Antiseptic on umbilical cord fights infection

Cleaning a newborn’s umbilical cord at birth can help to limit infections, experts say today.

Serious infections cause about a third of global neonatal deaths (within 28 days of birth) each year, and up to half of neonatal deaths where death rates are high.

One "key entry point" for germs is the freshly-cut umbilical cord stump, say Professor Abdullah Baqui of Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, and colleagues.

In the Lancet, they publish their study of two cord-cleansing methods based in Bangladesh. Both used the antiseptic chlorhexidine, either once at birth, or daily for a week. The study included 29,760 newborn babies.

The results were unclear, they say. Compared with standard care, death rates were 20 per cent lower in the single-cleansing group. Multiple-cleansing did not seem to reduce deaths – but this group did have significantly fewer severe cord infections.

The researchers say: "Chlorhexidine cleansing of a neonate’s umbilical cord can save lives, but further studies are needed to establish the best frequency."

In a second study, Professor Zulfiqar Bhutta of the Aga Khan University in Pakistan, and colleagues looked at the effect of umbilical cord cleansing with chlorhexidine, with or without hand-washing with antiseptic soap.

A total of 9,741 newborn babies in Pakistan received either standard care, chlorhexidine application to the cord at birth and for up to two weeks plus educational messages promoting hand-washing. A further group had chlorhexidine only, and the fourth group had hand-washing only.

Overall, cord cleansing reduced the risk of infection by 42 per cent and mortality by 38 per cent. Hand-washing alone had no beneficial effect.

"The results of these trials done in community settings lend support to the policy of application of chlorhexidine on newborn umbilical cord," say the authors.

The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial. Arifeen, S. E. et al. The Lancet, February 8 2012 doi:10.1016/S0140-6736(11)61848-5

Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based, cluster-randomised trial. Soofi, S. et al. The Lancet February 8 2012 doi:10.1016/S0140-6736(11)61877-1