Umbilical Cord Care in Newborns: Alcohol vs. Natural Drying
Alcohol should NOT be applied to a newborn's umbilical cord stump as it delays cord separation and provides no benefit over natural drying methods.
Evidence-Based Recommendations for Umbilical Cord Care
Natural Drying is Preferred
- Multiple studies demonstrate that natural drying (keeping the cord clean and dry without applying any substances) is superior to alcohol application 1, 2.
- Natural drying results in significantly faster cord separation times compared to alcohol application:
Safety Considerations
- No increased risk of infection has been observed with natural drying compared to alcohol application 1, 4.
- In a study of 1,811 newborns, not a single cord infection occurred in either the alcohol or natural drying groups 1.
- Bacterial colonization rates were actually higher in the alcohol group in some studies 3.
Potential Harms of Alcohol
- Alcohol application delays cord separation time, which can be a source of parental anxiety 1, 2.
- Alcohol can cause chemical irritation to the delicate tissues.
- Guidelines specifically recommend against topical antimicrobial treatments at insertion sites as they "may promote fungal infection, antimicrobial resistance and damage the surface" 5.
Proper Umbilical Cord Care Protocol
Recommended Approach
- Keep the cord clean and dry
- Expose the cord to air (keep it outside the diaper edge) 6
- Use sterile gauze around the base of the cord if needed 6
- Allow natural drying to occur
Important Precautions
- Secure the umbilical cord with a ligature rather than a cord clamp to prevent trauma around the umbilicus 5
- Cover any birth trauma with a non-adherent dressing to prevent further trauma 5
- Keep the diaper folded below the umbilical stump to prevent contamination with urine or stool
- Bathe the baby while the cord is still attached (this is safe with both methods) 3
Special Considerations
When to Seek Medical Attention
- Signs of infection: redness, swelling, discharge, or foul odor from the cord stump
- Prolonged bleeding from the cord stump
- Delayed cord separation (beyond 2 weeks)
- Granuloma formation (rare but possible) 6
For Healthcare Providers
- Educate parents about normal cord appearance during separation process, including possible mild odor 1
- Reassure parents that natural drying is evidence-based and safe
- Emphasize that alcohol application provides no infection prevention benefit and delays healing
By following these evidence-based recommendations, parents can provide optimal care for their newborn's umbilical cord stump, promoting faster healing without increasing infection risk.