Umbilical Cord Care
Introduction
Aseptic practice has reduced the rates of omphalitis, neonatal tetanus and sepsis. The practice of separating mothers and babies in the 1940's associated with prolonged hospital stays led to a steep rise in nosocomial infections. To control this problem routine application of antimicrobial agents to the cord stump became common.
However, current evidence supports the use of standard infection control procedures only, in this area of practice.
Well baby care
- clamp the cord with sterile clamps and cut it with sterile scissors or blade
- the recommended length of the stump after cutting is 2 or 3 cm
- practice rooming in where possible, with the mother as primary carer
- keep the cord dry and exposed to air. The napkin should be folded below the umbilicus
- wash hands before handling the umbilical cord and where possible avoid touching the cord stump
- remove the cord clamp on day 2 of life
Nursery Care
- practices vary between hospitals because of a lack of relevant high quality evidence with care being either
- as for routine care
- or a solution of 0.5% Chlorhexidine and 70% alcohol is used to clean the cord twice daily on admission and daily for the first three days, or while an umbilical catheter is in situ
Areas of Uncertainty
- a study comparing daily bathing with no bathing showed no difference in umbilical cord colonization or infection between the groups, and that immersing the newborn in a bath is not harmful to the cord
- when reviewed for the Cochrane database use of topical antiseptics for routine care was associate with
- no systemic infections or deaths
- a trend to reduced colonisation with antibiotics compared to antiseptics
- prolonged cord separation time
- no effect on cord or other skin infections within 6 weeks with use of antiseptics
- there is a lack of studies concerning effects on the rate of umbilical cord infections for infants requiring nursery admission. Some non-randomized studies have suggested that antiseptics reduce staphylococcal infections in the nursery and after discharge
- various agents have been used as topical antimicrobials for umbilical cord care with a variety of complications
- alcohol is a bactericidal agent with limited effectiveness if not correctly applied
- chlorhexidine is a bactericidal agent (some pseudomonas and proteus may be resistant). Skin sensitivity has occasionally been reported. Percutaneous absorption has been found with the use of a 1% solution in ethanol
- iodine tincture is bactericidal, sporicidal, cysticidal and virucidal. Action persists for several hours and toxicity is low
- iodophors - iodine is absorbed through the skin and its use has been associated with transient hypothyroidism
- triple dye has been shown to effectively reduce colonisation by MRSA but ineffective for GBS. It is a combination of brilliant green, proflavine hemisulfate and gentian violet
- crystal violet has been associated with necrotic skin reactions in adults and babies. Sensitization to brilliant green has been reported
- silver sulphadiazine may cause bacterial resistance to sulphonamide and allergic reactions
References
Zupan J, Garner P. Topical umbilical cord care at birth (Cochrane Review). The Cochrane Library, 2, 2001. Oxford
World Health Organization, Reproductive Health (Technical Support) Maternal and Newborn Health/Safe Motherhood, Geneva. Care of the Umbilical Cord, A review of the evidence1999
Dore, Sharon et al. Alcohol Versus Natural Drying for Newborn Cord Care. JOGGN Vol 27(6) November/December 1998.
Web links
WHO Sexual and reproductive health: Publications
www.cochrane.org
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