Abstract
Background: Umbilical cord infection (omphalitis) is a major cause of neonatal mortality and morbidity in a developing country like Nepal. Detached umbilical stump is an important colonizing site for different types of bacteria and it also provides direct access to bloodstream. Hence, inadequate cord care may lead to omphalitis as well as neonatal sepsis.
Objectives: This study aims to compare two different cord care regimens (dry cord care versus chlorhexidine cord care) on their cord separation time and the incidence of omphalitis.
Methodology: This is a comparative observational study conducted at the Neonatal unit of Kathmandu Medical College over a three months period (August 2019 to October 2019). All newborn babies born between 37 to 42 weeks of gestation were enrolled. Randomization for dry cord care and chlorhexidine cord care group was done via computer generated numbers. Statistical package for social sciences 19 version was used for statistical analysis. Results: Among 514 term babies, 256 babies were included in the dry cord care group while 258 babies were enrolled in the chlorhexidine cord care group. The two groups had similar baseline characteristics. The mean cord separation time in the dry cord care group was 7.70±1.2 days (range 3-15 days), whereas in the chlorhexidine group, it was 7.77±1.4 days (range 4-18 days).
Conclusion: There was no significant difference between the cord separation times in dry and chlorhex
References
Seale AC, Blencowe H, Manu AA, Nair H, Bahl R, Qazi SA, et al. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis. Lancet Infect Dis. 2014 Aug;14(8):731-41.[PubMed | Full Text|DOI]
Population division, Ministry of Health and Population (MOHP), Government of Nepal. Infant and child mortality. In: New ERA and Macro International Inc. eds. Nepal Demographic and Health Survey (NDHS) 2016. Kathmandu: Ministry of Health and Population, New ERA, and Macro International Inc; 2016. 142p. [Full Text]
Mullany LC, Darmstadt GL, Katz J, Khatry SK, Leclerq SC, Adhikari RK, et al. Risk of mortality subsequent to umbilical cord infection among newborns of southern Nepal: cord infection and mortality. Pediatr Infect Dis J. 2009 Jan;28(1):17-20. [PubMed | Full Text |DOI]
Stewart D, Benitz W, COMMITTEE ON FETUS AND NEWBORN. Umbilical Cord Care in the Newborn Infant. Pediatrics. 2016 Sep;138(3):e20162149. [PubMed | Full Text |DOI]
Güvenç H, Aygün AD, Ya?ar F, Soylu F, Güvenç M, Kocabay K. Omphalitis in term and preterm appropriate for gestational age and small for gestational age infants. J Trop Pediatr. 1997 Dec;43(6):368-72. [Full Text |DOI]
World Health Organization. WHO recommendations on postnatal care of the mother and newborn. World Health Organization; 2014. [Full Text]
Manandhar SR. Outcome of surfactant replacement therapy in preterm babies with hyaline membrane disease at neonatal intensive care unit of a tertiary hospital. Birat Journal of Health Sciences. 2018; 3(3):486-8.[Full Text | DOI]
Department of Health, Government of Sindh. Role of 7.1% chlorhexidine digluconate in prevention of Neonatal Sepsis. Department of Health, Government of Sindh; 2014. [Full Text]
Mir F, Tikmani SS, Shakoor S, Warraich HJ, Sultana S, Ali SA, et al. Incidence and etiology of omphalitis in Pakistan: a community-based cohort study. J Infect Dev Ctries. 2011 Dec 13;5(12):828-33. [PubMed|Full Text | DOI]
Mullany LC, Arifeen SE, Khatry SK, Katz J, Shah R, Baqui AH, et al. Impact of Chlorhexidine Cord Cleansing on Mortality, Omphalitis and Cord Separation Time Among Facility-Born Babies in Nepal and Bangladesh. Pediatr Infect Dis J. 2017 Oct;36(10):1011-3.[PubMed | Full Text| DOI]
Kapellen TM, Gebauer CM, Brosteanu O, Labitzke B, Vogtmann C, Kiess W. Higher rate of cord-related adverse events in neonates with dry umbilical cord care compared to chlorhexidine powder. Results of a randomized controlled study to compare efficacy and safety of chlorhexidine powder versus dry care in umbilical cord care of the newborn. Neonatology. 2009;96(1):13-8. [PubMed |DOI]
López-Medina MD, López-Araque AB, Linares-Abad M, López-Medina IM. Umbilical cord separation time, predictors and healing complications in newborns with dry care. PLoS One. 2020 Jan 10;15(1):e0227209.[PubMed |Full Text |DOI]
Mullany LC, Darmstadt GL, Katz J, Khatry SK, LeClerq SC, Adhikari RK, et al. Risk factors for umbilical cord infection among newborns of southern Nepal. Am J Epidemiol. 2007 Jan 15;165(2):203-11. [PubMed | Full Text| DOI ]