindications; Cross Infection; Hand Disinfection; Humans; Hypothyroidism; Incidence; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Infection Control; Infectious Disease Transmission, Professional-to-Patient; Intensive Care, Neonatal; Povidone-Iodine; Skin; Skin Absorption; Solvents; Water

Recent advances in neonatology and dermatology have provided us with a better understanding of neonatal and premature infant skin. The problems associated with immature skin become evident immediately after birth and require constant attention throughout the neonatal period. As advances in neonatal care push the gestational age of viability lower, skin maturation and function become increasingly important clinical problems. Premature skin immaturity contributes to elevated water loss, problems with electrolytes and thermoregulation, increased risk of local or systemic infection, increased uptake of potentially toxic agents, and vulnerability to trauma. This review discusses the unique nature of dermal structure and function in very low birth weight infants, evidence of mechanical fragility, toxicity of various topical agents, and the use of emollients. The opinions expressed are those of the authors and do not necessarily represent the views of the Navy or Department of Defense.

Topics: Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Ointments; Petrolatum; Povidone-Iodine; Risk Factors; Skin; Skin Diseases; Thyroxine

The influence of topical iodine-containing antiseptics on thyroid function test results of premature infants was determined in two separate studies. Thyroxine and thyrotropin levels were measured on blood-spotted filter paper. Samples were obtained from 128 premature infants on their tenth day of life; the infants were treated in two neonatal intensive care units. Both units used similar treatment protocols; however, one routinely used topical iodinated antiseptic agents (n = 73), whereas the other used chlorhexidine-containing antiseptics (n = 55). There was no difference in the mean T4 levels between the two groups. The mean thyrotropin levels were elevated in preterm babies exposed to iodine (15.4 vs 7.8 mIU/L, p < 0.01). Among the iodine-exposed infants, elevated thyrotropin levels (> 30 mIU/L) were found in 13.7% of infants, compared with none in the chlorhexidine-treated group (p < 0.01). We then studied an additional 46 premature infants who were treated in one neonatal intensive care unit. Iodine-containing solutions were used in 24 infants and chlorhexidine was used in 22 infants. T4 and thyrotropin levels were measured weekly during the first 28 days, one every 2 weeks until the age of 60 days, and at the age of 90 days. Among iodine-exposed infants, 20.8% had thyrotropin values > 30 mIU/L, whereas none of the infants in the chlorhexidine group had elevated thyrotropin values (p < 0.05). The elevated thyrotropin levels correlated positively with the area of disinfection. Elevated urine iodine levels were present reflecting an abnormally high iodine absorption. This study suggests that iodine absorption from topical iodine-containing antiseptics may cause disturbances in thyroid function test results in premature infants. We recommend that caution be exercised in the use of iodine-containing antiseptics in premature infants.

Topics: Anti-Infective Agents, Local; Chlorhexidine; Cross-Over Studies; Female; Humans; Hypothyroidism; Infant; Infant, Newborn; Infant, Premature, Diseases; Intensive Care, Neonatal; Male; Povidone-Iodine; Retrospective Studies; Thyrotropin; Thyroxine

Chemical pleurodesis with povidone-iodine has been used to treat congenital idiopathic chylothorax in neonates. We report successful use of povidone-iodine in an extremely premature infant to treat a pneumothorax that had persisted for more than one week despite high-frequency ventilation.

Topics: Chest Tubes; High-Frequency Ventilation; Humans; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Infant, Premature, Diseases; Injections; Male; Pleurodesis; Pneumothorax; Povidone-Iodine; Pulmonary Surfactants; Respiration, Artificial; Respiratory Distress Syndrome, Newborn

In early 1983 we experienced a small scale epidemic of Staphylococcus aureus coagulase type IV in the premature infants unit. Children had bacteraemia or impetigo. The microorganism was resistant to methicillin, erythromycin and lincomycin and was susceptible to tetracycline, chloramphenicol and cefmetazole. The results of coagulase typing and antimicrobial sensitivities indicated that these cases represented nosocomial infection with MRSA. The source and route of the infection were investigated, and measures were taken to prevent bacterial spread from carriers and to keep instruments and environments clean. As the source of infection was not identified, we tried wiping the body surface of the premature infants with a diluted IsodineR solution (10% povidone-iodine; 1:100 dilution) in order to prevent colonization of the microorganism on the body surface. As a result, no additional MRSA infection occurred in the premature infant unit. During the subsequent 6 years of frequent surveys of carriers and wiping the appropriate body surface with diluted IsodineR solution we have had no recurrence of MRSA. None of the premature infants wiped with IsodineR solution showed any objective abnormalities, although laboratory testing disclosed an elevated blood iodine level and a transient mild reduction of T4 in some infants.

Topics: Administration, Topical; Carrier State; Cross Infection; Disease Outbreaks; Environmental Microbiology; Follow-Up Studies; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Japan; Methicillin Resistance; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Thyroid Gland

We investigated the staff in our neonatal intensive care unit (NICU) for the presence of methicillin-resistant Staphylococcus aureus (MRSA) in the nasal cavity, and then applied intranasal povidone-iodine cream to the physicians and nurses working on the unit. Prior to the application of povidone-iodine cream, the isolation rate of S. aureus from the nasal cavity was 30% for the physicians and nurses in contact with NICU patients (contact group), not significantly different from the 33.3% rate for other hospital staff (control group). The isolation rate for the contact group decreased to 10.5% after application of the cream. Although MRSA was not isolated from the nasal cavity of those in the control group, it was isolated from 13.3% of those of the contact group before application of the cream. Nasal MRSA disappeared after use of the cream. No adverse reactions or abnormalities in serum levels of thyroid hormone-related substances were observed in any of the subjects. These results indicated that the nasal application of povidone-iodine cream is safe and effective for eradicating MRSA in the nasal cavity.

Topics: Administration, Intranasal; Carrier State; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infectious Disease Transmission, Professional-to-Patient; Intensive Care Units, Neonatal; Medical Staff, Hospital; Methicillin Resistance; Nasal Cavity; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Thyroid Gland

The ostomy sites of four premature infants undergoing bowel reanastomosis were lavaged with a 10% solution of povidone iodine to reduce local bacterial contamination and the risk of anastomosis dehiscence. There was a significant decrease in serum thyroxin from 112 (+/- 11) mumol/L to 90 (+/- 33) mumol/L 24 hours following surgery (P less than .05), but no change in serum thyroid stimulating hormone (TSH). The total serum iodine rose from 1.5 (+/- 0.05) mumol/L before surgery to 61.6 (+/- 46.4) mumol/L 24 hours later and urinary iodine excretion was 60 times the preoperative value in the second 24 hours following surgery. Both the hormonal and biochemical indices returned to normal 2 weeks following surgery except for total serum iodine, which remained slightly elevated. Povidone iodine is a safe and effective antiseptic agent. However, as it may cause transient suppression of thyroid function in neonates, thyroid status should be tested in all such infants at approximately 2 weeks following repeated or widespread use.

Topics: Humans; Ileostomy; Infant, Newborn; Infant, Premature, Diseases; Iodine; Postoperative Period; Povidone; Povidone-Iodine; Risk; Surgical Wound Infection; Therapeutic Irrigation; Thyroid Gland; Thyrotropin; Thyroxine

Topics: Disinfection; Female; Humans; Hypothyroidism; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Male; Povidone; Povidone-Iodine; Preoperative Care; Prospective Studies; Sterilization; Thyrotropin; Thyroxine

Topics: Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Infant, Premature, Diseases; Infection Control; Infections; Obstetric Labor, Premature; Povidone-Iodine; Pregnancy; Pregnancy Complications, Infectious; Thyrotropin

Topics: Catheterization; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infant, Premature, Diseases; Povidone; Povidone-Iodine; Pregnancy; Puerperal Infection; Vaginitis