Abstract
There is still some uncertainty on cord care practices all around the world, especially in developing countries. The aim of our study was to investigate the effects of six different umbilical cord care practices on the rate of colonization and cord separation time. A total of 516 newborns were randomly allocated to the following six umbilical cord care groups: group 1 received dry care; groups 2-4 received a single application of 70% alcohol, 4% chlorhexidine, or povidon-iodine in the delivery room, respectively, which were discontinued thereafter; groups 5 and 6 received a single application of 70% alcohol or 4% chlorhexidine, respectively, starting in the delivery room andcontinuing every six hours until discharge. Umbilical cords were examined on the second and third days and between the fifth and seventh day for signs of omphalitis. Swab cultures were taken on the second or third day from all cases. Cord separation time (median [interquartile range]) was the shortest for group 1 (7 [6-7] days) and the longest for group 3 (10 [7-12] days) and group 6 (10 [8-12] days) (p < 0.001). The cord colonization in the swab cultures was significantly lower in groups 3 and 6 (p < 0.001). Omphalitis was detected in eight (1.5%) patients among the study population, and there was no significant difference between the groups. Our study showed that chlorhexidine application was the most effective agent in decreasing colonization, though it increased cord separation time significantly in both groups.
Highlights
There is still some uncertainty on cord care practices all around the world, especially in developing countries
Since 1998, the World Health Organization has recommended promotion of clean and dry cord care for newborns, while noting that topical antiseptics may be used where risk of infection is high; controversy still exists in the literature 5
A Cochrane review by Zupan et al 6 reported studies mainly conducted in hospitals in high-income countries; the results cannot be generalized to community settings in low-income countries, where achieving clean and dry cord care is difficult [7,8,9,10]
Summary
There is still some uncertainty on cord care practices all around the world, especially in developing countries. The aim of our study was to investigate the effects of six different umbilical cord care practices on the rate of colonization and cord separation time. Conclusions: Our study showed that chlorhexidine application was the most effective agent in decreasing colonization, though it increased cord separation time significantly in both groups. The idea of preventive treatment evolved from the assumption that bacterial growth in the umbilicus is harmful This resulted in routine umbilical cord care with disinfectants and antimicrobial agents to prevent systemic infection 4. A Cochrane review by Zupan et al 6 reported studies mainly conducted in hospitals in high-income countries; the results cannot be generalized to community settings in low-income countries, where achieving clean and dry cord care is difficult [7,8,9,10]. The effect of chlorhexidine compared to dry cord care on neonatal mortality in hospital settings remains largely unknown
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