Chlorhexidine cleansing linked to prolonged umbilical stump separation

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1. Umbilical separation time is prolonged by 2-3 days with chlorhexidine cleansing as compared to dry and clean care. 

2. Prolonged umbilical separation time did not significantly increase risk of omphalitis.

3. Although parents were aware of and displeased with the increased separation time in the chlorhexidine group, there was no increase in overall dissatisfaction.

Previous studies have demonstrated that chlorhexidine cleansing can substantially decrease infant mortality in low-resource settings with a high rate of infection. The authors of this study have previously reported mortality reductions that range from 6 to 38%. The data presented here show that chlorhexidine cleaning on both the first and first seven days of life significantly prolong umbilical cord separation. Parents do perceive this delayed separation and there was greater dissatisfaction about this with the chlorhexidine cleansing regimen as compared to a clean/dry regimen; however, overall satisfaction was not significantly different among the groups. The authors also demonstrated that although prolonged cord separation is related to a slightly increased risk of omphalitis, this risk is not significant.

Click to read the study, published today in Pediatrics

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Image: PD

1. Umbilical separation time is prolonged by 2-3 days with chlorhexidine cleansing as compared to dry and clean care. 

2. Prolonged umbilical separation time did not significantly increase risk of omphalitis. 

3. Although parents were aware of and displeased with the increased separation time in the chlorhexidine group, there was no increase in overall dissatisfaction. 

This [cluster randomized] study evaluated the time to cord separation, infection rates, and parental satisfaction with one of three cord regimens: dry and clean cord care per WHO recommendations or chlorhexidine cleansing on either only the first (“single”) or the first seven days (“multiple”) of life in 29,760 newborns in Bangladesh. Dry/clean cord care yielded a mean cord separation time of 4.78 days. Cord separation was prolonged for both single and multiple chlorhexidine cleansing (6.90 and 7.46 days, respectively), with a significantly elevated rate of cord separation beyond 7 days (RRs 3.37 and 4.09, respectively). Parental dissatisfaction with cord separation time was higher with chlorhexidine use than the clean/dry regimen (11.1% and 17.6% respectively, versus 2.5%). Importantly, although the risk of omphalitis was increased by 3.1% for each day without cord separation, this was not statistically significant, even for infants whose cords did not separate for > 7 days.

Previous studies have demonstrated that chlorhexidine cleansing can substantially decrease infant mortality in low-resource settings with a high rate of infection. The authors of this study have previously reported mortality reductions that range from 6 to 38%. The data presented here show that chlorhexidine cleaning on both the first and first seven days of life significantly prolong umbilical cord separation. Parents do perceive this delayed separation and there was greater dissatisfaction about this with the chlorhexidine cleansing regimen as compared to a clean/dry regimen; however, overall satisfaction was not significantly different among the groups. The authors also demonstrated that although prolonged cord separation is related to a slightly increased risk of omphalitis, this risk is not significant.

Click to read the study, published today in Pediatrics

By Emilia Hermann and Devika Bhushan

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