Umbilical Cord Care in Premature Infants: The Effect of Two Different Cord-Care Regimens (Salicylic Sugar Powder vs Chlorhexidine) on Cord Separation Time and Other Outcomes

Abstract

ABSTRACT. Objectives. To evaluate the effect of 2 cord-care regimens (salicylic sugar powder vs chlorhexidine as a 4% detergent water solution) on cord separation time and other outcomes in preterm infants.Methods. A prospective, randomized, controlled trial was conducted on 244 preterm newborns with a gestational age of <34 weeks and a birth weight of <2500 g. All preterm newborns were enrolled, regardless of their health condition. We excluded from the study infants whose conditions during the first hours of life required the catheterization of umbilical vessels. We also excluded from the general statistical analysis all newborns who had their programmed cord-care regimen changed because of the presence or the suspicion of omphalitis. On arrival at our neonatal intensive care unit or neonatal special care unit, infants were bathed thoroughly with a soap solution (Saugella, Guieu, Italy), and the umbilical cord (UC) was treated with 1 of the 2 antiseptic products chosen for the study. The stump was then folded and covered with common sterile, dry gauze and kept in place by an elastic net. Until cord detachment and at every diaper change, the cord stump was cleaned with sterile water and treated with the same product initially used for first-time cord care. On the third day of life, we obtained an umbilical swab either from the base of the cord or from the umbilicus if the cord was already sloughed. Six weeks after birth, during hospitalization or during a follow-up visit if already discharged, all infants had a medical examination to check the umbilicus area. Cord separation time, changing of the programmed cordcare regimen, death, omphalitis, sepsis, cord bleeding, nurses' opinion on treatments efficacy, and UC colonization were measured.Results. The cord separation time was significantly lower in infants who were treated with salicylic sugar powder (6 ؎ 2 days) than in infants who were treated with chlorhexidine (9 ؎ 2 days). The programmed cordcare regimen was changed in a significantly higher number of newborns in the chlorhexidine group (17) than in the salicylic sugar group (3). None of the newborns died, and we found only sporadic cases of sepsis (1 patient in each group) and omphalitis (1 patient in the chlorhexidine group). A significantly higher percentage of nurses were satisfied with the salicylic sugar powder treatment (98%) than with the chlorhexidine treatment (67%), notwithstanding a more frequent occurrence of slight cord scar bleeding in the salicylic sugar group (7.8%) than in the chlorhexidine group (4%). The rate of negative umbilical swabs was significantly higher in infants treated with salicylic sugar powder (73.1%) than with chlorhexidine (53%).Conclusions. T he umbilical cord (UC) is an important bacterial colonization site. 1 A possible consequence of bacterial colonization is cord stump infection, a factor that can greatly increase morbidity and mortality in developing countries. 2 In the 1940s, the introduction of nurseries in hospitals increased the risk of colonization and infecti...

Comparative Effects of Using Alcohol, Natural Drying, and Salicylic Sugar Powder on Umbilical Stump Detachment of Neonates

“…1 Pezzati et al 5 found no significant difference in the percentages of S aureus, Streptococcus, E coli and total colonization in the alcohol, natural drying, and SSP groups. Although no neonate developed omphalitis, and the rate of omphalitis was not necessarily related to the colonization rate, 4,6,9 in this study, colonization percentages were high in the alcohol and natural drying groups. It is possible that the swab sites in the SSP group had already shown less moisture and fast withering in comparison with the other groups on the third day after birth.…”

“…6 The shortest period was 2 days in this study's SSP group. This supports the conclusion that the use of powder form is more effective in Table 2 shortening cord separation time than the use of liquid form.…”

“…This supports the conclusion that the use of powder form is more effective in Table 2 shortening cord separation time than the use of liquid form. 6 It is inferred that powder can absorb the moisture of the cord surface 13 and reduce bacterial growth. Meanwhile, salicylic acid, commonly contained in numerous skincare products, can cause the cells of the epidermis to shed more readily.…”

“…4,6 Omphalitis is referred to as loss of elasticity in the skin surrounding the stump and an area of redness and swelling larger than 2 cm or accompanied with secretion. 7 Odor occurs following anaerobic bacterial infection.…”

“…Salicylic sugar powder, as suggested by Pezzati et al, 5,6 could detach the umbilical cord early and has a high rate of negative umbilical swabs compared with other regimens. Janssen et al 13 infer that salicylic sugar in powder form has rapid water-absorbent characteristics that dries up the cord stump soon and thus yields a shorter cord separation time than alcohol.…”