Stump Care Research Articles

Umbilical cord stump medication with a topical dermo protective powder compared to dry care in healthy full-term and near-term newborns: a two-center prospective cohort study.

Proper umbilical cord stump care during the first days of life (both in hospital and at home) should not be overlooked to prevent possible complications (e.g., purulent discharge, granulomas, or periumbilical erythema or omphalitis). Despite the known benefits of its correct execution, the care of umbilical cord stump remains controversial, and many different approaches are described. The World Health Organization suggests the use of dry cord stump care (easy and economic technique) in developed countries, but in many cases in the real life various topical antiseptics are used in combination with dry cord stump. The extracts of Arnica Montana (AM) have been reported to possess antibacterial, anti-inflammatory, antifungal, and immunomodulatory activities, very useful in the management of cord stump in full term infants. In our study we evaluated the efficacy of a powder containing AM (study group- GrA) versus dry cord stump (control group-GrB) in a population of healthy newborn >35 weeks of gestational age (GA). Three hundred twenty-six neonates (mean GA 39±1 in both groups and body weight 3200 g and 3400±448 g respectively in GrA and GrB) were enrolled in two standard neonatal care units (163 neonates in GrA and 163 in GrB). At T1 (48 hours after discharge) GrA showed significantly reduced incidence of mild complications in toto, in particular a lower rate of wet umbilical cord stump). No differences between the two groups at T2 (1 week after discharge). The use of a natural topical dermo-protective powder containing AM reduces the risk of minor complications, both nurse and parental workload in the first days after discharge, but does not have an impact on cord detachment and other complications in neonates >35 weeks GA.

Mapping the spatial distribution of harmful umbilical cord stump care among neonates in Ethiopia: A spatial with multilevel analysis.

The umbilical cord (UC) serves as the main pathway for bacteria to reach the neonate's body, potentially causing local and severe infections, sepsis, and even death. Consequently, neonatal mortality remains a significant public health concern, particularly in Ethiopia. The World Health Organization (WHO) recommends that the umbilical cord stump be kept clean and dry, with the exception of applying topical antiseptics. However, various harmful substances are still applied to the umbilical cord of neonates. Data on the geographical distribution and risk factors for harmful umbilical cord stump (UCS) care are scarce. Therefore, this study aims to fill this gap. A secondary data analysis of the Ethiopian Demographic Health Survey (EDHS 2016) was conducted using a weighted sample of 7,168 live births. ArcGIS version 10.7.1 software was utilized to visualize the spatial distribution of harmful umbilical cord stump (UCS) care practices in Ethiopia. Additionally, a Bernoulli probability model-based spatial scan statistic was applied using Kulldorff's SaTScan version 9.6 software to identify significant clusters of harmful UCS care. A multilevel logistic regression model was used to determine the factors associated with UCS care practices in Ethiopia. Statistical significance was declared at a two-sided P-value of < 0.05. Overall, the prevalence of harmful UCS care in Ethiopia was 15.09% (95% CI: 13.9-16.3), with significant spatial heterogeneity across geographical areas. The hotspot areas of harmful US care were observed in the eastern (Somali) and northern (Tigray and Amhara) parts of Ethiopia. In spatial scan analysis, the most likely primary clusters were observed in South Nation Nationalities and Peoples region (SNNPR), secondary clusters in the Somali, tertiary clusters in Tigray, and the next clusters in the Amhara regions, respectively. In the final multilevel model, maternal age (Adjusted odds ratio/AOR 1.07, 95% CI: 1.02-1.12), institutional delivery (AOR 0.64, 95% CI: 0.42-0.97), female neonates (AOR 1.31, 95% CI: 1.04-1.61), rural residence (AOR 2.18, 95% CI: 1.05-4.52), living in Tigray region (AOR 3.79, 95% CI: 1.38-9.38), living in Somali region (AOR, 2.95% CI: 1.02-8.52), and living in Harari region (AOR 3.51, 95% CI: 1.28-9.60) were identified as a significant factors of harmful US care practice in Ethiopia. In Ethiopia, the distribution of harmful UCS care practices is non-random and highly clustered in the SNNPR, Somalia, Tigray, and Amhara regions. Both individual and community-level factors were significantly associated with the practice. Special emphasis needs to be provided for neonates from those hot-spot areas and to address the identified predictors of harmful umbilical cord stump care practices.

Cultural influence on angolan maternal care of newborns and health strategies: health professionals’ perspective

Child mortality is a key indicator not only for child health and wellbeing, but also for the general progress towards the Sustainable Development Goals (SDGs). Health professionals are bestowed a prominent position and must be provided with skills for fostering quality and culturally consistent healthcare. Health education practice acts as a means for optimising self-care. This is a descriptive, exploratory and transversal study with qualitative methodology, the sample of which is non probabilistic as a matter of convenience, composed of Angolan health professionals. We analysed cultural influence on Angolan maternal care of newborns and strategies for health intervention from the perspective of Angolan health professionals, as well as the performance of said professionals. Health professionals mention that cultural influence on care fosters practices which are not recommended by the WHO, with a detrimental effect on health, as happens for example in umbilical cord stump care by using products which cause omphalitis and increase the risk of sepsis and neonatal death. Said professionals defend that in view of this finding, it is fundamental to invest in strategies which will improve the quality of healthcare, in order to reduce neonatal mortality in Angola. These results support what has been described in scientific literature and studies within the same framework, reinforcing the need to pay attention to this reality.

A comparative study of knowledge of accredited social health activist (ASHA) workers regarding child health services working in rural and urban areas of a block of Haryana

National Rural Health Mission (NRHM) has created a cadre of trained female community health activists called Accredited Social Health Activist (ASHA) to strengthen the health care system and to mobilize community towards increased utilization of existing health services. The contribution of the Accredited Social Health ActivistASHA) to the achievement of the country’s targets for new-born &amp; child health services is critical. The present study was planned with objective to assess &amp; compare the level of knowledge of ASHA workers regarding child health services working in rural and urban areas of a block of Haryana. The present cross-sectional, community-based study was conducted in block Barwala, district Hisar of Haryana. The assessment of knowledge of ASHA workers was done on the basis of scoring. Appropriate statistical tests like percentages and chi-square (χ2) test were applied. Regarding child health services majority of ASHA workers had good knowledge, assessed by score gained by them and none of them was having poor knowledge about child health services. However, in rural area score gained was better than urban area &amp; the observed difference was found to be statistically significant. Majority of ASHA workers either working in rural or urban areas, were having inadequate knowledge about identification of danger signs during diarrhoea &amp; acute respiratory infection in a child and danger signs of new born. They had adequate knowledge regarding cord stump care; breast Feeding practices; routine Immunization; Vitamin A supplement and home based post natal care (HBPNC) visits. Inadequate knowledge of ASHA workers regarding new born care should be taken into consideration. Supportive supervision should be done in their working area.

Construção e validação de cenário de simulação clínica sobre o cuidado com o coto umbilical

To develop and validate clinical simulation scenario for teaching women in their puerperium and their families about care for the newborn's umbilical cord stump. Methodological study in two stages: 1 - elaboration of the checklist of the procedure for cleaning the umbilical cord and of the clinical case; and 2 - development of the simulated scenario. A Content Validity Index of 0.8 was adopted as the valid range of agreement. After validation, the case was validated, being approved by 100% of the experts. All items of the simulation scenario obtained agreement scores above 0.91. The validated scenario can be used in different contexts: teaching of Neonate Nursing, training teams, and teaching women in their puerperium and their families, who were the target of the study. Considering the benefits of simulation, we believe the simulation here will contribute to better and safer care.

Umbilical cord medication in healthy full-term newborns: a before-after uncontrolled quality improvement study

Umbilical cord care can be a stressful practice for parents. Complications of cord care can increase neonatal morbidity and mortality. The extracts of Arnica montana (AM) have been reported to possess antibacterial, anti-inflammatory, antifungal, and immunomodulatory activities. We aim to demonstrate the efficacy of AM on cord detachment and parents’ stress level induced by cord medication in healthy full-term newborns. We enrolled full-term infants with a birth weight ≥ 2500 g in healthy conditions. Cord stumps of infants in the PRE-group were cleaned and dried, while cord stumps of infants in the POST-group were cleaned, dried, and medicated with a natural topic dermo-protective powder containing AM. After discharge, we interviewed parents on the stump status during follow-up visits in a pediatric office at 7 and 14 days of life, or by phone calls after follow-up visits. Long-rank test showed that time of cord separation of newborns in the PRE-group was significantly higher compared to that in the POST-group (p < 0.001). Parents of newborns in the PRE-group were significantly more stressed during cord medication compared to parents in the POST-group (2.0 (1.2 to 2.1) vs 1.0 (0.8 to 1.3), p = 0.011). Multivariate analysis showed a significantly linear relation with group assignment for cord separation (p < 0.001) and parents’ stress during the medication (p = 0.033).Conclusion: The use of a natural topic dermo-protective powder containing AM reduces the time of cord separation, improves parents’ stress level, and reduces the risk of complications.What is Known:• Cord stump care can be a stressful practice for parents.• Antiseptic treatment recommended for cord care could be associated with side effects such as burning and sensitization.What is New:• The medication of cord stump with a natural topic dermo-protective powder containing Arnica montana reduces time of cord detachment and of complication such as redness’, bleeding, or secretions.• The use of Arnica montana for cord medication may have a positive impact on the family, reducing parents’ stress, and the use of other medications.

Non-nutritional use of breast milk for umbilical cord stump care: a case report

Background: Human milk, in addition to nutrients, contains many biologically active substances including immunoglobulins, growth factors, cytokines, and a diverse population of somatic cells. Breast milk involves no risk of allergy, contains antibodies, and contains factors such as epidermal growth factor (EGF) and erythropoietin, which may promote the growth and repair of skin cells. The discovery of stem cells and the HAMLET complex in breast milk has led to increased interest in human milk as a natural medicine. Aim of the study: The aim of the study was to identify the effect of topical application of breast milk on the separation time of the umbilical cord stump in newborns. Case report: This paper presents the case of a patient who decided to treat her child’s umbilical cord stump with colostrum/breast milk because her two older children had experienced long umbilical stump separation times. As a result of this treatment, separation of the stump occurred 90 hours after labor. There were no abnormalities in the construction of the navel, complications, or separation disorders of the umbilical cord stump. Conclusion: This research demonstrates that colostrum/mother’s milk was used as an easy, cheap, effective, and natural method of umbilical cord care.

Factors Associated with Umbilical Cord Stump Healing Practices: Literature Review

Objective: To analyze the evidence in the evolution of scientific production on the factors associated with curative practices of the umbilical stump. Materials and Methods: The study data collection took place in April 2017. The electronic databases used to search the articles were: PubMed (National Library of Medicine and National Institutes of Health) and VHL (Virtual Health Library). We used the keywords “perinatal care”, “umbilical cord”, “patient care team”, “neonatology”, “newborn”, in the Portuguese, English and Spanish languages, accompanied by the expression AND and selected through DeCS (Descriptors in Health Sciences). Results: A final sample of 9 articles was obtained from the PubMed and VHL databases, which met the inclusions criteria. It has been found that traditional umbilical stump care practices are still present in many communities, however, have been replaced by appropriate practices, the most recommended being: chlorhexidine 4% sanitation, soap and water and alcohol antisepsis 70%. Conclusions: There is a need for multi-professional involvement, approaching these women since pregnancy, with detailed information and accessible language about proper care with the newborn and the umbilical stump.

Collective memory of umbilical cord stump care: an educational experience.

To report the educational experience with pregnant women considering the recovery of collective memory inherited from the care for the umbilical cord stump provided by grandmothers. This case study was based on collective memory and resulted from a workshop with 20 pregnant women from a Basic Health Unit in a city in the inland of Bahia. The study showed that pregnant women's grandmothers are significant in the stump care process because they transmit their memories pervaded by beliefs, myths and superstitions that, although should be respected by nurses and other health professionals, can sometimes contribute to the occurrence of omphalitis and neonatal tetanus. The results indicated the need for raising awareness and education of all persons involved in this care, especially grandmothers, so that they can reflect on the risks and damage that certain empirical knowledge can cause to the health of the umbilical cord.

Amputation and Postoperative Stump Care : Up to Date

Amputation and Postoperative Stump Care : Up to Date

Umbilical Cord Management and Stump Care in Normal Childbirth in Slovenian and Croatian Maternity Hospitals.

The aim was to investigate first-care procedures for the newborn's umbilical cord at maternity hospitals in Slovenia and Croatia. The study was based on an empirical survey research approach and quantitative research paradigms and included all Slovenian (n=14) and all Croatian (n=35) maternity hospitals. Leaders of midwifery team of 14 Slovenian and 35 Croatian labor wards were invited to participate. The study was conducted in 2013, with 67% of Slovenian and 66% of Croatian maternity hospitals having responded. A causal and non-experimental method of empirical research was used. The research instrument was a questionnaire. Descriptive statistics was used on data analysis. The independence hypothesis was tested with the χ2-test or Kullback 2Î-test. A vast ma-jority of study wards employed delayed umbilical cord clamping, i.e. clamping the cord after pulsa-tion had ceased. Only 10% of Slovenian in comparison with 36.4% of Croatian maternity hospitals practiced dry cord care. Others applied disinfectant on the cord, in Slovenia most frequently 6% po-tassium permanganate, and in Croatia a combination of octenidine and phenoxyethanol. Most Croa-tian -maternity wards (95.7%) still covered the stump, while it was not regular practice in Slovenia. The authors estimate that the prevailing Slovenian and Croatian practices in regard to cord clamping are in accordance with the evidence, while improvements could be made regarding stump care, since dry cord care is the recommended method.

Evaluation of home care management of umbilical cord stumps by mothers at Ilesa, Southwestern Nigeria

Background: Umbilical cord care is an integral part of neonatal care in all communities and cultures and appropriate cord care reduces the risk of infection in the newborn infant.Objective: The present study assessed the home care management of the umbilical stump by the mothers at Ilesa, Southwestern Nigeria.Subjects and methods: The subjects were newborn babies brought for routine immunization in health facilities at Ilesa, Nigeria. Informed consent was obtained from the mothers and permission sought from the nurses in charge of the immunization centres. Data collected were entered into a research proforma designed for the study. The babies had complete physical examination with special emphasis on the umbilical cord stump forany abnormality or complications resulting from care.Results: Of 331 babies aged 0 to 28 days assessed, 194 (58.6%) weremales and 137 (41.4%) females. The age range at dropping of the cord was 3 to 25 days with a mean and standard deviation of 8.64 ± 3.55 days. Common methods of umbilical cord care are cleaning with methylated spirit, hot water formentation and the application of shea butter. None of the mothers had appropriate cord care practice of hand-washing before and after cord care, washing the cord with clean water and soap, keeping thecord dry and exposed to air. However, 225 (68.0%) had fair cord care while 106 (32.0%) had poor cord care. Fifty six (16.9%) of the 331 babies had various localized complications of the umbilicus. These were purulent discharge/umbilical sepsis, bleeding, umbilical granuloma, periumbilical cellulitis and omphalitis. Associated factors to poor cord care and complications were no antenatal care and lower social class of the mothers.p =0.000.Conclusions: It is concluded that improved antenatal care, improved social class and training on appropriate cord care during antenatal care visit will improve incidence of cord complications. Key words: Evaluation, Home Care, Umbilical cord stump care, Nigeria

Stump care for lower limb amputee

Stump care for lower limb amputee

Determinants of cord care practices among mothers in Benin City, Edo State, Nigeria

Mothers care for their infants' umbilical cord stump in various ways. Different cord care practices have been documented; some are beneficial while others are harmful. Who and what influence the cord care practiced by mothers have, however, not been fully explored particularly in the study locale. The objective of this study was to determine the factors that influence cord care practices among mothers in Benin City. The study subjects included 497 mothers who brought their babies to Well Baby/Immunization Clinic at the University of Benin Teaching Hospital (UBTH), Benin City, Edo State, between July and August 2009. A structured questionnaire served as an instrument to extract information on their biodata and possible determinants of cord care practices. Significantly older women (P=0.023), educated mothers (P=0.029), and those who had male babies (P=0.013) practiced beneficial cord stump care practices. Beneficial cord care practice increased with increasing maternal educational status. The best predictors of beneficial cord care practices are maternal level of education (P=0.029) and infant's sex (P=0.013). The use of harmful cord care practices was more common among mothers who delivered outside the Teaching hospitals. Most (71.2%) of the mothers were aware of hygienic/beneficial cord care. The choices of cord care methods eventually practiced by mothers were influenced mainly by the disposition of nurses (51.3%), participants' mothers (32.0%), and their mothers-in-law (5.8%). There was no significant relationship between cord care practice on one hand and maternal parity, tribe, and socioeconomic classes on the other. The need for female education is again emphasized. The current findings strongly justify the need for public enlightenment programs, using the mass media and health talks in health facilities, targeting not only women of reproductive age but also secondary audience like their mothers, mothers-in-law, nurses, and attendants at health facilities. Proper hygiene including proper hand washing techniques while caring for newborns along with vaccination of infants and their mothers will help prevent infections including tetanus while prompt health-seeking behavior is advised to improve outcome should such infections occur.

Traumatic amputation — a contemporary approach

The management of patients with loss or near loss of a limb secondary to high-energy trauma is particularly challenging. Management consists of an acute phase of resuscitation and initial surgery, followed by a longer chronic phase, consisting of rehabilitation, fitting of a prosthesis and stump care. Acute assessment by the full trauma team along standard 〈C〉ABCDE guidelines should not conflict with early stemming of on-going stump or limb haemorrhage as required. Patients with traumatic limb loss are likely to be shocked and have traumatic coagulopathy; initial and on-going resuscitation should satisfy the need to replace blood with packed cells and plasma in a 1 : 1 ratio consistent with the concept of `Damage Control Resuscitation'. The surgical goal is to tailor surgery to the patients' physiological state, removing dead and unviable tissue, restoring perfusion to live tissue, stabilising fractured bone and addressing the loss of soft tissues. The imperative to preserve length should not outweigh the need to leave the patient with a stump that will heal in a timely fashion. Lifelong prosthetic preventive maintenance is paramount as residual limbs change in volume with muscle atrophy and changes inpatient weight. Replacement may also be indicated as improved designs appear from time to time. Early rehabilitation and prosthetic fitting also improves routine prosthetic use, which has been found to positively affect return to work.

Plastic Soda Bottles

This paper describes a new fabrication process for making low-cost transradial sockets using recyclable plastic soda bottles. Easy, fast, and inexpensive to fabricate, the resulting socket can be used as a temporary device for stump care. Multiple sockets can be made and individually incorporated with various terminal devices for light-duty self-care or functional activities, such as feeding, showering, typing, swimming, or gardening. The formed socket is lightweight and also suitable for use with a cosmetic passive hand prosthesis. This process has been developed as a potential cost-effective assistive technology appropriate for individuals with transradial amputation in resource-limited countries.

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.

Cord-care practice in Scotland

Objective: to identify the range of policies, practices and rationale for umbilical-cord stump care in the NHS in Scotland.Design: a postal questionnaire survey completed in two stages. The first stage elicited the views of Heads of Midwifery/Senior Midwives, and the second stage the views of midwives, enrolled nurses and nursery nurses.Setting: NHS units in Scotland providing intrapartum care. They were separated into large and small units with small units having ⩽1000 deliveries per year (n=178), and large units >1000 deliveries per year (n=300).Participants: the Heads of Midwifery/Senior Midwives from the 51 units were invited to participate in the study and 49 (96.1%) replied. In stage two 512 maternity unit employees were sent questionnaires and 390 (76.2%) replied. These were six enrolled nurses, 20 nursery nurses and 360 midwives and four respondents of unspecified occupation.Measurements: the existence of cord-care policies and their rationale.Findings: about half of the units that responded had a written policy. Large units were four times more likely than small units to have a written policy. Both managers and staff reported that the most common policy/agreed practice was no specific care (cord observed and only cleaned if soiled). Where a written policy existed, less than one-half of the Heads of Midwifery/Senior Midwives and less than one third of the staff reported that the basis for this policy was research.Key conclusions: units with a written policy are in the minority and small units are far less likely to have such a policy. Wide variation exists in policy, practice and rationale. Diversity within and between units creates anxiety and disillusionment for practitioners. It may also cause confusion for patients who are exposed to different cord-care practices either as these change over time or because they use different units.Implications for Practice: the midwifery profession must examine this area of practice and determine how to address this lack of evidence. Further research is required to determine the most effective method of cord care and how best to put the findings into practice. Outstanding questions which beg further investigation are:•How do cords heal and separate and what bacteria are naturally involved in this process?•What constitutes an infected cord as opposed to a colonised cord?

Mulheres falando sobre suas crenças e práticas no cuidado ao coto umbilical do recém-nascido

Este estudo teve como objetivo verificar o significado do coto umbilical, o auxílio à nova mãe no cuidado ao RN e as práticas no cuidado ao coto umbilical. Utilizou-se técnicas qualitativas para entrevistar mulheres com experiência no cuidado ao RN. Verificou-se que o auxílio no cuidado ao RN é feito pelos familiares de forma hierárquica onde a mãe da puérpura ocupa primeiro lugar. Este auxílio irá influenciar na percepção que a nova mãe tem coto bem como nas práticas do cuidado. Conclui-se que a Enfermangem, no processo de cuidar deve levar em consideração a família e as percepções desta, para que possa haver diálogo e respeito mútuo.

MIDTHIGH AMPUTATIONS FOR ARTERIOSCLEROTIC AND DIABETIC GANGRENE

MIDTHIGH amputations for gangrene resulting from peripheral vascular disease, arteriosclerotic and/or diabetic, have presented a number of important problems which have a direct relationship to morbidity and mortality. They include procrastination and timing of operation; technical methods; closed versus open stumps; anesthesia, especially the contraindicated refrigeration anesthesia with tourniquet; postoperative stump care, and supportive and nutritional therapy. During World War II, the Surgeon General's Office deemed it advisable to adopt a standard method for midthigh amputations, leaving the stumps open and applying traction. This was sound practice in comparatively young men, whose wounds almost always had virulent mixed infections and frequent long latent periods before operative therapy. It was also possible that this procedure was safer in the hands of those with limited experience. Medical officers became so thoroughly indoctrinated with the principle of traction on stumps which were left open that some of them have permitted this method to