30 March 2012

Cord Cleansing and Prevention of Neonatal Infection


IMPROVED MORBIDITY AND MORTALITY FROM NEONATAL INFECTION FOLLOWING THE CLEANSING OF THE UMBILICAL CORD WITH CHLORHEXIDINE

Approximately 40% of neonatal deaths in high mortality settings are due to infections.  The majority of these infections originate in the freshly cut umbilical cord stump.  In recent years the World Health Organization has emphasized the importance of clean cord care in preventing these infections.   However, both the infection and the death rate have remained unacceptably high, particularly in home deliveries by relatively untrained birth attendants.  Recently three large studies from South Asia addressing this issue have been reported in Lancet.  The three studies compare a group who received only the WHO recommended standard dry cord care with groups that added the immediate application of 4% chlorhexidine (Hibiclens), and continued daily applications for 7-14 days.  The chlorhexidine treated groups had an up to 40% lower infection rate and a 20-40% reduction in mortality due to infection.  Although further research is needed to identify the best specific frequency of application, the large size of these studies, (30,000 in the Bangladesh trial alone), and the cost effectiveness and simplicity of treatment, suggest that it can and should be implemented in areas with high neonatal mortality
According to one of the study authors, “This is a simple intervention.  It has the potential to avert about a half million deaths globally each year (from neonatal infection).  We should go ahead and implement.(1)
(1)   Arifeen, Baqui, et al.  The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial.
Lancet: 379, 1022-27, March 2012.
Submitted by Roger Boe MD 

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