Topical chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality

Early antisepsis with chlorhexidine of the umbilical cord reduces neonatal mortality and omphalitis compared to dry cord care in a developing country setting.

, 413 communities (with a total of 15 123 infants) in Nepal, were assigned to 4.0% chlorhexidine, to cleansing with soap and water, and to dry cord care. Frequency of omphalitis (pus, redness, or swelling) was reduced in the chlorhexidine group. Severe omphalitis in chlorhexidine clusters was reduced by 75% (incidence rate ratio 0.25, 95% CI 0.12–0.53; 13/4839 neonatal periods) compared with dry cord-care clusters (52/4930). Neonatal mortality was 24% lower in the chlorhexidine group (RR 0.76; 95% CI 0.55–1.04) than in the dry cord care group. In infants enrolled within the first 24 h, mortality was significantly reduced by 34% in the chlorhexidine group (RR 0.66, 95% CI 0.46–0.95). Soap and water did not reduce infection or mortality risk."?> A Cochrane review included 34 trials involving a total of 69 338 babies. Three were large, cluster-randomized trials conducted in community settings in developing countries and contributed 78% of the total number of children included. 31 studies were conducted in hospital settings mostly in developed countries with mainly small sample sizes. Data for community and hospital studies were analyzed separately. Only one antiseptic, chlorhexidine was studied in community settings for umbilical cord care. Three community trials reported data on all-cause mortality that comprised 1 325 deaths in 54 624 participants and combined results showed a reduction of 23% (average risk ratio (RR) 0.77, 95% CI 0.63 to 0.94, random-effects, T² = 0.02, I² = 50%) in the chlorhexidine group compared with control. The reduction in omphalitis ranged from 27% to 56% depending on the severity of infection. Cord separation time was increased by 1.7 days in the chlorhexidine group compared with dry cord care (mean difference (MD) 1.75 days, 95% CI 0.44 to 3.05, random-effects, T² = 0.88, I² = 100%). Washing of umbilical cord with soap and water was not advantageous compared with dry cord care in community settings. No antiseptic was advantageous to reduce the incidence of omphalitis compared with dry cord care in hospital settings.

Ədəbiyyat

1. Mullany LC, Darmstadt GL, Khatry SK, Katz J, LeClerq SC, Shrestha S, Adhikari R, Tielsch JM. Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial. Lancet 2006 Mar 18;367(9514):910-8.
2. Imdad A, Bautista RM, Senen KA et al. Umbilical cord antiseptics for preventing sepsis and death among newborns. Cochrane Database Syst Rev 2013;(5):CD008635.