Simple solution to saving newborn lives
Umbilical cord cleansing with 4% chlorhexidine saves newborn lives
Photo: Tareq Salahuddin
Each year 3.1 million newborns die globally, and infection causes more than a quarter of these deaths. In resource poor, high mortality settings, infections can account for over half of the neonatal deaths. Lack of hygiene and antisepsis at birth and in the first week of life increases the risk of deadly but preventable infections. While the World Health Organisation (WHO) guidelines recommend clean and dry umbilical cord care, they also include application of topical antiseptics to the cord stump in areas with high infection risk as acceptable. A recent community-based randomised trials in rural areas in Bangladesh, Nepal and Pakistan have shown that applying 4% chlorhexidine (7.1% chlor-hexidine digluconate) to the umbilical cord stump prevents infection and saves newborn lives. These trials and concurrent research support chlor-hexidine cord cleansing as an efficacious, acceptable, feasible and cost-effective newborn care intervention. WHO recommendationsThe most recent WHO recommendations for umbilical cord care were published in 1998 and included the following: 1. Clean and dry cord care practices are recommended; 2. In settings where the risk of bacterial infection is high, it may be prudent to apply an antiseptic to the cord per local preference; and 3. With most cord care research from developed countries, additional research from developing countries is needed for optimal guidelines in high risk, low resource settings. How to apply
Immediately after cutting the cord, apply chlorhexidine to the tip of the cord, the stump and around the base of the stump. If feasible, repeat application once daily through the first week of life or until the cord separates, whichever occurs earlier. Further benefits may be realised from multiple applications including reduced local infection or improved hygiene practices. Key findings
In the research trials in Bangladesh revealed the following key findings. * In the context of a basic community-based newborn care package, two regimens were compared to the standard recommendation of dry cord care: single, first-day chlorhexidine application and 7-day chlorhexidine application; * Single chlorhexidine application on the first day of life reduced neonatal mortality by 20%, and moderately reduced severe omphalitis, as well as cord bacterial colonisation; * 7-day chlorhexidine application reduced severe cord infection by 65% and reduced bacterial colonisation; neonatal mortality was 6% lower in this group. Despite high statistical power, the study still had a 20% chance of not finding a true impact on neonatal mortality. The investigators could not explain this result except that it had occurred as a result of the 20% chance of not measuring a true effect. * Mortality reduction was greatest in preterm babies.
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