Newborn Cord Care Research Articles

Appropriateness of use of antimicrobials versus dry cord care in newborns from an urban slum

Appropriateness of use of antimicrobials versus dry cord care in newborns from an urban slum

Newborn umbilical cord and skin care in Sylhet District, Bangladesh: implications for the promotion of umbilical cord cleansing with topical chlorhexidine

Newborn cord care practices may directly contribute to infections, which account for a large proportion of the four million annual global neonatal deaths. This formative research study assessed current umbilical and skin care knowledge and practices for neonates in Sylhet District, Bangladesh, in preparation for a cluster-randomized trial of the impact of topical chlorhexidine cord cleansing on neonatal mortality and omphalitis. Unstructured interviews (n=60), structured observations (n=20), rating and ranking exercises (n=40) and household surveys (n=400) were conducted to elicit specific behaviors regarding newborn cord and skin care practices. These included hand-washing, skin and cord care at the time of birth, persons engaged in cord care, cord cutting practices, topical applications to the cord at the time of birth, wrapping/dressing of the cord stump and use of skin-to-skin care. Overall 90% of deliveries occurred at home. The umbilical cord was almost always (98%) cut after delivery of the placenta, and cut by mothers in more than half the cases (57%). Substances were commonly (52%) applied to the stump after cord cutting; turmeric was the most common application (83%). Umbilical stump care revolved around bathing, skin massage with mustard oil and heat massage on the umbilical stump. Overall 40% of newborns were bathed on the day of birth. Mothers were the principal provider for skin and cord care during the neonatal period and 9% of them reported umbilical infections in their infants. Unhygienic cord care practices are prevalent in the study area. Efforts to promote hand-washing, cord cutting with clean instruments and avoiding unclean home applications to the cord may reduce exposure and improve neonatal outcomes. Such efforts should broadly target a range of caregivers, including mothers and other female household members.

Umbilical Cord Care: A Pilot Study Comparing Topical Human Milk, Povidone‐Iodine, and Dry Care

To compare the incidence of omphalitis among three groups, each using a different type of newborn cord care: povidone-iodine, dry care, and topical human milk. Case control. A large urban university hospital in Turkey and participant homes after discharge. 150 healthy, full-term newborns and their mothers. Umbilical cord care consisted of one of three methods: topical application of povidone-iodine twice daily, topical application of mother's milk twice daily, or dry care (keeping the cord dry and clean). Outcome was measured in terms of the presence or absence of omphalitis and the number of days elapsed before cord separation. An ongoing questionnaire was administered by telephone every other day after the participants left the hospital. In addition to demographic information, the cord separation day and any signs of omphalitis were recorded in the questionnaire. There were no significant differences between the three groups in terms of omphalitis occurrence. Two cases of omphalitis were observed (one in the human milk group, one in the povidone-iodine group). Interestingly, babies in the dry care or topical human milk group had shorter cord separation times than those in the povidone-iodine group. The cultural practice of applying human milk to the umbilical cord stump appears to have no adverse effects and is associated with shorter cord separation times than are seen with the use of antiseptics.

Alcohol Versus Natural Drying for Newborn Cord Care

To compare alcohol cleaning and natural drying of newborn umbilical cords. Prospective, randomized controlled trial. Tertiary-level university teaching hospital and level II community hospital. Of 1,876 singleton full-term newborns enrolled, 1,811 completed the study. Newborns, from birth until separation of the cord, were randomized to either (a) umbilical cleansing with 70% isopropyl alcohol at each diaper change or (b) natural drying of the umbilical site without special treatment. Umbilical infection, cord separation time, maternal comfort, and cost. No newborn in either group developed a cord infection. Primary care providers obtained cultures for cord concerns in 32 newborns (1.8%), with colonization for normal flora, Staphylococcus aureus, and Group B streptococcus proportionately equal in alcohol and air dry groups. Cord separation time was statistically significantly different (alcohol group, 9.8 days; natural drying group, 8.16 days; t = 8.9, p = < .001). Mothers described similar comfort with cord care and relief with cord separation. Costs of alcohol drying while in the hospital were greater than those of natural drying. (a) Evidence does not support continued use of alcohol for newborn cord care; (b) health care providers should explain the normal process of cord separation, including appearance and possible odor; and (c) health care providers should continue to develop evidence to support or eliminate historic practices.