Topical umbilical cord care at birth

No differences were found in umbilical cord infection rates when use of a topical antiseptic was compared with dry cord care or placebo. However, the author regards the available evidence as incomplete and recommends that in settings where the risk of bacterial infection is high, it may be prudent to use an antiseptic as per local preferences.

RHL Commentary by Haroldo Capurro

EVIDENCE SUMMARY

The revised review covers 22 trials involving 8959 subjects. Eleven of these trials are new, and include 2 conducted in a developing country (Thailand). There were no systemic infections or deaths—the primary outcomes of the review —in any of the trials. No differences were found in umbilical cord infection rates when a topical antiseptic was compared with dry cord care or placebo (Relative Risk [RR]: 0.53; 95% confidence interval [CI]: 0.35–1.13). Topical triple dye seemed to be more effective than alcohol (four trials, 1560 infants RR: 0.30; 95% CI: 0.19–0.49) or povidone-iodine (one trial, 183 infants RR: 0.15, 95% CI: 0.07–0.32) in preventing cord infection. Topical triple dye and antibiotics seemed to be associated with longer cord separation times. In one study use of a topical antiseptic was associated with less parental anxiety when compared with dry cord care.

The statistical methods used were appropriate. A subgroup analysis of term versus preterm and developed versus developing country settings would be appropriate if data permit.

The full RHL commentary also includes sections on:

Relevance
- Magnitude of the problem
- of the results
- Implementation of the intervention
Research
References

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This document should be cited as: Haroldo Capurro. Routine topical umbilical cord care at birth: RHL commentary (last revised: 30 September 2004). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com