Bacterial colonization and neonatal infections. Effects of skin and umbilical disinfection in the nursery. Does routine newborn bathing reduce Staphylococcus aureus colonization rates? A randomized controlled trial. Midwifery: umbilical cord care in pre-term babies. Hydrophobic material in routine umbilical cord care and prevention of infections in newborn infants. Cleaning solutions and bacterial colonization in promoting healing and early separation of the umbilical cord in healthy newborns. Antiseptics for preventing omphalitis. Alcohol versus natural drying for newborn cord care. Randomized study of six umbilical cord care regimens. Comparing length of attachment, microbial control, and satisfaction. The effect of isopropyl alcohol and triple dye on umbilical cord separation time. Treatment of umbilical cords: a randomised trial to assess the effect of treatment methods on the work of midwives. Umbilical cord care: the effect of eight different cord-care regimens on cord separation time and other outcomes. The effectiveness of single and multiple applications of triple dye on umbilical cord separation time. Group B beta-hemolytic streptococcal colonization. Acquisition, persistence, and effect of umbilical cord treatment with triple dye. Umbilical care and cord separation. Effect of antiseptic cord care on bacterial colonization in the newborn infant. Randomized trial of alcohol versus triple dye for umbilical cord care. Brief clinical and laboratory observations.
In a prospective randomized study different regimens for skin and umbilical disinfection in newborn infants were tested: daily whole body soap wash (control group), daily whole body soap wash and umbilical cleansing with (i) benzine solution, or (ii) 0.05% chlorhexidine, and daily whole body wash and umbilical cleansing with a 4% chlorhexidine detergent solution (Hibiscrub). Bacterial cultures were taken from the nose and umbilical area at discharge. Clinical infections were registered in the nursery, and after discharge until 6 weeks of age. Cultures were taken from infected areas. In the control group a high colonization rate was found for S. aureus (91%), E. coli (39%), and group B streptococci (GBS) (20%). The colonization rates were influenced by the Hibiscrub regimen (colonization rate for S. aureus 59%, E. coli 23%, and GBS 10%), but not by the other regimens. Infections (pemphigus, paronychia, conjunctivitis, umbilical infection) occurred in 12.9% of the infants, of whom 65% got infection after discharge from the nursery. 96% of the infections were caused by S. aureus, and 87% caused by strains colonizing the infants in the nursery. None of the tested regimens reduced the rate of infections during the first 6 weeks of life. nan A trial was undertaken to investigate infection rates and to measure cord separation time under four different cord care regimes in pre-term babies within the Neonatal Unit of Ninewells Hospital, Dundee. The evidence of the trial suggests that the present method of treating umbilical cords in pre-term babies with Sterets and Ster-zac powder is sound. More importantly, there is good evidence that a policy of leaving umbilical cords untreated cannot be recommended as safe practice within the unit. It is noted that the numbers in this trial (about 100) were not large, but the trial did run for a full year. Any further trials would need to be multicentered to obtain a larger sample set in a reasonable amount of time. In a prospective randomized study 2 different regimens for umbilical disinfection in newborn infants were tested: (i) a bandage of hydrophobic material (Sorbact; n = 1,213), and (ii) daily cleansing with 0.5% chlorhexidine in 70% ethanol (n = 1,228). Infections were registered in the nursery as well as after discharge until 6 weeks of age, and bacterial cultures taken from infected areas. A total of 410 infections were registered in 377 (15.4%) of the 2,441 infants. Total infection rates of 16.3 and 14.6% were found in the hydrophobic material group and the chlorhexidine-ethanol group respectively (p greater than 0.05). No differences were found between the groups in infection rates in the nursery (8.9 vs. 8.7%), after discharge (7.4 vs. 5.9%), or in rates of different types of infections (conjunctivitis, pyoderma, paronychia, omphalitis) (p greater than 0.05). 536 strains were isolated. 498 (92.9%) were gram-positive, 45 (8.4%) gram-negative, and 7 (1.3%) candida strains. 229 (55.9%) were Staphylococcus aureus strains. No differences were found between the two groups concerning distribution of the different strains isolated. Separation of the umbilical cord occurred significantly later in the hydrophobic material group than in the chlorhexidine-ethanol group (6.2 +/- 2.2 vs. 5.8 +/- 2.1 days; p less than 0.05). Hydrophobic material does not prevent infections more effectively compared to 0.5% chlorhexidine in 70% alcohol. The efficacy of alcohol or water in promoting umbilical cord separation was compared in a randomized controlled trial. Rates of skin colonization between groups were also evaluated on three occasions. Time to cord separation, rates of colonization, and species of organisms that colonized were compared between groups. Of 148 participants, 136 (92%) completed the protocol. Cords that were cleaned with sterile water separated more quickly than those cleaned with alcohol (t = 3.15, p = 0.002). Between-group differences in colonization rates were not found (F = 1.59, df = 2, p = 0.205). Umbilical or other infections did not occur. Bacterial colonization of the umbilical area and surrounding skin occurs over time in healthy term neonates. Cleaning with alcohol will increase the length of time from birth to cord separation but will not prevent colonization of the umbilical area. Omphalitis may cause serious complications and contribute to neonatal morbidity and mortality. From January 1997 to August 1998, the incidence of omphalitis in the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital had been increased from 0.9 to 17.4 per 1,000 live births. A prospective randomized trial using antiseptic applied directly to the umbilical stump was conducted aiming to reduce an epidemic outbreak of omphalitis in the newborn nursery.
                To determine which antiseptic is appropriate for preventing omphalitis in the newborn infants.
                Newborn infants delivered in the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital were randomized into group A (Triple dye) or group B (70% Alcohol). The infant with omphalitis was assessed by a pediatrician or a neonatology fellow. At home, the same antiseptic will be continually applied to the umbilical stump daily until a few days after cord detachment. Relative risk was calculated and statistical significance was tested by Chi-square test.
                Four hundred and twenty-seven infants were enrolled. Birth weight, gestational age and gender of the infants in both groups were not different. There were no known maternal risk factors for omphalitis. Omphalitis was observed in 9/213 (4.2%) infants in group A and 23/214 (10.7%) infants in group B. The relative incidence rate between each group was statistically significant (p<0.01). Triple dye group was 60 per cent less likely to develop omphalitis compared to 70 per cent Alcohol group (RR 0.39, 95% CI: 0.19-0.83). The mean duration for cord detachment were 13.6 and 11.5 days in group A and group B, respectively.
                During an epidemic outbreak of omphalitis, Triple dye was the most appropriate and effective antiseptic to prevent omphalitis but could delay cord separation. To compare alcohol cleaning and natural drying of newborn umbilical cords.
                Prospective, randomized controlled trial.
                Tertiary-level university teaching hospital and level II community hospital.
                Of 1,876 singleton full-term newborns enrolled, 1,811 completed the study.
                Newborns, from birth until separation of the cord, were randomized to either (a) umbilical cleansing with 70% isopropyl alcohol at each diaper change or (b) natural drying of the umbilical site without special treatment.
                Umbilical infection, cord separation time, maternal comfort, and cost.
                No newborn in either group developed a cord infection. Primary care providers obtained cultures for cord concerns in 32 newborns (1.8%), with colonization for normal flora, Staphylococcus aureus, and Group B streptococcus proportionately equal in alcohol and air dry groups. Cord separation time was statistically significantly different (alcohol group, 9.8 days; natural drying group, 8.16 days; t = 8.9, p = < .001). Mothers described similar comfort with cord care and relief with cord separation. Costs of alcohol drying while in the hospital were greater than those of natural drying.
                (a) Evidence does not support continued use of alcohol for newborn cord care; (b) health care providers should explain the normal process of cord separation, including appearance and possible odor; and (c) health care providers should continue to develop evidence to support or eliminate historic practices. Two hundred and seventy one infants were enrolled in a study to compare six different methods of treating the umbilical cord. Antimicrobial control was equal for all methods. Repeated triple dye application was considered least acceptable by staff and parents and had the longest attachment time. Povidone-iodine was associated with the shortest attachment time and was most liked. If there is no special need to treat a specific nosocomial outbreak, duration of cord attachment and satisfaction of staff and parents can help clinicians decide on a cord care regimen. nan nan In this study we evaluate the effect of eight cord-care regimens on cord separation time and other secondary outcomes: omphalitis, sepsis, death, cord bleeding, compliance, satisfaction or dissatisfaction with regard to the type of treatment, umbilical cord colonization--in 1,535 healthy term infants. The eight cord-care regimens studied were: 70% alcohol, natural drying, salicylic sugar powder, triple dye, micronized green clay powder, colloid silver-benzyl-peroxide powder, neomycin-bacitracin powder, 1% basic fuchsine. None of the newborns developed sepsis or died and we found only sporadic cases of omphalitis. With regard to cord separation time the best results were obtained with salicylic sugar powder (5.6 +/- 2.3 days) and green clay powder (6.7 +/- 2.2 days). Both forms of treatment proved to be more effective (p < 0.05) than all the others. We found that salicylic sugar powder allows for early cord detachment resulting in excellent parent treatment compliance and reduction of their concern, notwithstanding higher percentages of cord bleeding. The rate of positive umbilical swabs was low and was significantly higher only than the results obtained with neomycin-bacitracin powder treatment. This study demonstrates that, in hospital nurseries of developed countries, salicylic sugar powder can be effectively and safely used for umbilical cord care of healthy term infants.
                Copyright 2002 S. Karger AG, Basel The effectiveness of single and multiple applications of triple dye for umbilical cord care in the umbilical cord separation time (UCST) was evaluated in 180 neonates. Seven neonates were excluded, three where the cord stump separation time was uncertain and four to whom contact was lost. The participating neonates were randomly assigned to two groups. Group 1, 101 neonates, were treated with a regimen of a single application of triple dye. Group 2, 79 neonates, were treated with multiple applications of triple dye. Complete information was obtained from 97 neonates (96.2%) in group 1 and 76 (96%) in group 2. The UCST was 12.6 +/- 0.45 (mean +/- SE) days in group 1 and 16.68 +/- 0.65 days in group 2 (P < 0.0001) and showed no significant association with infants' gender, mode of delivery, gravidity, gestational age, birth weight, or hospital stay.
                A single application of triple dye may be a more favourable regimen with a similarly antimicrobial effect, a shorter UCST and may be more cost effective than multiple applications of triple dye in umbilical cord care. Following an outbreak of group B beta-hemolytic streptococcal neonatal infection (GBS), a prevalence survey of GBS colonization was performed on 238 infants. No important differences were noted in the prevalence of colonization when the infants were grouped according to age. Follow-up of 24 colonized babies for three months disclosed that most had persistence of GBS at the rectum and pharynx. Local umbilical cord care with triple dye (TD) or hexachlorophene skin cleanser was compared with untreated controls with respect to rates of GBS colonization. At birth the colonization rates of the three groups were similar. The rate of acquisition of colonization with GBS was 1.0% in the TD group, 6.3% in the hexachlorophene group, and 8.3% in the control group. Triple dye was much more effective than no specific cord care or hexachlorophene in preventing acquisition of GBS colonization. Four different treatments for the care of the umbilical cord were compared in a randomised, controlled study. Triple dye was associated with a significantly earlier separation of the cord than either 1% neomycin or 1% silver sulphadiazine ointment, and it was nearly as effective as bismuth subgallate (an astringent powder) in causing rapid sloughing. If the mother is made aware that care of the umbilical cord may delay cord separation she may be spared unnecessary concern. A randomized controlled study was undertaken to compare the effectiveness of three umbilical cord treatment regimens in controlling neonatal bacterial colonization. The regimens studied included daily application of castile soap, triple dye and silver sulfadiazine. The triple dye and silver sulfadiazine regimens inhibited bacterial colonization. Staphylococcal colonization was inhibited most effectively by triple dye treatment. Group B streptococcal colonization was equally inhibited by triple dye and silver sulfadiazine. Silver sulfadiazine was more effective in controlling colonization with gram-negative microorganisms. Over a 4-month period, all infants admitted to the well-baby nursery were enrolled in a prospective study designed to compare cord separation times between infants treated with triple dye once, followed by daily alcohol application, to infants treated with daily alcohol application alone. Follow-up phone calls were done 7 days after discharge, with weekly calls until cord separation occurred. The objective was to determine whether the umbilical cord care regimen of triple dye followed by alcohol has an advantage over the alternative regimen of alcohol alone, with regard to cord separation, parenting, or healthcare caretaker preferences. In total, 634 infants were enrolled, with 599 infants (94%) completing the study. Infants in the alcohol alone group had a shorter cord separation time by 3 days (10 versus 13 days) (p < 0.0001). There was no reported increase in infection, and monetary savings were noted. We conclude that alcohol applied once a day appears to be a safe and effective means of promoting cord detachment. nan
Good trials in low-income settings are warranted. In high-income settings, there is limited research which has not shown an advantage of antibiotics or antiseptics over simply keeping the cord clean. Quality of evidence is low.