Can a Gentle Antiseptic Wash Stop Germs Passing From Mother to Newborn?

What Beales and colleagues' NeoVT-AMR study in Malawi (JAMA Network Open, 2026) found about cleaning mothers in labour and newborn babies with chlorhexidine and octenidine washes

Newborn babies can pick up harmful germs from their mother's birth canal during labour and from the hospital around them, and in poorer countries these germs cause many serious infections. A study in Malawi tested whether gently cleaning mothers in labour, and newborn babies, with antiseptic washes could reduce the number of germs. A mild 1% chlorhexidine wash lowered germ numbers, a stronger chlorhexidine wash or a different antiseptic gave no clear extra benefit, and the washes appeared safe. It did not yet test whether this prevents infections.

Why germs around birth matter so much

Before birth, a baby lives in a well-protected space. During labour and in the first hours of life, the baby meets a whole new world of bacteria, first in the birth canal and then on the skin, from hands, blankets and the hospital ward. Most of these bacteria are harmless, and some are even helpful, but a few can cause an infection of the blood called sepsis. When sepsis starts in the first few days of life it is called early-onset sepsis, and it can be very dangerous for a tiny baby. Some of these early infections are caught from the mother's birth canal during labour, which doctors call "vertical" spread [1]. Researchers who study this problem worry most about germs that have learned to resist common antibiotics, because they are harder to treat.

The scale of the problem is large. One major review estimated that possible severe bacterial infections were linked to about 680,000 newborn deaths in a single year across sub-Saharan Africa, south Asia and Latin America [2]. A study of babies born in three large hospitals in Delhi, India, found that most infections began within the first three days of life, and that about two in every three germs were of a type called "gram-negative", many of them resistant to several antibiotics [3]. Scientists have also found genetic evidence that resistant germs pass between mothers and their babies, and between babies [4]. That is why a research team working in Malawi set out to find a simple way to lower the number of germs a baby meets at the very start of life [1].

What doctors have tried before

The idea of cleaning the birth canal is not new. In a study published in 1997, doctors at a hospital in Blantyre, Malawi, began wiping the birth canal with a weak chlorhexidine solution during labour and also wiping the babies. Chlorhexidine is a widely used antiseptic, the same kind of germ-killing liquid used to clean skin before an injection or operation. Compared with the months when no wiping was done, fewer babies were admitted with infection, and fewer died from it [5]. This was exciting, but it was not a fair test: the two groups were treated at different times, so other changes in the hospital could explain the difference.

When researchers later ran a much larger and fairer study in Soweto, South Africa, involving about 8,000 women, and decided by chance who received chlorhexidine wipes, the wipes did not reduce infections in the babies [6]. A review pulling together 11 fair tests also found no clear benefit [7], and a review focused on one common germ, group B streptococcus, reached the same conclusion [8]. Meanwhile, studies of washing newborn skin showed that chlorhexidine does kill bacteria, but the germs return within a day or a few days [9][10][11]. A recent study in South Africa and Bangladesh found that stronger chlorhexidine was no better than weaker chlorhexidine for washing babies [12]. So, for families and doctors, the honest answer has long been: we do not know which antiseptic to use, how strong it should be, or how often to apply it.

How the new study was set up

The new study is called the NeoVT-AMR trial (Strategies to reduce vertical transmission of multi–drug-resistant pathogens to neonates). "Vertical transmission" simply means germs passing from mother to baby around birth. The trial took place at one government hospital, Zomba Central Hospital in Malawi, between March 2022 and March 2023 [1].

The researchers studied two separate groups. The first was 149 women in early labour. The second was 147 newborn babies under a day old, weighing more than 1 kilogram, whose mothers were not part of the study. In each group, a computer decided by chance, a bit like drawing names from a hat, which treatment each person received. The options were a 1% chlorhexidine wash, a stronger 2% chlorhexidine wash, or a different antiseptic that combines octenidine and phenoxyethanol. Some people received their wash once, others several times. A comparison group received usual care: mothers were cleaned with sterile water, and babies were not washed at all.

For mothers, the antiseptic was applied with soaked cotton wool around and inside the vagina. For babies, it was applied to the body, but not the face or head. Nurses then took gentle swabs, small cotton buds rubbed on the skin, over the following hours and days, and a laboratory counted how many bacteria grew from each swab. The laboratory staff did not know which wash each person had received, which helps keep the counting fair.

It is important to understand what the study measured. It counted bacteria, not infections. Counting germs is a useful first step to choose the best wash, but it does not tell us for certain whether fewer babies will become ill.

What the researchers found

For mothers, the results were clear. A single wash with 1% chlorhexidine left many times fewer bacteria in the birth canal than sterile water. The octenidine product also reduced bacteria, but not as much as 1% chlorhexidine. The stronger 2% chlorhexidine was not clearly better than 1%, and washing several times was not clearly better than washing once [1].

For babies, the picture was gentler. Bacteria on the babies' skin increased over the first few days in every group, which is normal as newborns are colonised by the world around them. But babies washed with 1% chlorhexidine gained bacteria more slowly than babies who were not washed. Again, 2% chlorhexidine and the octenidine product did not clearly do better than 1%, and repeated washes were not clearly better overall, although their benefit seemed to grow over time.

The researchers also swabbed the babies born to the women in the mothers' group, to see whether cleaning the birth canal passed any protection on to the baby. Here the results were less clear. Babies whose mothers had been washed with 1% chlorhexidine did not have clearly fewer germs than babies whose mothers had been cleaned with sterile water. Babies whose mothers had received the octenidine product, however, had somewhat more germs than those whose mothers had received 1% chlorhexidine. This is one reason the researchers are cautious: fewer germs in the mother does not automatically mean fewer germs on the baby.

Safety was reassuring. Skin condition scores stayed very low: almost every check scored 0 or 1. Out of 277 checks on mothers, only 3 reached a score of 2, and out of 262 checks on babies, only 5 did; none scored higher. There was no sign that babies got cold after being washed. Serious health problems happened to 7 of the 149 women, almost all of them problems affecting their babies, and to 16 of the 147 babies. Many babies in the study were already being cared for in the nursery, and about a third had been admitted after a difficult birth in which they lacked oxygen. There was no clear evidence that these problems were more common in any one group (they were a little more frequent among babies washed with 2% chlorhexidine, which could be chance), and none was judged to have been caused by the antiseptic.

What this means for families

If you are expecting a baby, or have a newborn in hospital, this study does not mean that you should ask for antiseptic washes, and if your baby is not washed with an antiseptic there is no reason to worry. Its value is that it tells researchers which wash is most worth testing in a much bigger study: a single, mild 1% chlorhexidine wash. The other important message is that the washes appeared safe for both mothers and babies, causing very little skin irritation and no sign of chilling.

Washes are only one small piece of protecting babies from infection. Clean hands, clean equipment and good hospital practices remain the foundation. In Zambia, a simple package of measures including hand rub, cleaning and baby washing was followed by fewer babies dying in hospital [13]. Families can help too, by washing hands before touching their baby and asking staff about infection prevention on the ward. Readers interested in how hospitals manage germ spread may also like our article on antibiotic resistance in newborn units.

What researchers are working on next

The research team plans a much larger study using 1% chlorhexidine to find out whether it actually prevents infections and saves lives, rather than just lowering germ counts [1]. This matters because, in one large newborn unit in Johannesburg, South Africa, infections caused by hard-to-treat germs have been increasing [14]. Researchers will also want to learn whether one wash for mothers is enough, how often babies should be washed, and whether the washes protect against the resistant germs that worry doctors most.

The bottom line

This careful study from Malawi showed that a single gentle wash with 1% chlorhexidine reduced germs in the birth canal of women in labour and slowed the build-up of germs on newborn skin, and that it appeared safe. Stronger chlorhexidine and another antiseptic did not clearly do better. Whether these washes will prevent infections in babies is the important question that the next, larger study is meant to answer.

References

  1. Beales E, Clements MN, Feasey NA, et al. Antiseptic Cleansing to Reduce Vertical Transmission of Pathogens to Neonates: The NeoVT-AMR Randomized Clinical Trial. JAMA Netw Open. 2026;9(6):e2615665. doi:10.1001/jamanetworkopen.2026.15665 ↩
  2. Seale AC, Blencowe H, Manu AA, et al. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis. Lancet Infect Dis. 2014;14(8):731-741. doi:10.1016/S1473-3099(14)70804-770804-7) ↩
  3. Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study. Lancet Glob Health. 2016;4(10):e752-760. doi:10.1016/S2214-109X(16)30148-630148-6) ↩
  4. Carvalho MJ, Sands K, Thomson K, et al. Antibiotic resistance genes in the gut microbiota of mothers and linked neonates with or without sepsis from low- and middle-income countries. Nat Microbiol. 2022;7(9):1337-1347. doi:10.1038/s41564-022-01184-y ↩
  5. Taha TE, Biggar RJ, Broadhead RL, et al. Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in Malawi: clinical trial. BMJ. 1997;315(7102):216-9; discussion 220. doi:10.1136/bmj.315.7102.216 ↩
  6. Cutland CL, Madhi SA, Zell ER, et al. Chlorhexidine maternal-vaginal and neonate body wipes in sepsis and vertical transmission of pathogenic bacteria in South Africa: a randomised, controlled trial. Lancet. 2009;374(9705):1909-1916. doi:10.1016/S0140-6736(09)61339-861339-8) ↩
  7. Bell C, Hughes L, Akister T, Ramkhelawon V, Wilson A, Lissauer D. What is the result of vaginal cleansing with chlorhexidine during labour on maternal and neonatal infections? A systematic review of randomised trials with meta-analysis. BMC Pregnancy Childbirth. 2018;18(1):139. doi:10.1186/s12884-018-1754-9 ↩
  8. Ohlsson A, Shah VS, Stade BC. Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection. Cochrane Database Syst Rev. 2014;2014(12):CD003520. doi:10.1002/14651858.CD003520.pub3 ↩
  9. Mullany LC, Khatry SK, Sherchand JB, et al. A randomized controlled trial of the impact of chlorhexidine skin cleansing on bacterial colonization of hospital-born infants in Nepal. Pediatr Infect Dis J. 2008;27(6):505-511. doi:10.1097/INF.0b013e31816791a2 ↩
  10. Johnson J, Suwantarat N, Colantuoni E, et al. The impact of chlorhexidine gluconate bathing on skin bacterial burden of neonates admitted to the Neonatal Intensive Care Unit. J Perinatol. 2019;39(1):63-71. doi:10.1038/s41372-018-0231-7 ↩
  11. Dramowski A, Pillay S, Bekker A, et al. Impact of 1% chlorhexidine gluconate bathing and emollient application on bacterial pathogen colonization dynamics in hospitalized preterm neonates - A pilot clinical trial. EClinicalMedicine. 2021;37:100946. doi:10.1016/j.eclinm.2021.100946 ↩
  12. Russell N, Clements MN, Azmery KS, et al. Safety and efficacy of whole-body chlorhexidine gluconate cleansing with or without emollient in hospitalised neonates (NeoCHG): a multicentre, randomised, open-label, factorial pilot trial. EClinicalMedicine. 2024;69:102463. doi:10.1016/j.eclinm.2024.102463 ↩
  13. Mwananyanda L, Pierre C, Mwansa J, et al. Preventing Bloodstream Infections and Death in Zambian Neonates: Impact of a Low-cost Infection Control Bundle. Clin Infect Dis. 2019;69(8):1360-1367. doi:10.1093/cid/ciy1114 ↩
  14. Thomas R, Ondongo-Ezhet C, Motsoaledi N, Sharland M, Clements M, Velaphi S. Incidence, pathogens and antimicrobial resistance of blood and cerebrospinal fluid isolates from a tertiary neonatal unit in South Africa: A 10 year retrospective review. PLoS One. 2024;19(1):e0297371. doi:10.1371/journal.pone.0297371 ↩