Two recent studies published in The Lancet indicate that cleansing of the umbilical cord during childbirth could substantially reduce the risk of infection and rate of mortality in babies in developing countries.

One of the studies, led by Prof Zulfiqar A Bhutta, Division of Women and Child Health, The Aga Khan University, assessed whether or not umbilical cord cleansing with 4% chlorhexidine (CHX) solution had any effect on the rate of cord infection (omphalitis) and neonatal mortality in babies.

The study involved assorting 187 clusters of the population in the Sind province of Pakistan – covered by a functional traditional birth attendant (TBA) – into four different groups: the first group were only to hand wash, the second were told to hand wash, as well as receive a 4% CHX solution to be applied at birth and daily for fourteen days after, the third only received the CHX solution, and the control group received typical dry cord care.

A total of 9,741 babies were delivered through the aid of the TBAs. The researchers found that the 4% CHX solution was extremely effective at reducing mortality – by 38% – and risk of infection – by 42% – in babies, whereas hand washing did not have any affect at all.

The authors say:

“These results of these trials done in community settings lend support to the policy of application of chlorhexidine on newborn umbilical cord for prevention of omphalitis and mortality.”

A second study, led by Professor Abdullah H Baqui and Dr Luke Mullany (Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, reported the results of two cord-cleansing regimens and dry cord care across 133 clusters in Sylhet, Bangladesh. The clusters were divided into three different groups, with approximately 10,000 babies each: one with a chlorhexidine cleansing just after birth, the second with daily cleansing daily for 7 days after birth, and the third with dry cord care.

The group with the lowest rate of neonatal mortality was the single-cleansing group (22·5 per 1000 live births), followed by the multiple-cleansing group (26.6 per 1000 live births) and then the dry cord care group (28·3 per 1000 live births). The single cleansing group had a 20% lower rate of mortality than the dry cord care group, a significant difference. The results also show a lower number of severe cord infections (redness with pus) among the multiple and single cleansing groups, compared to the dry cord care group (1.2 vs 4.2 per 1000 births) and single-cleansing group (3.3 vs 4.2 per 1000 births).

The authors conclude:

” “These data…provide evidence that chlorhexidine cleansing reduces risk of neonatal mortality and omphalitis; further randomised trials in sub Saharan-African settings are needed.”

Dr David Osrin and Dr Zelee Hill, UCL Institute for Global Health, London, UK, say:

“On balance, we think that sufficient evidence has accrued to claim proof-of-principle that application of 4% chlorhexidine to the cord stump can prevent omphalitis and neonatal mortality in high-mortality settings.”

Written by Joseph Nordqvist