Umbilical cord care may save infants’ lives

JOHNS HOPKINS (US) — Cleaning umbilical cord stumps with a cheap antiseptic can dramatically reduce newborn deaths in poor countries.

The findings are from a study that is the latest in a series showing the chemical chlorhexidine can prevent potentially fatal infections in the first weeks of life.

“Chlorhexidine cord cleansing is a simple, safe, effective, and inexpensive intervention,” says Abdullah Baqui, principal investigator and professor of international health at Johns Hopkins University.

“Large-scale implementation of this intervention with universal coverage has the potential to avert an estimated half a million neonatal deaths per year.”

Neonatal deaths, nearly all in poor and middle-income countries, account for more than 40 percent of the estimated 8.8 million annual deaths of children under 5.

About 30 percent of those deaths are due to infection, and the umbilical cord stump is a potential entry point for infectious disease in the first days after birth, according to a commentary published online alongside the Johns Hopkins study in the journal The Lancet.

The team enrolled more than 29,000 newborns in rural Bangladesh in a randomized trial to determine the effectiveness of either a single cleansing with 4 percent chlorhexidine or a seven-day cleansing regimen with chlorhexidine, both as compared with standard dry cord care.

Chlorhexidine is a chemical antiseptic used in consumer products such as mouthwash and contact lens solution, as well as in skin cleansers, including surgical scrub products.

The researchers found that infants who received a single cleansing with chlorhexidine were 20 percent less likely to die than infants who received dry cord care. Additional reductions in mortality among the seven-day cleansing group were not statistically significant, but those babies did have fewer signs of cord infection.

An earlier study, conducted by Johns Hopkins researchers in Nepal, showed cleansing the umbilical cord with chlorhexidine for seven of the first 10 days of life resulted in a 24 percent decrease in mortality compared with dry cord care.

A separate study by researchers from Aga Khan University in Pakistan, also published online by The Lancet, found that cord cleansing with chlorhexidine reduced infant mortality 38 percent and infections by 42 percent.

“Giving birth and a child’s first week is a risky time for a mother and her newborn,” says Rajiv Shah, administrator of the U.S. Agency for International Development.

“These studies provide evidence of a simple, low-cost technology that can prevent illness and death for the most vulnerable children. USAID is committed to transforming research into better results and access to life saving interventions.”

The study, conducted in rural Bangladesh, was led by researchers from JHU’s Bloomberg School of Public Health in partnership with the International Center for Diarrheal Disease Research, Bangladesh, and a Bangladeshi non-government organization, Shimantik.

The Johns Hopkins research was funded by USAID and Save the Children’s Saving Newborn Lives program, through a grant from the Bill & Melinda Gates Foundation.

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