Topical umbilical cord care at birth

Umbilical cord infection caused many neonatal deaths before aseptic techniques were used.

To assess the effects of topical cord care in preventing cord infection, illness and death.

We searched the Cochrane Pregnancy and Childbirth Group trials register (September 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2003). We also contacted experts in the field.

Randomized and quasi-randomized trials of topical cord care compared with no topical care, and comparisons between different forms of care.

Two reviewers assessed trial quality and extracted data.

Twenty-one studies (8959 participants) were included, the majority of which were from high-income countries. No systemic infections or deaths were observed in any of the studies reviewed. No difference was demonstrated between cords treated with antiseptics compared with dry cord care or placebo. There was a trend to reduced colonization with antibiotics compared to topical 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.

Good trials in low-income settings are warranted. In high-income settings, there is limited research which has not shown an advantage of antibiotics or antiseptics over simply keeping the cord clean. Quality of evidence is low.