Applying chlorhexidine, a simple antiseptic, to the umbilical cord likely lowers the risk of cord infection in low- and middle-income countries (LMICs), according to a recent review published in the Cochrane Database of Systematic Reviews. The practice may also reduce neonatal deaths in these settings.
The umbilical cord, which connects the fetus to the placenta during pregnancy, is composed of blood vessels and connective tissue. When the umbilical cord is clamped and cut after birth, it leaves behind a temporary stump that can be an entry point for harmful bacteria and other germs.
A team led by a researcher at the University of Iowa conducted the review to see if applying antiseptics to the umbilical cord stump could reduce the risk of infection, especially in LMICs, where rates of neonatal deaths can be high.
Chlorhexidine slashes infection risk by 29%
To assess the effectiveness of different antiseptics, the researchers looked at 18 randomized controlled trials involving 143,150 newborns. The studies included in their analysis looked at a handful of antiseptics, including 70% alcohol, 4.0% chlorhexidine (CHX), silver sulfadiazine, and povidone iodine, in LMICs.
Five studies included in the analysis looked at the use of CHX in LMICs. The findings suggest that applying CHX to the umbilical cord stump in these settings may lead to a small reduction in all‐cause neonatal mortality, from 18 to 15 per 1,000 live births, but the evidence was low-certainty (average risk ratio [RR], 0.86).
Applying CHX cut rates for omphalitis, a life-threatening bacterial infection of the umbilical stump, by 29%, reducing infections from 87 to 62 per 1,000 live births (RR, 0.71). The data also showed that applying CHX delayed the time it takes for the stump to fall off by one to two days (the delay is not usually considered harmful).
“In many parts of the world, newborns are still born into environments where hygiene conditions are poor,” lead author Aamer Imdad, MD, MPH, said in a Cochrane news release. “Simple and accessible cord-care interventions can significantly reduce infections in these settings, which is critical given the large share of neonatal deaths linked to infection.”
Only one study in the analysis looked at the use of CHX in high-income countries. The study didn’t look at all‐cause neonatal mortality, and the evidence for the use of topical CHX to prevent omphalitis was considered very uncertain (RR, 0.28). Dry cord care, or keeping the newborn’s stump clean and dry without applying antiseptics, is the recommended approach in most high-income countries with low infant mortality rates.
Benefits depend on context
The findings underscore the need to tailor umbilical cord care to local settings, which aligns with the World Health Organization’s recommendation to use dry cord care for infants born in low-mortality settings and to use a 4% CHX solution for newborns born at home in settings with high neonatal mortality (30 or more neonatal deaths per 1,000 live births).
“Our findings broadly support current World Health Organization guidance, but they also underline an important point: these interventions are not necessarily universal solutions. The benefits depend strongly on the context in which babies are born,” coauthor Zulfiqar A. Bhutta, PhD, said in the news release. “What works best depends on local circu