Abstract
ABSTRACTObjective:to compare the effect of dry care and the application of chlorhexidine to the umbilical cord of newborns at risk of developing omphalitis. Method:systematic review with meta-analysis. Clinical trials comparing dry care with the application of clorexidine to evaluate omphalitis were selected. Methodological quality was evaluated using the Consolidated Standards of Reporting Trials. Results:the joint analysis of the studies shows a significant decrease in the risk of omphalitis in the chlorhexidine group compared to the dry care group (RR=0.58, CI: 0.53-0.64). However, in the analysis by subgroups, chlorhexidine umbilical cord care did not reduce the risk of omphalitis in hospital births (RR=0.82, CI: 0.64-1.05), in countries with a low infant mortality rate (RR=0.8, CI: 0.5-1.28), or at chlorhexidine concentrations below 4% (RR=0.55, CI: 0.31-1). Chlorhexidine acted as a protective factor at a concentration of 4% (RR=0.58, CI: 0.53-0.64), when applied in cases of home births (RR=0.57, CI: 0.51-0.62), in countries with a high infant mortality rate (RR=0.57, CI: 0.52-0.63). Conclusion:dry cord care is effective in countries with low infant mortality rate and in hospital births. However, 4% chlorhexidine for umbilical cord care protects against omphalitis in home births, in countries with a high infant mortality rate.
Highlights
Omphalitis is an important cause of neonatal mortality and its prevention is of great importance for public health[1]
The analysis of the summaries led to exclusion of 28 through a complete reading of 15 articles, and 6 were eliminated for different reasons: chlorhexidine was not compared with dry cord care[15]; be a research project ; [16] not be a clinical trial[17]; exclusively measure the time until the umbilical cord stump falls off[18,19,20]
In countries with very low neonatal mortality rates, such as Germany, with 2 deaths per 1,000 live births[31], application of chlorhexidine does not differ from dry care in relation to the risk of omphalitis, these studies investigated a small sample when compared with those whose NMR>10
Summary
Omphalitis is an important cause of neonatal mortality and its prevention is of great importance for public health[1]. The incidence of omphalitis in newborns (NB) in developed countries is 0.7%, rising to 2.7% in developing countries[1,2], and it affects both sexes [1] It is defined as a periumbilical acute bacterial infection with induration, erythema, bad smell, pain, and presenting or not association with purulent exudate at the base of the navel[3]. It is peculiar at the neonatal period, and the average age for its incidence is the third or fourth day of life[2,3]. Topical triple dye is a treatment used in the United States, and there are several studies comparing the topical triple dye with alcohol application for UC care, and the results of these studies show that there are no differences between the treatment groups of omphalitis[7,8]
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