Dry Cord Care: Definition and Recommendations
Dry cord care is the practice of keeping the umbilical cord stump clean and dry without the routine application of antiseptics, allowing for natural drying and separation of the cord. This approach is recommended by the American Academy of Pediatrics (AAP) as the standard method for umbilical cord care in high-resource settings 1.
Key Components of Dry Cord Care
- Keep the cord clean and dry
- Fold the diaper below the umbilical stump to prevent urine and stool contamination
- Avoid tight clothing over the umbilical area
- No application of antiseptics is necessary in high-resource settings
- Allow air exposure to facilitate natural drying
Evidence Supporting Dry Cord Care
Dry cord care has been established as the preferred method in high-resource settings based on several key findings:
- The incidence of omphalitis in high-resource countries is very low (approximately 1 per 1000 infants) with dry cord care 2
- Multiple studies have demonstrated that antiseptics provide no additional benefit over dry cord care in hospital settings in developed countries 2, 3
- A non-inferiority trial showed that dry cord care was non-inferior to antiseptic use in preventing omphalitis in full-term newborns in developed countries 3
Advantages of Dry Cord Care
- Faster cord separation time: Studies show that dry cord care results in earlier cord separation compared to antiseptic use (10.1 days vs 12.0 days with alcohol) 4
- Simpler and more cost-effective: Eliminates the need for antiseptic solutions and additional supplies
- Promotes natural colonization: Allows for colonization with non-pathogenic bacteria from the mother's flora, which may help prevent colonization with more pathogenic organisms 2
- Reduces parental workload: Simplifies newborn care instructions for families 5
Setting-Specific Recommendations
High-Resource Settings (Developed Countries)
- Dry cord care is the recommended approach for healthy full-term infants 2, 1
- No evidence supports routine antiseptic application in these settings 3
Low-Resource Settings (Developing Countries)
- Application of 4% chlorhexidine solution or gel to the umbilical cord stump is recommended 2, 1
- Evidence shows chlorhexidine reduces both omphalitis (RR: 0.48; 95% CI: 0.40–0.57) and neonatal mortality (RR: 0.81; 95% CI: 0.71–0.92) in these settings 2
- Traditional materials (ash, herbal poultices, human milk) should be avoided as they may introduce pathogenic bacteria 2
Monitoring for Complications
When practicing dry cord care, parents and healthcare providers should monitor for signs of infection:
- Redness or swelling around the base of the cord
- Foul-smelling discharge
- Bleeding
- Delayed cord separation (beyond 2-3 weeks)
- Systemic signs of infection (fever, lethargy, poor feeding)
When to Seek Medical Attention
Immediate medical evaluation is necessary if signs of omphalitis develop, as this condition can rapidly progress to systemic infection. Treatment typically includes diagnostic evaluation and empiric antibiotic therapy with intravenous ampicillin plus an aminoglycoside 1.
Conclusion
Dry cord care represents a simple, evidence-based approach to umbilical cord care in high-resource settings. It is associated with faster cord separation, reduced costs, and no increase in infection rates compared to antiseptic use. The World Health Organization and AAP support this practice in developed countries, while recommending chlorhexidine in low-resource settings where the risk of omphalitis and related mortality is significantly higher.