Umbilical Cord Care: The Effect of Eight Different Cord-Care Regimens on Cord Separation Time and Other Outcomes

Pezzati, Marco; Biagioli, Elena; Martelli, Elena; Gambi, Beatrice; Biagiotti, R; Rubaltelli, Firmino F.

doi:10.1159/000047182

Cited by 41 publications

(66 citation statements)

References 21 publications

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Section: Discussionmentioning

confidence: 99%

“…These data support the idea that length of parenteral infusion alone and phototherapy alone do not affect cord separation time. Because general hydration is connected to weight loss, 14,17 it is clear that localand not general-dehydration influences cord detachment.We think that it is very important to consider the group of 20 newborns whose programmed cord-care regimen changed because of the presence or suspicion of omphalitis. Regarding these data, the efficacy of salicylic sugar powder was significantly higher than chlorhexidine.…”

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confidence: 99%

“…These findings partially differ with respect to the lower negativity of colonization rate (43.7%) that we found in term infants who were treated with salicylic sugar powder. 14 We think that it could be because of the major attention to hygienic procedures adopted with premature infants.In terms of pluricolonization (2 or 3 microorganisms) and of contamination rates caused by S aureus, E coli, and S hemolyticus group B, we did not find significant differences between the 2 study groups because of the small sample examined. As a matter of fact, although pluricolonization in chlorhexidine group (5.1%) is roughly twice that in the salicylic group (2.6%), this difference could be considered significant (power ϭ 0.8, ␣ ϭ 0.05) only in a population 8 times greater (2014) than ours (244).…”

mentioning

confidence: 99%

“…We also considered the following outcomes: changing of programmed cord-care regimen, bacterial umbilical colonization, omphalitis, sepsis, death, stump bleeding, and nurses' opinion regarding the 2 treatments' efficacy. For the UC care, we compared 2 products: salicylic sugar powder, which we recently showed to give excellent results in terms of early UC detachment and other outcomes in term infants, 14 and chlorhexidine, 1 of the 4 suggested antimicrobials found in the WHO cord-care drug list. 2 …”

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confidence: 99%

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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

et al. 2003

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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...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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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

et al. 2003

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“…By allowing neonates to "room-in" with their mothers, one can create an environment conducive for colonization from less pathogenic bacteria acquired from the mother's flora. 39 This type of colonization helps to reduce colonization and infection from potentially pathogenic organisms that are ubiquitous in the hospital environment. Over time, attempts to decrease bacterial colonization with topical antimicrobial agents may actually select for resistant and more pathogenic organisms 35 (level of evidence: III).…”

Section: Promoting Nonpathogenic Colonization Of the Umbilical Cordmentioning

confidence: 99%

Umbilical Cord Care in the Newborn Infant

Stewart¹,

Benitz²,

Newborn³

2016

Pediatrics

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Postpartum infections remain a leading cause of neonatal morbidity and mortality worldwide. A high percentage of these infections may stem from bacterial colonization of the umbilicus, because cord care practices vary in refl ection of cultural traditions within communities and disparities in health care practices globally. After birth, the devitalized umbilical cord often proves to be an ideal substrate for bacterial growth and also provides direct access to the bloodstream of the neonate. Bacterial colonization of the cord not infrequently leads to omphalitis and associated thrombophlebitis, cellulitis, or necrotizing fasciitis. Various topical substances continue to be used for cord care around the world to mitigate the risk of serious infection. More recently, particularly in high-resource countries, the treatment paradigm has shifted toward dry umbilical cord care. This clinical report reviews the evidence underlying recommendations for care of the umbilical cord in different clinical settings.

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