Umbilical Cord Stump Research Articles

Cord care education and its content given to mothers at antenatal clinics in various health facilities in Edo state, Nigeria

Introduction: Hygienic umbilical cord care is necessary for the well-.being of the newborn. Health education is a strong tool for lifestyle modification aimed at healthy living. This ought to extend to mothers who care for their infants' umbilical cord stump in various ways especially after discharge from hospital. The content of health education on cord care given to mothers (if any) at various health institutions which they accessed for antenatal care is thus worth evaluating. Objective: To evaluate the content of health education on cord care given to mothers at various health facilities which served as their places of antenatal care in Benin City, Nigeria. Methods: The study subjects included mothers who brought their babies to Well Baby/Immunization Clinic of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. A structured questionnaire was used to assess their biodata, places of antenatal care, whether health education on cord care constituted part of the services received in health facilities and the content of the cord care education. Results: Of the 497 subjects studied, 487 (98.0%) received antenatal care (ANC) in both orthodox and unorthodox facilities. Amongst these, 352 (72.3%) received health education on cord care while 135 (27.7%) did not. Teaching and private hospitals contributed 116 (48.9%) and 103 (43.5%) respectively to the total documentation of the advice concerning use of methylated spirit alone. The relationship between content of health education on cord care and method of cord care practiced by mothers was statistically significant. Conclusion: Health education on cord care is lacking in some of our health facilities and where available, content may not be evidence-.based. We must equip health workers with facts required to enlighten patients. A standard and universal method of cord care should be adopted to reduce or abolish the confusion which mothers presently encounter in caring for their babies' umbilical cords.

The Effect of Topical Application of Mother Milk on Separation of Umbilical Cord for Newborn Babies

Global policy regarding optimal umbilical cord care to prevent neonatal illness is an active discussion among researchers and policy makers. The objective of the study is to identify the best available evidence regarding newborn umbilical cord care through, assessing the knowledge of mothers regarding best practice of umbilical cord care and monitoring the effect of both methods of topical mother milk application versus dry method on quickly separation time of umbilical cord stump of newborn babies. The study method is an experimental design. The study result showed that topical application of mother milk on the remaining part of the cord reduces the cord separation time and it can be used as an easy, cheap and noninvasive way for cord care.

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

Intra-abdominal inverted umblical cord in gastroschisis: a unique ultrasound finding

A relatively new surgical technique allows for sutureless closure of a gastroschisis defect. Immediately after birth, a long umbilical cord stump is temporarily inverted into the abdominal cavity and later retracted and used to close the abdominal wall defect. Knowledge of this entity is important since the inverted umbilical cord simulates an intra-abdominal mass on cross-sectional imaging. While this procedure is well described in the surgical literature, the imaging features of inverted umbilical cord have yet to be reported. The case presented here highlights the sonographic imaging findings of the umbilical cord during the intestinal decompression phase of sutureless repair of gastroschisis.

Newborn umbilical cord care in an Obstetric and Gynecology Hospital in Shanghai: a best practice implementation project

Background The umbilical cord stump may be a potential route for infection. There is still confusion regarding the best care of the umbilical cord stump, especially for new parents. This is highlighted by requests from new parents and midwives, and the need to improve umbilical cord care according to evidence-based practice. Objectives The purpose of this project is to evaluate the knowledge of new parents and nurses regarding evidence-based practice of umbilical cord care. Umbilical cord complications can be reduced by shortening the cord separation time, and also decreasing umbilical cord infection rates. This will lead to improved satisfaction rates for parents. Methods This project adopted a pre- and post-implementation audit approach. It utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. The project utilized five audit criteria that are considered the best practice standards. Results The post-implementation audit findings revealed a significant improvement in staff and parent education, as well as the correct procedure for nappy change. Conclusion The introduction of an education program during the audit project improved umbilical cord care in the ward.

Umbilical cord antiseptics for preventing sepsis and death among newborns.

The umbilical cord is a structure made of blood vessels and connective tissue that connects the baby and placenta in utero. The umbilical cord is cut after birth, which separates the mother and her baby both physically and symbolically. Omphalitis is defined as infection of the umbilical cord stump. Tracking of bacteria along the umbilical vessels may lead to septicaemia that can result in neonatal morbidity and mortality, especially in developing countries. To determine the effect of application of antimicrobials on newborn's umbilical cord versus routine care for prevention of morbidity and mortality in hospital and community settings. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 October 2012). In addition, we also searched LILACS (1982 to 11 October 2012) and HERDIN NeON (October 2012) We included randomized, cluster-randomized and quasi-randomized controlled trials of topical cord care compared with no topical care, and comparisons between different forms of care. Two review authors independently assessed trials for inclusion, trial quality and subsequently extracted data.Data were checked for accuracy. The search identified 77 trials. We included 34 trials in the review involving 69,338 babies, five studies are awaiting classification and there are two ongoing community trials. Included studies were conducted in both developed and developing countries. Among the 34 included trials, three were large, cluster-randomized trials conducted in community settings in developing countries and 31 studies were conducted in hospital settings mostly in developed countries. Data for community and hospital studies were analyzed separately. The three trials conducted in community settings contributed 78% of the total number of children included in this review. Of the trials conducted in hospital settings, the majority had small sample sizes. There were 22 different interventions studied across the included trials and the most commonly studied antiseptics were 70% alcohol, triple dye and chlorhexidine.Only one antiseptic, chlorhexidine was studied in community settings for umbilical cord care. Three community trials reported data on all-cause mortality that comprised 1325 deaths in 54,624 participants and combined results showed a reduction of 23% (average risk ratio (RR) 0.77, 95% confidence interval (CI) 0.63 to 0.94, random-effects, T² = 0.02, I² = 50%) in the chlorhexidine group compared with control. The reduction in omphalitis ranged from 27% to 56% depending on the severity of infection. Cord separation time was increased by 1.7 days in the chlorhexidine group compared with dry cord care (mean difference (MD) 1.75 days, 95% CI 0.44 to 3.05, random-effects, T² = 0.88, I² = 100%). Washing of umbilical cord with soap and water was not advantageous compared with dry cord care in community settings.Among studies conducted in hospital settings, no study reported data for mortality or tetanus. No antiseptic was advantageous to reduce the incidence of omphalitis compared with dry cord care in hospital settings. Topical triple dye application reduced bacterial colonization with Staphylococcus aureus compared with dry cord care (average RR 0.15, 95% CI 0.10 to 0.22, four studies, n = 1319, random-effects, T² = 0.04, I² = 24%) or alcohol application (average RR 0.45, 95% CI 0.25 to 0.80, two studies, n = 487, random-effects, T² = 0.00, I² = 0%). There was no advantage of application of alcohol and triple dye for reduction of colonization with streptococcus. Topical alcohol application was advantageous in reduction of colonization with Enterococcus coli compared with dry cord care (average RR 0.73, 95% CI 0.58 to 0.92, two studies, n = 432, random-effects, T² = 0.00, I² = 0%) and in a separate analysis, triple dye increased the risk of colonization compared with alcohol (RR 3.44, 95% CI 2.10 to 5.64, one study, n = 373). Cord separation time was significantly increased with topical application of alcohol (MD 1.76 days, 95% CI 0.03 to 3.48, nine studies, n = 2921, random-effects, T² = 6.54, I² = 97%) and triple dye (MD 4.10 days, 95% CI 3.07 to 5.13, one study, n = 372) compared with dry cord care in hospital settings. The number of studies was insufficient to make any inference about the efficacy of other antiseptics. There is significant evidence to suggest that topical application of chlorhexidine to umbilical cord reduces neonatal mortality and omphalitis in community and primary care settings in developing countries. It may increase cord separation time however, there is no evidence that it increases risk of subsequent morbidity or infection.There is insufficient evidence to support the application of an antiseptic to umbilical cord in hospital settings compared with dry cord care in developed countries.

Visual Diagnosis: 2-week-old Has a Red, Peeling Rash

1. Anita Gupta, MD* 2. Norman Jacobs, MD† 1. *Neonatology Fellow, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL. 2. †Attending Physician, John H. Stroger Jr. Hospital of Cook County, Chicago, IL. A 2-week-old term female presents to the emergency department with a history of an abrupt, generalized red rash with peeling of the skin. Her mother reports that she first noticed the skin peeling around her daughter’s umbilicus 3 days ago, about the same time the umbilical cord stump fell off. She also noted some brownish discharge from the umbilicus at that time. Twenty-four hours earlier, the infant had developed irritability and a generalized red rash over her body, with areas of peeling skin. There is no history of fever, cold, hypothermia, cough, or eye discharge. Up to this point, the infant has been feeding and stooling well. The infant was born term via a normal spontaneous vaginal delivery without complications. Birthweight was 2,700 g, and Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. However, the maternal group B Streptococcus status was unknown; the mother received two doses of intravenous penicillin 4 hours before delivery. On physical examination, the patient’s vital signs are appropriate for age, and there is no fever. The infant reacts to touch as if it hurts. Examination of the skin reveals erythroderma (scaling erythematous dermatitis) and large, thin sheets of peeling skin with underlying shallow, bright red erosions around the face (Fig 1), lower abdomen, axillae and antecubital fossae (Fig 2), and both ankles and feet (Fig 3). There are no vesicles or bullae. There is no increased erythema around, or oozing or crusting from, the periumbilical area. The mucous membranes of the mouth and anus are unaffected. The rest of the physical examination is normal for age. A clinical diagnosis is made. …

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.

Necrotizing upper limb fasciitis in a newborn

Necrotizing fasciitis is an uncommon but life-threatening infection in the pediatric population. It is rarely reported in neonates. In these rare cases, the reported origin of infection was the umbilical cord stump, infection due to circumcision, and similar lesions. We hereby report a 3-week-old neonate sustaining necrotizing fasciitis without detectable origin of infection. We describe the clinical course of her illness, the diagnostic process, and eventual surgical intervention. We discuss the importance of awareness to this potentially lethal infectious disease and the need for urgent use of certain imaging modalities and aggressive surgical approach.

Comparative Effects of Using Alcohol, Natural Drying, and Salicylic Sugar Powder on Umbilical Stump Detachment of Neonates

This study compares the effectiveness of alcohol, natural drying, and salicylic sugar powder on umbilical separation time of the neonate in our high-humidity region. From September 2007 to May 2008, a total of 143 neonates in a community hospital were divided into 3 groups according to their birth month in sequence. Each umbilical care regimen was randomly assigned to a 3-month period. Data on occurrence of omphalitis and cord separation time were collected by telephone follow-up until stump separation. The salicylic sugar powder group had the lowest rates of colonization and shortest cord separation time compared with the natural drying and alcohol groups. No omphalitis developed in any of the 3 groups. Natural drying and salicylic sugar powder are safe and effective ways to care for the umbilical cord stump in high-humidity regions. Nursing professionals should consider choosing a more effective umbilical care regimen and provide mothers with thorough instruction.

The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial

Up to half of neonatal deaths in high mortality settings are due to infections, many of which can originate through the freshly cut umbilical cord stump. We aimed to assess the effectiveness of two cord-cleansing regimens with the promotion of dry cord care in the prevention of neonatal mortality. We did a community-based, parallel cluster-randomised trial in Sylhet, Bangladesh. We divided the study area into 133 clusters, which were randomly assigned to one of the two chlorhexidine cleansing regimens (single cleansing as soon as possible after birth; daily cleansing for 7 days after birth) or promotion of dry cord care. Randomisation was done by use of a computer-generated sequence, stratified by cluster-specific participation in a previous trial. All livebirths were eligible; those visited within 7 days by a local female village health worker trained to deliver the cord care intervention were enrolled. We did not mask study workers and participants to the study interventions. Our primary outcome was neonatal mortality (within 28 days of birth) per 1000 livebirths, which we analysed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT00434408. Between June, 2007, and September, 2009, we enrolled 29 760 newborn babies (10 329, 9423, and 10 008 in the multiple-cleansing, single-cleansing, and dry cord care groups, respectively). Neonatal mortality was lower in the single-cleansing group (22·5 per 1000 livebirths) than it was in the dry cord care group (28·3 per 1000 livebirths; relative risk [RR] 0·80 [95% CI] 0·65-0·98). Neonatal mortality in the multiple-cleansing group (26·6 per 1000 livebirths) was not statistically significantly lower than it was in the dry cord care group (RR 0·94 [0·78-1·14]). Compared with the dry cord care group, we recorded a statistically significant reduction in the occurrence of severe cord infection (redness with pus) in the multiple-cleansing group (risk per 1000 livebirths=4·2 vs risk per 1000 livebirths=1·2; RR 0·35 [0·15-0·81]) but not in the single-cleansing group (risk per 1000 livebirths=3·3; RR 0·77 [0·40-1·48]). Chlorhexidine cleansing of a neonate's umbilical cord can save lives, but further studies are needed to establish the best frequency with which to deliver the intervention. United States Agency for International Development and Save the Children's Saving Newborn Lives program, through a grant from the Bill & Melinda Gates Foundation.

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.

Newborn Cord Care Practices Amongst Mothers in Yenagoa Local Government Rea, Bayelsa State, Nigeria

Background: Clean cord care is one of the essential newborn care practices recommended by the World Health Organisation to reduce morbidity and mortality amongst the World’s newborns. Despite this, cord infections are still prevalent in developing countries because of the high rates of unhygienic cord care practices. The study aimed to explore cord care practices in our environment and identify areas for intervention. Methods: This was a cross-sectional study carried out amongst mothers attending three primary health care facilities with their infants in Yenagoa Local Government Area of Bayelsa State, Nigeria. Simple structured questionnaires were used to obtain information concerning the ages and sexes of babies, place of antenatal care and birth, treatments applied to the umbilical cord stump and the socioeconomic status of the parents. Data were analysed using SPSS version 16.0. Results: Two hundred and twenty one mothers participated in the study. The infants were aged 0 - 6 months with a male to female ratio of 1:1. Fifty four (24.4%) of mothers were of high social class. Cord care was done by grandmothers in 107(48.4%) and mothers in 89(40.3%) of babies. Sixty four (29.0%) mothers had their babies cord cleaned with Methylated spirit alone while 138(62.4%) cleaned with Methylated spirit and then applied other substances including antibiotic ointments and herbs. Maternal education, social class of parents and place of delivery were significantly associated with application of potentially harmful substances to the cord, (p = 0.049, 0.010 and 0.030 respectively). The commonest sources of information on cord care were nurses in 99 (44.8%) and grandmothers in 44 (19.9%). Conclusion: There is still a high rate of use of potentially harmful substances for cord care. All heath workers should participate in educating, mothers and grandmothers about optimal cord care.

A Novel Nonsense Mutation of F13A1 Gene Causing Inherited Factor XIII Deficiency in a Chinese Han Family

Abstract 4661 Introduction:Coagulation factor XIII (FXIII) is a protransglutaminase that has a major role in the final stage of blood coagulation process by forming cross-links between γ-glutamyl and ε-lysine residues of fibrin chains. The plasma FXIII (pFXIII) circulates in plasma as a heterotetramer (FXIII-A2B2) consisting of two catalytic A subunits (FXIII-A2) and two carrier B subunits (FXIII-B2). Inherited FXIII deficiency is a rare autosomal recessive disease with lifelong bleeding. Most cases of FXIII deficiency are heterogeneous due to mutations in the F13A gene. Currently, more than 100 mutations have been reported. Aim:To identify the genetic defect of inherited coagulation factor XIII (FXIII) deficiency in a Chinese Han family. Methods and Results:A 13 year-old patient complained of poor wound healing after operation and had a history of an excessive bleeding from the umbilical cord stump after her birth. The routine laboratory tests are normal. Her bleeding time is more than 15 minutes and fibrin clot was solubilized very quickly in 5mol/L urea, and became insoluble when normal plasma was mixed with her plasma in vitro. Her plasma FXIII activity was zero with the amine incorporation assay and plasma FXIII antigen was also near zero by one-step sandwich ELISA method, the plasma FXIIIA antigen was zero using an indirect competitive ELISA assay. The plasma FXIIIA antigen, FXIII activity and antigen were assayed in all available family members. The testing results of patient's grandfather and maternal grandmother were within normal range. But the other pedigree members' results were lower in different level compare with normal ranges. All members of her family had normal coagulation test.All the exons of F13A gene as well as F13B gene and their flanking regions were amplified by PCR for direct sequencing to identify the mutations in the proband. Direct DNA sequencing of all purified amplification products from the patient's F13A gene demonstrated a homozygous nonsense mutation in exon8 (C to A transversion at nucleotide 98531 which caused Cys327X). And the patient didn't have the Val34Leu polymorphism. In the pedigree except of the proband, the Cys327X mutation was found in the heterozygous state in all investigated members except for her grandfather and maternal grandmother. A family study revealed that the mutation was inherited from both parents.The identified mutation was validated by PCR-RFLP technique in the family members and healthy people. Restriction enzyme analysis of amplified exon 8 DNA fragment confirmed that the patient was homozygous for this mutation. Then the quantitative RT-PCR method was used for studying the mRNA expression level of mutant FXIIIA. And the results indicated that F13A mRNA transcripts in heterozygous mutant were reduced by 25% when compared to transcripts in wild-type one, while the homozygous mutant level of F13A mRNA transcript was nearly zero relative to the normal transcript. Conclusion:We have identified a novel Cys327X nonsense mutation in human FXIIIA gene which we have not found in the FXIII database (www.f13-database.de) or in previous publications.And the identified nonsense mutation is causative for severe factor XIII deficiency with a bleeding disorder. Further, in vitro expression studies of the factor XIII mutation is required to confirm their pathological mechanism. Disclosures:No relevant conflicts of interest to declare.

INCENTIVISING INNOVATION OR SUPPORTING OTHER INTERESTS? EUROPEAN REGULATION OF ORPHAN MEDICINAL PRODUCTS

Shortly after she was born, Emily Bartko's1 parents noticed severe bleeding from her umbilical cord stump. As she grew older, every bump or scrape resulted in severe, and potentially life-threatening, bruising, or bleeding for Emily, and her activities (and those of her family) became significantly constrained. Emily was diagnosed with afibrinogenaemia, the most severe form of congenital fibrinogen deficiency. This congenital disease,2 which affects only around one in one million people globally,3 is characterised by a reduced quantity and/or quality of circulating fibrinogen, resulting in blood coagulation disorders and hence abnormal bleeding, ranging from mild to severe (as in Emily's case). Fortunately for patients like Emily, the pharmaceutical industry has developed therapies and products that can be used to treat diseases such as congenital fibrinogen deficiency and conditions such as specific haemorrhaging. In the normal course of events, the significant investment involved in developing, testing, and licensing new therapies for rare diseases would not prove commercially viable for pharmaceutical companies. To give incentives to pharmaceutical companies to develop such therapies and to ensure that health care systems do not ignore the needs of those with rare diseases on economic grounds,4 the European Union has created a special regulatory system for rare diseases and for the development of valuable therapies that would not otherwise be commercially viable.

Methicillin-Resistant Staphylococcus aureus Bacteremia and Chorioamnionitis After Recurrent Marsupialization of a Bartholin Abscess

Methicillin-resistant Staphylococcus aureus (MRSA) is an extremely rare etiology of chorioamnionitis. A young primigravida, with sickle cell (Hb SS) disease and beta thalassemia presented at 37 weeks of gestation with fever, chills, and lower abdominal pain in the presence of intact fetal membranes, 10 days after recurrent marsupialization of a Bartholin abscess. Overt clinical chorioamnionitis was diagnosed. The patient received intravenous triple antibiotics and delivered by immediate cesarean. Maternal blood, uterine, placental and neonatal nares, external auditory canal, and umbilical cord stump cultures all yielded MRSA. Both the mother and infant received intravenous vancomycin and did well. Our case and the literature suggest that it may be prudent to consider MRSA when contemplating the possibility of chorioamnionitis in the presence of intact fetal membranes, especially in gravidas with recurrent admissions or minor surgical procedures or who are hospital staff.

Consumption of fallen umbilical cord stump as a treatment for infertility: A case study from Puducherry

Infertility is a stigma. The high cost and inaccessibility to treatment turn infertile couples to faith-based alternatives or practices that have been passed down from generation to generation. This report describes a case in which a woman consumed the umbilical cord stump to treat infertility. Initially, this incidence was reported in March 2006 by undergraduate students from the Kurusukuppam area of the Urban Health Centre of the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). This lower-middle class family consisted of RK, his wife G, his mother T and daughters of RK and G. RK was 37 years old, semi-literate and a painter; G was a housewife and educated up to the eighth standard. Six months after their marriage, G became pregnant, but had an abortion in the third month of pregnancy. Thereafter, the couple waited for four years, but G could not conceive. She consulted private allopathic doctors, who prescribed her some medicines without carrying out any investigation/follow-up. Meanwhile, T advised G to consume the umbilical cord stump. In January 2003, G visited Chennai in order to assist her sister-in-law's delivery. Other women present there also advised her to consume the neonate's cord stump as a remedy for her infertility. After a simple ceremony on the eighth day, G consumed a 1-cm-long dried umbilical cord stump embedded in a banana. She conceived the next month. G opined that this sequence of events (pregnancy immediately following the consumption of stump) suggests the curative role of the cord stump. T recalled that 15 years ago, her neighbor had demonstrated the pro-fertility potential of the umbilical cord stump. Both T and her neighbor believed that the stomach (errai pai) is connected to the uterus (garppa pai), and that the cord had entered the uterus via the stomach, thus inducing pregnancy. In July 2006, during the community posting for undergraduates, a similar practice was reported in Pullichappallam, Tamil Nadu. A local remedy for infertility in this area was consuming the fallen cord stump. In a focus group discussion (FGD), P (a 40-year-old lady) commented, “If conception does not occur within five months of marriage, we wait for an opportunity to give a fallen cord stump to the ‘infertile’ woman. This practiceis common in our family and has been successful on all occasions.” She had recommended this to three of her relatives, one of whom was infertile for five years. In all instances, conception occurred within a few months. None of them took allopathic treatment. The FGD revealed the belief that the cord ‘donor’ can become infertile; hence, the infertile women should consume it without making the donor aware of it. Similar practice exists in Kattupalayam and Vannur areas of Tamil Nadu. A newspaper has reported the practice of consuming the products of the third-stage labor for curing infertility in the villages of Thirumangalam taluk of Madurai district, Tamil Nadu.(1) This practice has been documented in the Chenchu tribes of Nallamalai Hills in Andhra Pradesh.(2) They believed that the umbilical cord produces special fertility juice in the infertile woman. Elsewhere, a similar practice has been reported from primitive cultures of Australia, Africa and Hawaii.(3) This case report brings to light the fact that this practice is not restricted to few families. Reportedly, all known cases have resulted in pregnancy. While we may not share this belief, it highlights the common man's concept about the process of reproduction. Hence, the first step in infertility treatment should be creating awareness about human sexual function and clarify myths associated with infertility since they restrict the afflicted couples from seeking appropriate medical treatment. People's faith in modern medicine should actually improve when infertility treatments become more accessible and affordable. However, if a series of cases such as the abovementioned incidents occur, it may then become necessary to epidemiologically study such interventions.

Cochrane review: Vaccines for women to prevent neonatal tetanus

AbstractBackgroundTetanus is an acute, often fatal, disease caused by an exotoxin produced by Clostridium tetani. It occurs in newborn infants born to mothers who do not have sufficient circulating antibodies to protect the infant passively, by transplacental transfer. Prevention may be possible by the vaccination of pregnant and/or non‐pregnant women with tetanus toxoid, and the provision of clean delivery services. Tetanus toxoid consists of a formaldehyde‐treated toxin which stimulates the production of antitoxin.ObjectivesTo assess the effectiveness of tetanus toxoid, administered to women of childbearing age or pregnant women, to prevent cases of, and deaths from, neonatal tetanus.Search strategyWe searched the Cochrane Pregnancy and Childbirth Group Trials Register (December 2004) , The Cochrane Library (Issue 1, 2005), MEDLINE (1966 to December 2004), EMBASE (1974 to December 2004). We also used the results from handsearching and consultations with manufacturers and authors.Selection criteriaRandomised or quasi‐randomised trials evaluating the effects of tetanus toxoid in pregnant women or women of childbearing age on numbers of neonatal tetanus cases and deaths.Data collection and analysisThree review authors independently assessed trials for inclusion, data extraction and trial quality.Main resultsTwo trials (10,560 infants) were included. One study (1919 infants) assessed the effectiveness of tetanus toxoid in preventing neonatal tetanus deaths. After a single dose, the relative risk (RR) was 0.57 (95% confidence interval (CI) 0.26 to 1.24), and the vaccine effectiveness was 43%. With a two or three dose course, the RR was 0.02 (95% CI 0.00 to 0.30); vaccine effectiveness was 98%. No effect was detected on causes of death other than tetanus. The RR of cases of neonatal tetanus after at least one dose of tetanus toxoid was 0.20 (95% CI 0.10 to 0.40); vaccine effectiveness was 80%. Another study, involving 8641 children, assessed the effectiveness of tetanus‐diptheria toxoid in preventing neonatal mortality after one or two doses. The RR was 0.68 (95% CI 0.56 to 0.82); vaccine effectiveness was 32%. In preventing deaths at 4 to 14 days, the RR was 0.38 (95% CI 0.27 to 0.55), and vaccine effectiveness 62% (95% CI 45% to 73%).Authors' conclusionsAvailable evidence supports the implementation of immunisation practices on women of childbearing age or pregnant women in communities with similar, or higher, levels of risk of neonatal tetanus, to the two study sites. More information is needed on possible interference of vaccination by malaria chemoprophylaxis on the roles of malnutrition and vitamin A deficiency, and on the quality of tetanus toxoid production and storage.Plain language summaryVaccinating childbearing women against tetanus rather than influenza or cholera appears to decrease incidence of tetanus in newborn babies but possible adverse effects not assessedNeonatal tetanus is an infection causing rigidity, muscle spasm and often death in newborn babies. It is quite common in income‐poor countries and comes from insufficient protection being passed from mother to baby in utero together with infection getting into the baby through the umbilical cord stump. The review of studies assessing vaccinating women of childbearing age showed fewer cases of neonatal tetanus when two or three doses were used, but no potential adverse effects were assessed. Administrative and operational aspects also need to be of good quality for vaccination programmes to be effective.

Use of A Clean Delivery Kit and Factors Associated with Cord Infection and Puerperal Sepsis in Mwanza, Tanzania

Our objective was to determine the effectiveness of an intervention that incorporated education about the "six cleans" with the use of a clean delivery kit in preventing cord infection and puerperal sepsis. A stepped-wedge, cross-sectional study was conducted in 10 surveillance sites across two rural districts of Mwanza Region, Tanzania. A total of 3262 pregnant women between the ages of 17 and 45 years were enrolled in the study. Village health workers administered questionnaires to each mother at 5 days postpartum and inspected the infants' umbilical cord stumps for signs of infection. Newborns whose mothers used the delivery kit were 13.1 times less likely to develop cord infection than infants whose mothers did not use the kit. Furthermore, women who used the kit for delivery were 3.2 times less likely to develop puerperal sepsis than women who did not use the kit. Women who bathed before delivery were 2.6 times less likely to develop puerperal sepsis than women who did not bathe, and their infants were 3.9 times less likely to develop cord infection. Single-use delivery kits, when combined with education about clean delivery, can have a positive impact on the health of women and their newborns by significantly decreasing the likelihood of developing puerperal sepsis or cord infection.

Topical Applications of Chlorhexidine to the Umbilical Cord for Prevention of Omphalitis and Neonatal Mortality in Southern Nepal: A Community-Based, Cluster-Randomized Trial

In developing countries, contamination of the umbilical cord may lead to omphalitis and create a risk of septicemic death. Studies in developed countries show that applying antiseptic solution to the cord may substantially lessen bacterial colonization, but whether this translates into less infection remains uncertain. This community-based, double-blind, placebo-controlled, cluster-randomized trial evaluated antiseptic treatment in 413 Nepalese communities. A total of 4934 infants were assigned to antiseptic treatment with 4% chlorhexidine, whereas 5107 others had the cord cleaned with soap and water and 5082 received dry cord care. The groups were well matched for socioeconomic, household, and maternal characteristics as well as for the use of clean cord practices, including handwashing and cord cutting. Newborn infants had the cord cleaned at home on days 1 to 4, 6, 8, and 10 and were followed up on postpartum days 12, 14, 21, and 28. Cord infection, defined as redness extending to the skin at the base of the umbilical stump, was 32% less frequent in antiseptic-treated infants than in those given dry cord care (incidence rate ratio [IRR], 0.68; 95% confidence interval [CI], 0.58–0.80). Defining infection as the presence of pus with moderate or severe redness or severe redness alone, the risk of infection with chlorhexidine treatment was 54% lower than with dry cord care (IRR, 0.46; 95% CI, 0.36–0.59). Using the most rigid definition of omphalitis—severe redness with pus—the risk was lowered 75% by antiseptic treatment (IRR, 0.25; 95% CI, 0.12–0.53). Cord treatment with soap and water had no apparent protective effect. Risk reduction with antisepsis was most evident when infants wee enrolled less than 24 hours after birth regardless of how omphalitis was defined. Compared with the dry cord care group, mortality risk was 24% lower in chlorhexidine-treated infants (relative risk, 0.76; 95% CI, 0.55–1.04). Benefit from antisepsis still was noted after adjusting for ethnicity, maternal literacy, and cord treatment with topical mustard oil. No protective effect from antisepsis was evident for infants enrolled in the study 24 hours or longer after birth. The risk of omphalitis may be markedly reduced by applying 4% chlorhexidine to the umbilical cord stump. This is a safe, relatively inexpensive measure that should be part of neonatal care programs in low-resource settings, replacing the current World Health Organization recommendation for dry cord car.