From the Guidelines
For a neonate delivered at home with the umbilical cord clamped by a blade, immediate medical attention should be sought to minimize the risk of infection and ensure proper cord care. The primary concerns include infection risk, bleeding, and proper cord care. Clean the area around the cord stump with warm water and mild soap, keeping it dry and exposed to air. Watch for signs of infection such as redness, swelling, foul odor, or discharge. Apply an antiseptic like chlorhexidine 4% solution if available, as it has been shown to reduce the risk of omphalitis and neonatal mortality in community settings with high neonatal mortality rates 1. Avoid alcohol or iodine which can damage the tissue. Do not attempt to remove the blade yourself; this should be done by medical professionals to prevent further injury or bleeding. Monitor the baby for signs of distress including fever (temperature above 38°C), poor feeding, lethargy, or jaundice. Tetanus prophylaxis may be necessary depending on the cleanliness of the blade and the mother's immunization status. The risk of infection is significant because non-sterile blades can introduce bacteria directly into the bloodstream, potentially causing sepsis, especially in low-resource settings where the risk of omphalitis may be higher for infants delivered at home compared to hospital births 1. Until medical help arrives, keep the baby warm through skin-to-skin contact and ensure regular feeding.
Some key considerations for neonatal care in this context include:
- The importance of delayed cord clamping for at least 1 minute at term delivery, which is recommended by the Enhanced Recovery After Surgery Society 1.
- The need for proper cord care to prevent infection, as outlined in the 2021 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations 1.
- The potential benefits of chlorhexidine solution or gel in reducing omphalitis and neonatal mortality in community settings with high neonatal mortality rates 1.
Given the potential risks and benefits, immediate medical attention is crucial for a neonate delivered at home with the umbilical cord clamped by a blade to ensure proper care and minimize the risk of complications.
From the Research
Considerations for Newborns Delivered at Home
- The care of the umbilical cord until its detachment remains controversial, with various recommendations for different settings 2.
- In countries with adequate obstetric care and low neonatal mortality rates, dry cord care is often recommended 2, 3.
- However, in developing countries or low-resource settings, cleaning the umbilical cord with disinfectants, such as chlorhexidine, may reduce the risk of serious bacterial infections and neonatal mortality 3, 4, 5.
Clamping the Umbilical Cord with a Blade
- There is no direct evidence in the provided studies regarding the specific consideration of clamping the umbilical cord with a blade for newborns delivered at home.
- However, clean cord cutting and hand-washing before and after handling the baby are emphasized as important interventions to reduce exposure to infectious pathogens 4.
Umbilical Cord Care Regimens
- Various umbilical cord care regimens have been studied, including dry cord care, antimicrobial applications, and traditional practices 2, 3, 4, 5, 6.
- The use of antimicrobial agents, such as chlorhexidine, has been shown to reduce bacterial colonization and infection rates in some settings 4, 5.
- However, the optimal cord care regimen may vary depending on the specific context and setting, and further research is needed to determine the best practices 4, 5.