Can You Clean Umbilical Cord With Alcohol

Medicine (Baltimore). 2022 Apr; 95(14): e3207.

70% Alcohol Versus Dry String Care in the Umbilical String Care

A Case–Control Study in Italy

Rosanna Quattrin, Dr., Kim Iacobucci, DSN, Anna Lisa De Tina, DSN, Letizia Gallina, DSN, Carla Pittini, Md, and Silvio Brusaferro, Dr.

Monitoring Editor: Morten Breindahl.

Received 2022 Dec 28; Revised 2022 Mar two; Accustomed 2022 Mar 4.

Abstract

Recently the use of antibacterial agents to clean and dry out the stump of the newborns' umbilical cord (UC) after nascence has been abandoned past many neonatal units in favor of dry cord care. Aim of this written report was to compare the occurrence of agin events (AEs) and time to string separation amidst newborns treated with dry string care versus 70% alcohol in an Italian Bookish Hospital (AH).

From December 2022 to March 2022, 239 infants were born at the AH. The number of eligible infants was 200 and they were every bit assigned to either case group (dry string intendance) or control grouping (70% alcohol, standard procedure). Standard cord intendance consisted in i application of lxx% alcohol at birth followed by other ii times a day, while experimental dry cord care procedure was executed by the but application of a sterile gauze around the base of the UC at the 1st day of life and after the cord has been exposed to air off the diaper edge. The time to UC separation and any AEs such as local and systemic infections, hemorrhage, and granuloma formation were reported by mothers.

Nosotros plant a significant difference in the mean cord separation fourth dimension betwixt the ii groups (dry cord care: 10.1 days [standard deviation, SD = 4.0] vs 70% alcohol: 12.0 days [SD = 4.2]; P < 0.001), while no significant AEs resulted. Incidence rate of granuloma was 0.67 × 1000 days of life in dry cord intendance group.

Dry cord intendance is an easy, straight-forrard, and prophylactic method of handling the UC in healthy newborn infants born in a high-income hospital setting.

INTRODUCTION

The umbilical string (UC) which connects the baby and placenta in uterus (the womb) is made of claret vessels and connective tissue. It is covered past a membrane that is normally bathed in amniotic fluid. After birth, cutting the cord physically and symbolically separates the mother and her baby. The string stump (CS) dries, falls off, and the wound heals.^one

The cord ordinarily separates between 5 and 15 days later birth. Before the separation, the remaining stump tin can be considered to be a healing wound and thus a possible route for infection through the vessels into the infant's blood stream.¹

Soon after a normal delivery, the skin of the newborn baby including the CS is colonized mainly by nonpathogenic leaner such as coagulase negative Staphylococci and Diphtheroid bacilli. Pathogenic bacteria such as Coliforms and Streptococci may also be present on the skinⁱⁱ and can rail upward the CS causing infection.

In the developing countries, i-3rd of the deaths are acquired by infections, mostly considering of the delivery surroundings (more often than not the community and the houses). Cord infection may exist localized to the UC (omphalitis) or, subsequently its entry into the blood stream, information technology becomes systemic (due east.chiliad., neonatal sepsis).² The near observed infections upon the CS and the abdominal surface are due to bacterial omphalitis with polymicrobic aetiology,³ but also to Clostridium tetani.^iv The onset of the symptoms is usually observed between the 5th and the 9th day of life.

While there is a general agreement almost the make clean technique for cut the cord using a sterile cutting instrument (blade or pair of scissors) and regard to clean hands to avoid infection, there is less accordance on what is the best care of the CS.¹

Internationally, the Earth Health Arrangement (WHO) has advocated since 1998 for the employ of dry UC care (keeping the cord make clean without application of anything and leaving information technology exposed to air or loosely covered past a clean cloth, in example it becomes soiled it is simply cleaned with water).⁵ Also the American Academy of Pediatrics considers no antiseptic handling to be superior to any other⁶ and the guidelines from the German language Association for Neonatology and Pediatric Intensive Care recommend clean care and keeping the UC dry.⁷

On the basis of a Cochrane review¹ and other several studies,^viii–12 WHO recommends daily chlorhexidine (7.1% chlorhexidine digluconate aqueous solution or gel, delivering 4% chlorhexidine) awarding to the UC stump during the 1st week of life for newborns who are born at abode in settings with loftier neonatal mortality (30 or more than neonatal deaths per 1000 live births), while dry cord care for newborns built-in in health facilities and at abode in low neonatal mortality settings. The use of chlorhexidine in these situations may exist considered only to supercede application of a harmful traditional substance, such equally cow dung, to the CS. This is classified every bit a potent recommendation based on low to moderate quality evidence.¹³

Aim of this study was to compare the occurrence of all agin events (AEs) and the cord separation fourth dimension among newborns treated with dry cord care versus 70% alcohol in an Italian Bookish Infirmary (AH) to requite a valid recommendation to clinicians.

METHODS

Study subjects were recruited from December 2022 to March 2022 at Azienda Ospedaliero-Universitaria of Udine, a big Italian North Eastern AH, where almost 1600 deliveries take place annually. The minimum sample size (N = 150) was calculated using the formula of estimating a single population (N = 1600) portion, taking xv% proportion of 5% margin of error and 95% confidence level.

Infants were considered eligible according to the inclusion criteria reported in Table ​ 1 which are in line with inclusion criteria in other like studies.^11,xiv After obtaining written consent past parents, subjects were assigned to control group if born in December 2022 and Jan 2022, and to example group if born in Feb 2022 and March 2022. Standard cord care consisted in 1 application of 70% alcohol at birth followed by other 2 times a 24-hour interval, while experimental dry cord care procedure was executed past the only application of a sterile gauze effectually the base of the UC on the 1st solar day of life to absorb bloody secretions and afterward the cord has been exposed to air off the diaper edge. Mothers were instructed to wash the area around CS advisedly with water and stale when bathing the babe and to fold nappy and plastic nether cord surface area, leaving string exposed to air. Also parents were educated to find and report any signs of infection, that is, redness, stickiness, or offensive odor.

TABLE 1

Criteria to Including Newborns in the Experimental Study

A researcher nerveless personal data and mother'southward and the newborn's medical history reported in medical records. Delivery (natural, caesarean department, and vacuum extractor), birth weight, sexual practice, ethnic origin, hygiene and comfort after birth (immersion bath or sponging), assistants of phototherapy, and blazon of breastfeeding at discharge were the considered variables.

A questionnaire (bachelor on asking) was administered by phone to mothers 1 month after childbirth to investigate: type of breastfeeding at home, occurrence of AEs and their treatments, cord separation time, changes in cord care procedures at habitation, admission to hospital, and access to outpatient care. Parents were given a calendar where daily they had to report any changes in the umbilical wound and the day of the stump autumn.

Parents were asked to tape signs of UC infection including pus and redness (inflammation), swelling (edema), or both, of the CS and peel at the base of the stump. Infections were categorized into iv gradations (none, balmy, moderate, and severe) according Mullany.^ten Mild was divers as redness or swelling limited to the CS but; moderate was defined as <2 cm extension onto the abdominal skin at the base of the CS; and severe was divers as spreading noticeably (>2 cm) outward from the base of the stump. In instance of systemic infection (also known as neonatal sepsis), the describing criteria were the admission diagnosis of the newborn in the pediatric unit, the contingent analysis, and the cultural exams. The study also detected the umbilical granuloma that is the most common umbilical abnormality in the neonate.^eleven

Benchmark to ascertain CS fall was the complete detachment of the stump from the newborn's abdominal surface.

Ethical approving for this report was not needed, because dry cord care was already approved by the scientific customs and because the study did non include the use of antiseptics or other substances.

Data collected were entered in an Excel spreadsheet and were analyzed using the statistical software SPSS, version xx. Pearson chi-squared exam and Mann–Whitney test, for mean comparing, were used. Statistical significance was defined every bit P ≤ 0.05.

RESULTS

Two hundred inborn good for you term infants were recruited from Dec 2022 to March 2022 distributed equally in experimental grouping (dry cord care) and control group (70% alcohol).

Table ​ ii shows the newborns' characteristics in the 2 groups under study.

Tabular array 2

Baseline Characteristics of Subjects in the 2 Groups Under Written report

Table ​ 3 reports questions administered to mothers at home one month later on childbirth: blazon of breastfeeding at domicile, occurrence of AEs and their treatments (access in hospital or access to outpatient care), changes in string care procedures at home, and string separation time. The two cases of umbilical granuloma were treated with silvery nitrate stick.

Tabular array 3

Questions Administered to Mothers at Dwelling Ane Calendar month Afterwards Childbirth, Distributed in the 2 Groups Under Written report

Comparing means of UC separation time betwixt grouping treating with phototherapy and one that was not undergone to phototherapy, no statistical differences resulted among the ii groups, while considering only newborns treated with phototherapy a significant statistical differences emerged between case and control groups (nine.9 days [standard departure, SD = 3.7] in dry cord care vs 11.vi days [SD = 4.0] in lxx% alcohol; P < 0.01).

DISCUSSION

Even if in 2022 WHO recommended clean dry string care for infants born in wellness facilities and at dwelling house in low neonatal mortality settings, healthcare working in neonatal unit and caregivers use different procedures to care the UC according their experiences and their preferences. Also in high-income countries, where bloodshed is very low, important outcomes in the 1st month¹ of life regard to UC care must include more frequently AEs such as irritation, redness of the omphalus wall, weeping and bleeding of the omphalos, rarely infections similar omphalitis, sepsis, and umbilical granuloma, and the time to separation of the UC stump.¹¹

This case–control study compared 2 UC care procedures: dry cord care and 70% booze. Dry cord care is the process in which the umbilical stump is kept "clean and dry without applying anything" where anything stands for a dye, an antiseptic, or an antibiotic.^five In this study, a sterile gauze effectually the base of operations of the UC was practical only on the 1st day of life to absorb bloody secretions. The research found no difference in occurrence of UC AEs in the 2 groups. Information technology confirms data shown in other trials conducted in healthy term infants built-in in loftier-income or middle-income hospital setting.^2,fifteen,16

Although the report was open, treatment bias was non relevant. Blinding was impossible due to the 2 very different string care procedures. Treatment bias related to parents was not relevant because all subjects born from December 2022 to Jan 2022 were assigned to standard procedure and all subjects born from February 2022 to March 2022 were handled with dry cord care. It follows that mothers admitted to the hospital in the same period received the aforementioned UC care for their infants.

Some variables nerveless in this written report were distributed in dissimilar percentages among the two groups, such as indigenous origin, hygiene at birth, phototherapy treatments, breast-feeding only these characteristics did not influence the occurrence of UC complications. Regard to ethnic origin it is remarkable the fact that in dry cord intendance group there were more no Italian infants but at the same fourth dimension few of their mothers inverse UC care procedure at home, although the literature reported widespread potentially harmful traditional practices, including use of herbs mixed with cooking oil or water, especially in Africa and in Asia.^17,18 About hygiene at birth, we did not find studies referring that immersion bath and sponging afterward birth had departure occurrences of string infections and bacterial colonization.^19–21 With respect to administration of phototherapy, the literature did not written report more UC AEs in newborns undergoing to this treatment. Instead studies demonstrated that breast-feeding was significantly related to less incidence of string infection^22,23 just in our inquiry it was difficult to draw a conclusion because at discharge the percent of women that nursed was higher in case group than in command group, while at home it was the contrary.

In literature, the hateful UC separation time ranged from 4 to sixteen days depending on the intervention and study setting.^2–10 Studies which applied cipher to the cord had mean separation times of almost 9 days.^14,24,25 Meta-assay of iv studies with booze as the comparator showed a trend toward cord separation being significantly prolonged in the alcohol group but there was no pregnant deviation in cord separation,^ane while the nowadays written report showed a statistical difference between the ii groups: in DCC the mean UC separation time was about 2 days before of control grouping 1 (10 days vs 12 days). The clinical bear on of delays of cord separation is unknown, but information technology has social and toll implications: delay makes mothers anxious, and it increases the number of domiciliary midwife visits to the home.²⁶ It follows that health workers and families prefer more rapid cord separation.²

An other consideration consists in the fact that in our study, phototherapy did not influence UC separation fourth dimension in both case and control groups differently from literature reported that phototherapy delayed cord separation.²⁷

This report detected also the occurrence of granuloma. Information technology is an over growing tissue during the healing procedure of the umbilicus, usually occurs in reaction to a mild infection. It is not a built abnormality but represents continuing inflammation of granulation tissue, that has not nevertheless epithelialized.²⁸ The umbilical granuloma is the most common umbilical trouble in infants but, to our knowledge, at that place are non studies that reported incidence rate in terms of its occurrence per thousand days from childbirth only but the incidence percentages in 1 study of Kapellen et al^eleven (12.8% in clorexidine grouping and xi.seven% in dry out cord care group). A meaning finding of the present report was the calculation of incidence rate of granuloma equal to 0.67 × 1000 days of life in dry string care group.

The study had 3 limitations. First, it was conducted on babies and their mothers who were only eligible for option criteria, and it may not be generalized to other cultures or countries. The second limitation is related to difficulties of standardized procedures in collecting the civilisation samples from UC in home setting. Therefore, it was not possible to provide the decision of microorganisms responsible of detected complexity. Third, data on UC complications and treatments were obtained by telephone interview of mothers and not through direct observation by healthcare professionals. Before hospital belch, parents were of grade instructed to look for the warnings signs of UC complications and to contact their healthcare provider if in uncertainty.

Decision

This case–command written report compared ii different procedures for the UC care in infants born in a loftier-come hospital: dry out cord care versus seventy% alcohol. No statistically significant differences between the 2 UC care practices resulted regard to the occurrence of UC AEs (local infection, systemic disease, granuloma, haemorrhage, etc.), while time of UC separation was pregnant shorter in dry out cord care group. Dry cord care is an easy, straight-forward, and safe method of handling the UC in salubrious newborn infants born in a high-income infirmary setting.

Footnotes

Abbreviations: AEs = adverse events, AH = academic hospital, CS = cord stump, NICU = neonatal intensive intendance unit, PRAC = European Pharmacovigilance Risk Cess Committee, SD = standard difference, UC = umbilical cord, WHO = World Health System.

The authors have no funding and conflicts of interest to disclose.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998765/

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