Sunday, March 24, 2013

Chlorhexidine Cleansing of Umbilical Cord Increases Cord Separation Time

Mar 18, 2013
By Will Boggs, MD
NEW YORK (Reuters Health) Mar 18 - Chlorhexidine cleansing of the umbilical cord reduced infant mortality in a study in Bangladesh, but the increased separation time associated with it was troublesome to some parents, researchers said today in a paper online in Pediatrics.
Umbilical cord cleansing is known to reduce neonatal mortality in low-resource settings with high risk of infection. Doctors therefore need to prepare mothers and fathers in advance, telling them that longer separation times are normal with chlorhexidine and are a sign that the treatment is helping to make the baby safer, lead author Dr. Luke C. Mullany from Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland told Reuters Health.
"Cleansing of the cord with 4% chlorhexidine, starting as soon as possible after birth and continuing through the first week of life, is the most appropriate care of the cord" wherever neonatal infections are likely, Dr. Mullany said. "I would suggest this includes almost all facility and home birth settings in low and middle income countries."
Dr. Mullany and colleagues investigated separation times and other outcomes of 29,532 newborns in Bangladesh assigned to one of three cord regimens in a cluster-randomized trial: dry and clean cord care, or single- or multiple cleansing with 4.0% chlorhexidine.
Cord separation times were significantly longer with vs without chlorhexidine (mean, 6.90 vs 4.78 days). Separation times were longer than seven days in 13.5% of infants not receiving chlorhexidine, compared with 45.9% of infants in the single-cleansing group and 55.7% of infants in the multiple-cleansing group.
The risk of moderate or severe omphalitis increased by 3.1% for each additional day the cord did not separate. As a result, the risk was 13.8% higher among infants whose cords separated after seven days. These associations, however, were not statistically significant.
Mothers in the multiple-cleansing group were 2.55 times more likely than mothers of infants in the no-chlorhexidine group to report that separation took "longer than usual." Each 24-hour increase in directly observed separation time brought an 18.3% increase in the likelihood of reporting "longer than usual."
Similarly, dissatisfaction with the time to separation was more frequent in the single- (11.1%) and multiple-cleansing (17.6%) groups than in the no-chlorhexidine group (2.5%).
"We know from our community trials that chlorhexidine cord cleansing saves lives and greatly reduces cord infections," Dr. Mullany said. "These additional analyses confirm that putting chlorhexidine on the cord can make the time to separation a little bit longer. Physicians should assure moms and dads that is normal and is a sign that the baby's cord is cleaner and their baby is more protected from infections because of the chlorhexidine."
"I think that dry and clean cord care could be favored only in situations where providers are really confident that they can eliminate exposure of pathogens to the freshly cut cord stump," Dr. Mullany added. "In most resource poor settings, using topical chlorhexidine on the cord provides the simple and cost-effective way to eliminate these exposures."
Pediatrics 2013;131:708-715

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