Incidence Of Omphalitis Research Articles

THE STUDY OF CLINICAL AND PHYSIOLOGICAL PARAMETERS OF ENZYMATIC AND IMMUNE ACTIVITY IN NEWBORN CALVES AFTER THE APPLICATION OF MODERN DOMESTIC BIOPREPARATION RIBOTAN

The aim of the work was to study the clinical and physiological parameters of enzymatic and immune activity in newborn calves after the application of the domestic biological product Ribotan to their mother cows 3-9 days before calving. The objects of the study were 20 clinically healthy pregnant cows of the Black-and-white breed, selected according to the principle of paired analogues, which were divided into 2 groups (control and experimental) of 10 animals each (n=10), and newborn calves received from them. The cows of the experimental group were injected Ribotan given as a single dose intramuscularly in a dose of 5 ml 3-9 days before calving. The cows of the control group were injected isotonic sodium chloride solution. On the 2nd day of life, calves showed a decrease in lactic acid content by 45%, as well as a lactate/pyruvate ratio by 17.9%. An increase in the activity of superoxide dismutase by 50% and a decrease in the level of malondialdehyde by 25.8% were noted. It was found that the application of the biopreparation led to an improvement in clinical and physiological parameters in calves, namely: a firm standing position was realized 11.2 minutes faster, the sucking reflex formed 13.6 minutes faster. The level of total serum immunoglobulins increased by 63%. A higher level of colostral immunity caused a 2-3 – fold decrease in the incidence of omphalitis and gastrointestinal disorders in calves.

ОЦЕНКА ОБМЕННЫХ ПРОЦЕССОВ И ФОРМИРОВАНИЯ КОЛОСТРАЛЬНОГО ИММУНИТЕТА У НОВОРОЖДЕННЫХ ТЕЛЯТ ПОСЛЕ ПРИМЕНЕНИЯ БИОПРЕПАРАТА «РИБОТАН»

The aim of the work was to assess the metabolic processes of newborn calves and the formation of their colostral immunity after the application of biological preparation «Ribotan» to their mother cows 3-9 days before calving. In calves on the 2nd day of life, a decrease in the content of lactic acid by 45%, as well as a decrease in the lactate/pyruvate ratio by 17,9% was noted. An increase in superoxide dismutase activity by 50% and a decrease in the level of malondialdehyde by 25,8% were also noted. The result of the normalization of the metabolic processes state of newborn calves was a decrease in endogenous intoxication of their body, which led to an improvement in clinical and physiological parameters, including a confident standing position for 11,2 minutes, and also a sucking reflex appeared faster by 13,6 minutes. The level of total serum immunoglobulins increased by 63%. A higher level of colostral immunity led to a decrease in the incidence of omphalitis and enteritis form of escherichiosis in calves by 2-3 times in the early postnatal period of ontogenesis.

Effect of dry cord care versus chlorhexidine cord care on cord separation time in healthy newborns: A comparative study

Background: Umbilical cord infection (omphalitis) is a major cause of neonatal mortality and morbidity in a developing country like Nepal. Detached umbilical stump is an important colonizing site for different types of bacteria and it also provides direct access to bloodstream. Hence, inadequate cord care may lead to omphalitis as well as neonatal sepsis.
 Objectives: This study aims to compare two different cord care regimens (dry cord care versus chlorhexidine cord care) on their cord separation time and the incidence of omphalitis.
 Methodology: This is a comparative observational study conducted at the Neonatal unit of Kathmandu Medical College over a three months period (August 2019 to October 2019). All newborn babies born between 37 to 42 weeks of gestation were enrolled. Randomization for dry cord care and chlorhexidine cord care group was done via computer generated numbers. Statistical package for social sciences 19 version was used for statistical analysis.
 
 Results: Among 514 term babies, 256 babies were included in the dry cord care group while 258 babies were enrolled in the chlorhexidine cord care group. The two groups had similar baseline characteristics. The mean cord separation time in the dry cord care group was 7.70±1.2 days (range 3-15 days), whereas in the chlorhexidine group, it was 7.77±1.4 days (range 4-18 days). 
 Conclusion: There was no significant difference between the cord separation times in dry and chlorhexidine cord care regimens. Both dry cord care and chlorhexidine cord care regimens were found to be safe and effective.

Umbilical cord separation time, predictors and healing complications in newborns with dry care.

The objective of this study was to explore the umbilical cord separation time, predictors, and healing complications from birth until the newborn was one month old. A quantitative longitudinal observational analytical study by stratified random sample was adopted. Public health system hospitals in southern Spain and at newborns' homes. Between April 2016 and December 2017, the study included 106 neonates born after 35-42 weeks of gestation whose umbilical cord was cured with water and soap and dried later as well as newborns without umbilical canalisation whose mothers enjoyed a low-risk pregnancy. The data collection procedure comprised two blocks: from birth to the time of separation of the umbilical cord and from cord separation to the first month of life of the newborn. Umbilical cord separation time was measured in minutes; socio-demographic and clinical characteristics were measured by means of questionnaires, and the external diameter of the umbilical cord was measured using an electronic stainless-steel calliper and trailing roller. The mean umbilical separation time: 6.61 days (±2.33, IC 95%:6.16-7.05). Incidence of omphalitis was 3.7%; granuloma was 8.6%. Separation time predictors were wetting recurrence, birth weight, intrapartum antibiotics, birth season, and Apgar < 9 (R2 = 0.439 F: 15.361, p <0.01). The findings support the World Health Organization recommendations: dry umbilical cord cares is a safe practice that soon detaches the umbilical cord, taking into account the factors studied that will vary the length of time until the umbilical cord is separated.

The Use of Alcohol versus Dry Care for the Umbilical Cord in Newborns: A Systematic Review and Meta-analysis of Randomized and Non-randomized Studies.

Inadequate cord care in neonates is an important modifiable risk factor of cord stump infection, sepsis, and neonatal death, particularly in countries with limited resources. Dry cord care and alcohol 70% are commonly used in multiple developing countries. There is a need to investigate the efficacy and safety of both the cord care to achieve the best outcomes in neonates during this critical period of life. The objective of the study was to compare between dry cord care and topical application of alcohol 70% for cord care in newborn infants in terms of cord separation time (CST) as well as the incidence of omphalitis, sepsis, and neonatal mortality. The analysis was conducted up to April 2019 in MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar to include randomized clinical trials (RCTs) and quasi-experiments which investigated at least two infant groups receiving either dry cord care or alcohol 70%. Mean differences (MDs) and 95% confidence intervals (CIs) were used to analyze continuous data, while risk ratios (RRs) and 95% CIs were used to analyze dichotomous variables. A total of 13 articles were included (4967 infants, 50.35% females, six RCTs). Alcohol application was significantly associated with longer CST (MD = 1.93 days, 95% CI: 0.80, 3.06) with significant heterogeneity among studies (I2 = 97%) while no significant differences were found in the risk of omphalitis. On the other hand, dry cord care was associated with the risk of foul odor at the cord/surrounding tissues (RR = 0.49, 95% CI: 0.28, 0.85) and increased risk of E-coli colonization (RR = 0.75, 95% CI: 0.57, 0.98). Dry cord care is a simple and effective way to shorten CST, particularly in countries with limited resources. However, in light of the limitations of the included studies, future RCTs with higher methodological quality are warranted. The significant heterogeneity among studies is the limitations of the included studies.

Topical Breastmilk: Nursing Care of Newborn Umbilical Cord Model

Introduction: Omphalitis and umbilical cord separation time contributing to the number of morbidity and mortality in infants. There are various ways of cord care, but there was no significant difference in prevent of infection and cord separation time. Breast milk contains anti-infective and antiinflammatory factors that can be used for cord care. WHO recommends to develop it. The purpose of this study was to analyze the effect of topical breastmilk model on the incidence of omphalitis and separation time of the umbilical cord to the newborn.Methods: The study design was a quasy experimental. The subjects of this study were 30 newborns obtained by consecutive sampling in Rumah Sakit Ibu dan Anak Kendangsari Surabaya May–June 2012. The samples were divided into 2 groups (topical breastmilk and open dry treatment), each group consists of 15 newborns. Data were analyzed using chi-square and independent t-test with a signifi cance level ofα≤0.05.Results: There was no difference in the incidence of omphalitis in the use of topical breastmilk model compared to open dry treatment (p=0.33). However, there are significant differences in the average of cord separation time between topical breastmilk model and open dry treatment (p=0.020).Conclusion: Model of cord care with topical breastmilk lowers the risk of omphalitis and accelerate the cord separation time compared to open dry treatment. Using breastmilk as cord care are safe, effective and efficient.

Chlorhexidine skin or cord care for prevention of mortality and infections in neonates.

Affordable, feasible and efficacious interventions to reduce neonatal infections and improve neonatal survival are needed. Chlorhexidine, a broad spectrum topical antiseptic agent, is active against aerobic and anaerobic organisms and reduces neonatal bacterial colonisation and may reduce infection. To evaluate the efficacy of neonatal skin or cord care with chlorhexidine versus routine care or no treatment for prevention of infections in late preterm or term newborn infants in hospital and community settings. We searched CENTRAL, latest issue of The Cochrane Library, MEDLINE (1966 to November 2013), EMBASE (1980 to November 2013), and CINAHL (1982 to November 2013). Ongoing trials were detected by searching the following databases: www.clinicaltrials.gov and www.controlled-trials.com. Cluster and individual patient randomised controlled trials of chlorhexidine use (for skin care, or cord care, or both) in term or late preterm neonates in hospital and community settings were eligible for inclusion. Three authors independently screened and selected studies for inclusion. Two review authors independently extracted data, and assessed study risk of bias. The quality of evidence for each outcome was assessed using GRADE. We calculated pooled risk ratios (RRs) and risk differences (RDs) with 95% confidence intervals (CIs), and presented results using GRADE 'Summary of findings' tables. We included 12 trials in this review. There were seven hospital-based and five community-based studies. In four studies maternal vaginal wash with chlorhexidine was done in addition to neonatal skin and cord care. Newborn skin or cord cleansing with chlorhexidine compared to usual care in hospitalsLow-quality evidence from one trial showed that chlorhexidine cord cleansing compared to dry cord care may lead to no difference in neonatal mortality (RR 0.11, 95% CI 0.01 to 2.04). Moderate-quality evidence from two trials showed that chlorhexidine cord cleansing compared to dry cord care probably reduces the risk of omphalitis/infections (RR 0.48, 95% CI 0.28 to 0.84).Low-quality evidence from two trials showed that chlorhexidine skin cleansing compared to dry cord care may lead to no difference in omphalitis/infections (RR 0.88, 95% CI 0.56 to 1.39). None of the studies in this comparison reported effects of the treatments on neonatal mortality. Newborn skin or cord cleansing with chlorhexidine compared to usual care in the communityHigh-quality evidence from three trials showed that chlorhexidine cord cleansing compared to dry cord care reduces neonatal mortality (RR 0.81, 95% CI 0.71 to 0.92) and omphalitis/infections (RR 0.48, 95% CI 0.40 to 0.57).High-quality evidence from one trial showed no difference between chlorhexidine skin cleansing and usual skin care on neonatal mortality (RR 1.03, 95% CI 0.87 to 1.23). None of the studies in this comparison reported effects of the treatments on omphalitis/infections. Maternal vaginal chlorhexidine in addition to total body cleansing compared to no intervention (sterile saline solution) in hospitalsModerate-quality evidence from one trial showed no difference between maternal vaginal chlorhexidine in addition to total body cleansing and no intervention on neonatal mortality (RR 0.98, 95% CI 0.67 to 1.42). High-quality evidence from two trials showed no difference between maternal vaginal chlorhexidine in addition to total body cleansing and no intervention on the risk of infections (RR 0.93, 95% CI 0.82 to 1.16).Findings from one trial showed that maternal vaginal cleansing in addition to total body cleansing results in increased risk of hypothermia (RR 1.33, 95% CI 1.19 to 1.49). Maternal vaginal chlorhexidine in addition to total body cleansing compared to no intervention (sterile saline solution) in the communityLow-quality evidence from one trial showed no difference between maternal vaginal chlorhexidine in addition to total body cleansing and no intervention on neonatal mortality (RR 0.20, 95% CI 0.01 to 4.03). Moderate-quality evidence from one trial showed that maternal vaginal chlorhexidine in addition to total body cleansing compared to no intervention probably reduces the risk of neonatal infections (RR 0.69, 95% CI 0.49 to 0.95). These studies did not report effect on omphalitis. There is some uncertainty as to the effect of chlorhexidine applied to the umbilical cords of newborns in hospital settings on neonatal mortality. The quality of evidence for the effects on infection are moderate for cord application and low for application to skin. There is high-quality evidence that chlorhexidine skin or cord care in the community setting results in a 50% reduction in the incidence of omphalitis and a 12% reduction in neonatal mortality. Maternal vaginal chlorhexidine compared to usual care probably leads to no difference in neonatal mortality in hospital settings. Maternal vaginal chlorhexidine compared to usual care results in no difference in the risk of infections in hospital settings. The uncertainty over the effect of maternal vaginal chlorhexidine on mortality outcomes reflects small sample sizes and low event rates in the community settings.

English

BACKGROUND: Umbilical sepsis is an important cause of neonatal morbidity and mortality. Severe omphalitis necessitates the administration of parenteral antibiotics with a consequent prolongation of hospital stay. AIMS: To assess whether simple protocolised interventions for cord care with locally available chlorhexidine is effective in reducing the incidence of umbilical sepsis. METHODS: This is a retrospective study. A protocol was introduced for daily cord care using 0.5% chlorhexidine gluconate followed by cleaning with sterile water for all newborns in Government Medical College, Ernakulam (formerly Co-operative Medical College, Kochi, Kerala). The incidence and severity of omphalitis was audited for a 3 month period subsequent to this practice change and was compared with the incidence of omphalitis during the same 3 month period in the preceding year. RESULTS: Eighty six babies were in the pre-intervention group and seventy seven in the chlorhexidine group were compared and both the groups were similar with respect to gestational age, sex, mode of delivery and parenteral antibiotic use. There was a significant difference with regard to the overall incidence of omphalitis after chlorhexidine use. Incidence of omphalitis was 44% in the pre-intervention group as compared to 6.5% in the chlorhexidine group (p value<0.05). CONCLUSION: Local administration of 0.5% chlorhexidine is effective in preventing umbilical sepsis.

Eau de Dalibour vs. Alcohol for Umbilical Cord Care

This study was conducted to compare the effects of Eau de Dalibour and ethanol on preventing omphalitis and also on umbilical cord separation time in neonates. In this clinical trial, 178 randomly selected, healthy term neonates were investigated. To disinfect the umbilical cords, Eau de Dalibour was used for 84 infants (case group) and ethanol for 94 infants (control group). No cases of omphalitis were observed in either group. Umbilical cord separation time was significantly shorter in the Eau de Dalibour group than in the ethanol group: 4.04 ± 1.61 days vs. 6.3 ± 1.82 days, p = 0.001. This study revealed that although Eau de Dalibour and ethanol were equally effective in preventing the incidence of omphalitis in neonates, Eau de Dalibour induced the separation of umbilical cord significantly quicker in the infants. Thus, Eau de Dalibour could be used as a suitable replacement for ethanol in neonates' umbilical cord care.

Neonatal Omphalitis in Iraq

In developed countries aseptic delivery techniques, hygienic cord care and prompt antimicrobial therapy have decreased the occurrence as well as the severity of Omphalitis. However, the condition remains a significant cause of morbidity and mortality in the developing country. The objective is the risk factors, clinical and bacteriological profile of neonates with Omphalitis in Iraq. Regarding the patients sixty-four neonatal Omphalitis admitted at the Neonatal Intensive Care Units of Children Welfare Teaching Hospital and Neonatal Intensive Care Units of Al-elwya Teaching Hospital in Baghdad Iraq, during 8 months from October 2011 to May 2012. The risk factors and clinical, bacteriologic and relevant investigational profiles and outcomes were studied in neonates with Omphalitis. For the study purpose Omphalitis was classified into four categories based on severity. The result was show that the incidence of Omphalitis was higher in home births and in neonates with low birth weight. Staphylococcus aureus was the most common pathogen isolated from umbilical swabs followed by Escherichia coli. Regarding conclusion low birth weight and home delivery are considered as risk factors for Omphalitis in Iraq. The treatment should be received for Gram-positive and Gram-negative microorganism because of the predominance of Gram-negative microorganisms in neonatal infant with Omphalitis.

A Review of Studies with Chlorhexidine Applied Directly to the Umbilical Cord

Infection-related neonatal mortality due to omphalitis in developing country home births is an important public health problem. Three cluster randomized trials of 4% chlorhexidine applied to the umbilical cord stump from once to multiple times in the days following a home birth have evaluated this intervention compared with other types of cord care on the development of omphalitis and neonatalmortality. Each of the three studies showed significant reductions in either omphalitis, neonatal mortality, or both with the 4% chlorhexidine. However, the optimal dosing schedule remains uncertain. Although further studies are needed to clarify this issue, from the three studies it is now clear that with a minimum of one application of 4% chlorhexidine to the umbilical cord stump following delivery, the incidence of omphalitis and neonatal mortality can be reduced, especially in preterm newborns. This intervention, which is safe and inexpensive and requires minimal training and skill, should strongly be considered for adoption wherever home births occur.

Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based, cluster-randomised trial

Umbilical cord infection (omphalitis) is a risk factor for neonatal sepsis and mortality in low-resource settings where home deliveries are common. We aimed to assess the effect of umbilical-cord cleansing with 4% chlorhexidine (CHX) solution, with or without handwashing with antiseptic soap, on the incidence of omphalitis and neonatal mortality. We did a two-by-two factorial, cluster-randomised trial in Dadu, a rural area of Sindh province, Pakistan. Clusters were defined as the population covered by a functional traditional birth attendant (TBA), and were randomly allocated to one of four groups (groups A to D) with a computer-generated random number sequence. Implementation and data collection teams were masked to allocation. Liveborn infants delivered by participating TBAs who received birth kits were eligible for enrolment in the study. One intervention comprised birth kits containing 4% CHX solution for application to the cord at birth by TBAs and once daily by family members for up to 14 days along with soap and educational messages promoting handwashing. One intervention was CHX solution only and another was handwashing only. Standard dry cord care was promoted in the control group. The primary outcomes were incidence of neonatal omphalitis and neonatal mortality. The trial is registered with ClinicalTrials.gov, number NCT00682006. 187 clusters were randomly allocated to one of the four study groups. Of 9741 newborn babies delivered by participating TBAs, factorial analysis indicated a reduction in risk of omphalitis with CHX application (risk ratio [RR]=0·58, 95% CI 0·41-0·82; p=0·002) but no evidence of an effect of handwashing (RR=0·83, 0·61-1·13; p=0·24). We recorded strong evidence of a reduction in neonatal mortality in neonates who received CHX cleansing (RR=0·62, 95 % CI 0·45-0·85; p=0·003) but no evidence of an effect of handwashing promotion on neonatal mortality (RR=1·08, 0·79-1·48; p=0·62). We recorded no serious adverse events. Application of 4% CHX to the umbilical cord was effective in reducing the risk of omphalitis and neonatal mortality in rural Pakistan. Provision of CHX in birth kits might be a useful strategy for the prevention of neonatal mortality in high-mortality settings. The United States Agency for International Development.

Incidence and etiology of omphalitis in Pakistan: a community-based cohort study

Although omphalitis (umbilical infections) among newborns is common and a major cause of neonatal deaths in developing countries, information on its burden and etiology from community settings is lacking. This study aimed to determine the incidence and etiology of omphalitis in newborns in high neonatal mortality settings in Karachi, Pakistan. Trained community health workers surveyed all new births in three low-income areas from September 2004 to August 2007. Pus samples from the umbilical stumps were obtained from babies with pre-defined signs of illness and subjected to culture and antimicrobial susceptibility testing. Among 6904 births, 1501 (21.7%) newborns were diagnosed with omphalitis. Of these, 325 (21.6%) were classified as mild, 1042 (69.4%) as moderate, and 134 (8.9%) as severe; 141 (9.3%) were associated with clinical signs of sepsis. The incidence of omphalitis was 217.4/1000 live births; moderate-severe omphalitis 170.3 per 1000 live births; and associated with sepsis 20.4 per 1000 live births. Of 853 infants with purulent umbilical discharge, 64% yielded 583 isolates. The most common pathogens were Staphylococcus aureus, of which 291 (95.7%) were methicillin-susceptible Staphylococcus aureus (MSSA) and 13 (4.2%) methicillin-resistant S. aureus (MRSA); Streptococcus pyogenes 105 (18%); Group B beta-hemolytic streptococci 59 (10 %); Pseudomonas spp., 52 (8.9 %); Aeromonas spp. 19 (3.2%); and Klebsiella spp. 12 (2%). A high burden of omphalitis can be associated with sepsis among newborns in low-income communities in Pakistan. S. aureus is the most common pathogen isolated from umbilical pus. Appropriate low-cost prevention strategies need to be implemented.

Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial

Omphalitis contributes to neonatal morbidity and mortality in developing countries. Umbilical cord cleansing with antiseptics might reduce infection and mortality risk, but has not been rigorously investigated. In our community-based, cluster-randomised trial, 413 communities in Sarlahi, Nepal, were randomly assigned to one of three cord-care regimens. 4934 infants were assigned to 4.0% chlorhexidine, 5107 to cleansing with soap and water, and 5082 to dry cord care. In intervention clusters, the newborn cord was cleansed in the home on days 1-4, 6, 8, and 10. In all clusters, the cord was examined for signs of infection (pus, redness, or swelling) on these visits and in follow-up visits on days 12, 14, 21, and 28. Incidence of omphalitis was defined under three sign-based algorithms, with increasing severity. Infant vital status was recorded for 28 completed days. The primary outcomes were incidence of neonatal omphalitis and neonatal mortality. Analysis was by intention-to-treat. This trial is registered with , number NCT00109616. Frequency of omphalitis by all three definitions was reduced significantly in the chlorhexidine group. Severe omphalitis in chlorhexidine clusters was reduced by 75% (incidence rate ratio 0.25, 95% CI 0.12-0.53; 13 infections/4839 neonatal periods) compared with dry cord-care clusters (52/4930). Neonatal mortality was 24% lower in the chlorhexidine group (relative risk 0.76 [95% CI 0.55-1.04]) than in the dry cord care group. In infants enrolled within the first 24 h, mortality was significantly reduced by 34% in the chlorhexidine group (0.66 [0.46-0.95]). Soap and water did not reduce infection or mortality risk. Recommendations for dry cord care should be reconsidered on the basis of these findings that early antisepsis with chlorhexidine of the umbilical cord reduces local cord infections and overall neonatal mortality.