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

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Abstract
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. To determine the effectiveness of vaginal disinfection with chlorhexidine during labour for preventing early-onset GBS infection in preterm and term neonates. 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). Randomized and quasi-randomized trials comparing vaginal disinfection with chlorhexidine to placebo, or no treatment. Two review authors independently assessed the trials for inclusion and extracted the data. 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. 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.