Dry umbilical cord care in developing countries should be reconsidered

A topical antiseptic reduces umbilical cord infections and infant mortality risk, according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health.

In a study conducted in southern Nepal, babies who received umbilical cord cleanings after their cords were cut with chlorhexidine, a topical antiseptic, were 75 percent less likely to experience severe infections of their umbilical cord and were 24 percent less likely to die, as compared to a group of babies who received dry-cord care. When the cleansing of the cord was initiated within 24 hours of birth, mortality risk was reduced by 34 percent. The study is published in the March 18, 2006, edition of The Lancet.

In developing countries, many babies are born at home with the help of untrained attendants. While long-standing societal beliefs and practices play an important role in cord care, some traditional practices may introduce harmful pathogens to babies, which increases their risk of infection and death, explained Luke C. Mullany, PhD, MHS, lead author of the study and an assistant scientist in the Bloomberg School of Public Health's Department of International Health. "When the cord cleansing with chlorhexidine was started soon after birth, the risk of death fell by more than one-third. The bottom line is that this is an extremely simple and inexpensive--just pennies per baby--way to significantly reduce infant mortality in developing countries. Combined with education about the cord, the antiseptic can easily be applied to newborn children at home by their parents."

The Nepal Nutrition Intervention Project, Sarlahi, enrolled over 15,000 newborn infants from communities in southern Nepal between November 2002 and March 2005. One-third of the infants' umbilical cords were treated with chlorhexidine, one-third with soap and water and one-third were left dry. Soap and water did not reduce infection or mortality risk. The infants who received chlorhexidine, however, were 75 percent less likely to have umbilical cord infection and their neonatal mortality was decreased by 24 percent as compared to the dry-cord care group.

"Our study findings suggest that current recommendations for dry-cord care be reconsidered. The World Health Organization recommends dry-cord care for babies born in developing countries, but does note that antiseptics might benefit infants born in areas where tradition calls for the application of harmful substances, such as animal feces or mud," said James M. Tielsch, PhD, MHS, senior author of the study and a professor of international health at the Bloomberg School of Public Health.