From the Guidelines
Proper umbilical cord care involves keeping the stump clean and dry until it falls off naturally, which typically occurs within 1-2 weeks after birth, and the World Health Organization recommends "dry cord care" in clean environments, while chlorhexidine (0.5% solution) may be recommended in areas with high infection risk, as it has been shown to significantly reduce omphalitis and neonatal mortality in community settings with high neonatal mortality rates 1.
Key Principles of Umbilical Cord Care
- Clean the area once daily with plain water and mild soap, gently patting it dry afterward.
- Avoid covering the stump with a diaper by folding the diaper down below it.
- Do not submerge the baby in a bath until the cord falls off; instead, give sponge baths.
- Signs of infection requiring medical attention include redness extending from the base, foul odor, yellow or green discharge, bleeding, or swelling.
Prevention of Infection
Traditional practices like applying alcohol are no longer recommended as they can delay healing. Promoting colonization of the umbilical cord by nonpathogenic bacteria may prevent the development of neonatal omphalitis, and allowing neonates to “room-in” with their mothers can create an environment conducive for colonization from less pathogenic bacteria acquired from the mother’s flora 1.
High-Risk Settings
In areas with high infection risk, the application of 4% chlorhexidine solution or gel to the umbilical cord stump within 24 hours after birth has been shown to result in a significant reduction in both omphalitis and neonatal mortality, with a relative risk of 0.48 for omphalitis and a significant reduction in neonatal mortality 1.
From the Research
Umbilical Care Methods
- The study 2 compared the incidence of omphalitis among three groups, each using a different type of newborn cord care: povidone-iodine, dry care, and topical human milk.
- The results showed no significant differences between the three groups in terms of omphalitis occurrence, with only two cases of omphalitis observed, one in the human milk group and one in the povidone-iodine group.
- Babies in the dry care or topical human milk group had shorter cord separation times than those in the povidone-iodine group 2.
Antimicrobial Applications
- The application of antimicrobials to the umbilical cord stump may protect against neonatal tetanus, as suggested by a case-control study 3.
- The study found that the application of antibiotics or disinfectants at delivery, and the continuous or any application of disinfectants, were protective against neonatal tetanus 3.
- Another study 4 compared the effect of four antiseptic compounds on umbilical cord healing and infection rates in dairy calves, and found no treatment differences in healing rate or infection rates.
Comparison of Cord Care Regimens
- A study 5 compared umbilical cord colonization rates following topical application of bacitracin or triple dye, and found that cords treated with bacitracin had significantly higher colonization rates.
- A review of the evidence 6 examined the role of antimicrobial applications to the umbilical cord in neonates to prevent bacterial colonization and infection, and found that most investigators agree that topical antimicrobials reduce bacterial colonization of the cord, but a firm relationship between colonization and infection has not been established.
Best Cord Care Practices
- The review 6 highlighted the need for further research in developed countries, including follow-up beyond hospital discharge, to advise on "best cord care practices".
- The study 2 suggested that the cultural practice of applying human milk to the umbilical cord stump appears to have no adverse effects and is associated with shorter cord separation times than are seen with the use of antiseptics.
- The use of triple dye for routine cord care is supported by the study 5, which found that it had lower colonization rates compared to bacitracin.