Umbilical cord disinfection: an evidence-based review

Abstract

Objective: Umbilical cord care differs across cultures. Aseptic technique is generally accepted, although there is much debate on the best treatment. Keeping the umbilical cord stump clean and dry is often neglected. The aim of this study is to determine if umbilical cord disinfection reduces perinatal morbidity of newborns delivered in the hospital setting in developed countries. Data sources: MEDLINE, National Guideline Clearinghouse, NICE Guidelines Finder, Canadian Medical Association Practice Guidelines Infobase, The Cochrane Library, DARE, Bandolier, evidence-based medicine websites and bibliographic references of the selected articles were searched. Revision methods: A study of clinical guidelines, meta-analyses, systematic reviews and randomized clinical trials was carried out. The MeSH terms used were ‘Chlorhexidine’, ‘Disinfectants’ and ‘Umbilical cord’ for studies published between August 2005 and August 2015 in English, Spanish and Portuguese. To evaluate the levels of evidence and strength of recommendations, the Strength of recommendation taxonomy scale of American Academy of Family Physicians was used. Results: The search produced 315 results. Of these, three publications were included. One meta-analysis showed no significant difference in omphalitis with application of antiseptic versus placebo. Two clinical guidelines stated that application of antimicrobials was not superior to dry cord care in preventing cord infection and bacterial colonization. Conclusions: The analysis of the articles selected showed that there is insufficient evidence to advise the use of antiseptics in the care of the umbilical cord of infants born in hospital in developed countries (strength of recommendation A). Dry cord care is recommended. More high quality studies are needed including randomized controlled trials in relevant populations.