Role of antimicrobial applications to the umbilical cord in neonates to prevent bacterial colonization and infection: a review of the evidence

Abstract

In developing countries umbilical cord infections constitute a major cause of neonatal morbidity and pose significant risk for mortality, whereas outbreaks of cord infections continue to occur in developed country nurseries. Cord infections in developing countries can be prevented through increasing access to tetanus toxoid immunization during pregnancy, promoting clean cord care and reducing harmful cord applications and behaviors. Interventions introduced in both developed and developing countries to reduce exposure of the cord to infectious pathogens include clean cord cutting, hand-washing before and after handling the baby, bathing of the infant with antimicrobial agents and application of antimicrobials to the cord. Despite the importance of umbilical cord care, both traditionally and medically, there have been few randomized trials investigating the impact of different cord care regimens on rates of local or systemic infections, particularly in developing countries.This review examines available data on umbilical cord care, with a particular focus on those comparing rates of bacterial colonization and/or rates of cord infection among neonates receiving different umbilical cord care regimens. Although most investigators agree that topical antimicrobials reduce bacterial colonization of the cord, a firm relationship between colonization and infection has not been established. Further research in developed countries, including follow-up beyond hospital discharge, is required before advising on "best cord care practices." The paucity of published reports from developing countries indicates the need to investigate the impact of antimicrobial applications on cord and systemic infections in a community-based, prospective manner.

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

“…Additional efficacy trials are needed to confirm these results in different facility-based settings, to determine the relative contribution of vaginal cleansing versus newborn skin cleansing, and, thence, to evaluate potential applications and feasibility of the intervention within the community. Evaluation of higher-concentration formulations of chlorhexidine to prevent sepsis with pathogens from the skin 34 and to prevent maternalto-child transmission of HIV (1%) is also warranted.…”

“…20,26,32,34,35 Moreover, because the majority of perinatal and neonatal deaths in developing countries occur in the home, there is an urgent need to identify solutions at the community level. 18,20,22,26 To achieve Millennium Development Goal 4 of halving child mortality by the year 2015, major advances in neonatal survival must be achieved through widescale implementation of cost-effective interventions in the community.…”

“…27 Neonatal health experts agree that improving neonatal health and survival in developing countries depends in large measure on more effectively implementing what has already been shown to work. 18,26,34,35 Moreover, a number of health interventions for the mother and her newborn have been proposed by the WHO and others as global priorities for programmatic implementation. 14, 18,26,34,35,45,46 Although many advances in obstetric and neonatal care are costly and require technologies that are unavailable in resource-poor countries, a substantial proportion of perinatal and neonatal morbidity and mortality in developing countries could be prevented through appropriate adaptations and applications of inexpensive, relatively simple methods to improve antenatal, obstetric, and neonatal care.…”

Rates, timing and causes of neonatal deaths in rural India: implications for neonatal health programmes

“…5 Intral l partum use of chlorhexidine, coupled with communitylbased interventions to improve hygiene (such as handlwashing and clean delivery) and neonatal care practices (clean cord cutting and care, skin care) may reduce the incidence of neonatal infections. 6,38,44,45 Later deaths from infections including tetanus can be strongly linked to environmental exposures and practices during home delivery and care. 6 Neonatal tetanus can be prevented through maternal tetanus immunization, as well as clean cord care.…”

Maternal and Neonatal Tetanus

“…150 By contrast, clinical trials investigating the role of topical antimicrobials for cord care on neonatal illness and death have not shown any benefit in developed countries where aseptic obstetric and surgical practices prevail. 151,152 Hygienic deliveries and cord care clearly reduce neonatal tetanus, and have the additional benefit of reducing maternal and neonatal sepsis caused by other bacterial pathogens. As important as these measures are for the improvement of maternal and neonatal survival, progress in developing the necessary infrastructure and behavioural changes needed to ensure safe deliveries and neonatal care has proven difficult to achieve, especially in the areas with the greatest burden of maternal and neonatal tetanus.…”