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Introduction: Neonatal death due to infections is still a great concern worldwide. Umbilical cord related infections play significant role in the neonatal mortality specially in very low birth weight infants, mother chorioamnionitis and premature rupture of membranes. It is associated with umbilical colonization, delayed separation and poor hygiene. In the current study, effect of topical breast milk usage with dry cord care on separation time, complications and colonization were compared. Methods This is a randomized clinical-trial on 150 very low birth weight neonates in 2016-18. Patients' were divided in two groups; Group-M (N = 73) (3–4 drops of maternal breast milk were dropped on the umbilical cord stump within eight hours of birth and went on every eight hours until 48-hours after cord separation) and Group-D (N = 77) (the umbilical cord was drought gradually in open air). Umbilical cord culturing was performed from cord stump within 2–4 hours after delivery, three days after birth and at the day of separation. Cords were assessed considering omphalitis, bad smell, exudates formation and granulation tissue. Results Neonates of two groups were not statistically different regarding separation time (P = 0.09), incidence of omphalitis (P = 0.16), bad odor (P > 0.99), exudative secretions (P = 0.97), granulation tissue (P = 0.96) and sepsis (P = 0.13). In addition, hospitalization duration (P = 0.71), time to reach full enteral feeding (P = 0.31) and death (P > 0.99) were not statistically different. Three times cultures derived from two groups presented no significant difference (P > 0.05). Conclusion Based on findings of the current study, neither topical breast milk nor dry cord care was superior considering separation, associated complications and colonization. As neonatal death is still a serious concern worldwide and lacking of unanimous approach for prevention of cord related complications, further studies are strongly recommended.

W e thank Dr Mungmunpuntipantip and colleagues for their interest in our article "Limb Lymphedema After COVID-19 Vaccine Booster." 1 Their comments highlighted the importance of COVID-19 vaccine safety. This is a critical issue to address in any vaccine development.We agree that it is crucial to assess potential contraindications and patients' comorbidities before administering COVID-19 vaccine to minimize adverse events. However, this should be balanced with the risk of disease occurrence and its complications if the vaccine is not administered. 2