Topical umbilical cord care at birth
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1Division of Reproductive Health, World Health Organisation, 20 Avenue Appia, 1211 Geneva 27, Switzerland. zupanj@who.ch
Insights
Keeping the umbilical cord clean is as safe and effective as using antibiotics or antiseptics for newborn cord care. This simple practice prevents infection and reduces neonatal mortality.
Area of Science:
- Neonatal care and infectious disease prevention.
- Evidence-based medicine and systematic review methodology.
Background:
- Historically, umbilical cord infections led to significant neonatal mortality before the widespread adoption of aseptic techniques.
- The need for effective and safe cord care practices remains crucial in neonatal health.
Purpose of the Study:
- To evaluate the impact of topical umbilical cord care interventions on preventing neonatal infections, illness, and mortality.
- To compare the efficacy and safety of various topical cord care methods, including antiseptics, antibiotics, and no routine care.
Main Methods:
- Systematic review of randomized and quasi-randomized controlled trials.
- Searches conducted across major databases (Cochrane Pregnancy and Childbirth Group, Cochrane Controlled Trials Register, Medline) and expert consultations.
- Trial quality assessment and data extraction performed by two independent reviewers.
Main Results:
- Ten studies from developed countries were included; no systemic infections or deaths were reported across all interventions.
- Topical antiseptics did not significantly reduce cord or other skin infections within six weeks postpartum.
- Antibiotics showed a trend towards reduced colonization compared to antiseptics and no treatment; antiseptics delayed cord separation but reduced maternal anxiety.
Conclusions:
- Routine topical application of antibiotics or antiseptics for umbilical cord care is not superior to simple cleanliness.
- Maintaining basic hygiene for the umbilical cord is a safe and effective strategy for neonatal care.
- Further research may explore optimal cord care practices considering both clinical outcomes and parental concerns.
Background:
Umbilical cord infection caused many neonatal deaths before aseptic techniques were used.
Objectives:
The objective of this review was to assess the effects of topical cord care in preventing cord infection, illness and death.
Search Strategy:
We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register (Cochrane Library issue 4, 1997) and Medline. We also contacted experts in the field.
Selection Criteria:
Randomised and quasi-randomised trials of topical cord care compared with no routine care, and comparisons between different forms of care.
Data Collection And Analysis:
Two reviewers assessed trial quality and extracted data.
Main Results:
Ten studies were included, all from developed countries. No systemic infections or deaths were observed in any of the studies reviewed. Cord and other skin infections within six weeks of observation were not affected by use of antiseptics. There was a trend to reduced colonization with antibiotics compared to antiseptics and no treatment. Antiseptics prolonged the time to cord separation. Use of antiseptics was associated with a reduction in maternal concern about the cord.
Reviewer'S Conclusions:
Simply keeping the cord clean appears to be as effective and safe as using antibiotics or antiseptics.
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