Level 1: Likely reliable evidence


Level 2: Mid-level evidence

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A previous systematic review found no evidence that doing nothing but keeping the umbilical stump clean was harmful to the infant (Cochrane Database Syst Rev. 2004;[3]:CD001057). No systemic infections or deaths were observed in the 21 randomized and quasi-randomized trials of topical umbilical cord care (N= 8,959 infants). While antiseptics did not affect the rates of cord infections compared with dry cord care or placebo, use of the agents reduced maternal concern about the umbilical cord. Antiseptics also prolonged time to cord separation. There was a trend toward reduced skin colonization when antibiotics were used compared with antiseptics or no treatment, and when antiseptics were used compared with no treatment. Most trials included in the review took place in high-income countries.

Recently, a randomized trial evaluated antiseptic treatment of the umbilical cord in 413 communities in Nepal (Lancet. 2006;367:910-918). Infants were randomized to one of three cord-care regimens: 4,934 were assigned to 4% chlorhexidine on days 1-4, 6, 8, and 10; 5,107 were assigned to soap and water cleaning on days 1-4, 6, 8, and 10; 5,082 were assigned to dry cord care (education provided to the mothers).

Comparing chlorhexidine vs. soap and water vs. dry cord care, the rates of omphalitis, defined as moderate or severe redness, were 8.9% vs. 12.9% vs. 12.6% (NNT 29 for chlorhexidine vs. dry cord care). Using a definition of moderate or severe redness with pus, or severe redness alone, the rates were 3% vs. 5.5% vs. 6.2% (NNT 31 for chlorhexidine vs. dry cord care).

Using a definition of severe redness with pus, the rates were 0.26% vs. 1.04% vs. 1.02% (NNT 132 for chlorhexidine vs. dry cord care). Chlorhexidine might be associated with lower neonatal mortality; the reported absolute mortality was 1.46% vs. 1.92% vs. 1.93% (not statistically significant). However, the analysis did not account for the 1.26% vs. 1.15% vs. 1.54% mortality before the first assessment at 10 days.