Review: topical agents for cord care have not been shown to be effective in newborn infants in developed countries
Question Are topical agents for umbilical cord care effective for preventing cord infection, illness, and death in newborn infants in developed countries?
Studies were identified using the Cochrane Pregnancy and Childbirth Group Controlled Trials Register, the Cochrane Library, Medline, and contact with the World Health Organisation and experts in the field.
Randomised controlled trials were included if they studied newborn infants of any gestation using any of the following cord care interventions: topical antiseptic applications (alcohol, triple dye, silver sulphadiazine, acraflavine, iodine, chlorhexidine, or gentian violet), antibiotic applications (bacitracin, nitrofurazone, or tetracycline), powders with or without antiseptics, single or multiple applications to the cord area, washing the whole baby or dry care, and care of the cord compared with no care.
Data were extracted on study quality; country of study; infant characteristics and numbers; interventions; primary outcomes of cord infection (redness, swelling, or smell), disseminated bacterial infection (fever, meningitis, or septic foci), or death; and secondary outcomes of time to separation, bacterial colonisation, and maternal satisfaction with intervention.
10 studies met the selection criteria. All included healthy term infants and were done in developed countries (USA, Norway, Canada, Israel, and UK). Cord infection was not affected by use of antiseptics (alcohol, benzine, or 2 strengths of chlorhexidine) (4 studies) or closed dressing compared with open care (1 study compared hydrophobic gauze bandage with daily application of weak chlorhexidine). No systemic bacterial infections or deaths were seen in any of the …