`Umbilical cord cleaning during birth may cut infant deaths`

London: Cleansing the umbilical cord during and after baby`s birth could help reduce cord infection and the neonatal mortality in resource-poor countries, according to two new studies carried out in Pakistan and Bangladesh.

The studies, published in The Lancet, showed that by cleaning the umbilical cord during and after the birth not only reduces the incidence of infection, called omphalitis, but also cuts neonatal mortality.

In the first study, researchers led by Professor Zulfiqar A Bhutta of the Aga Khan University in Karachi, assessed the effect of umbilical cord cleansing with chlorhexidine (CHX) solution on the incidence of omphalitis and neonatal mortality in babies in rural parts of Sindh province, Pakistan.

Umbilical cords of more than 9,700 infants born across the province were cleansed with four per cent CHX solution at the birth and then at home for up to 14 days.

One intervention was CHX solution only and another was hand washing only. Standard dry cord care was promoted in the control group. The data showed that cord cleansing reduced the risk of infection in babies by 42 per cent and mortality by 38 per cent. Hand washing appeared to have no effect on infection or mortality risk.

"The results of these trials done in community settings lend support to the policy of application of chlorhexidine on newborn umbilical cord for prevention of omphalitis and mortality," the authors said.

In the second study, a team led by Prof Abdullah H Baqui and Dr Luke Mullany (Johns Hopkins Bloomberg School of Public Health, Baltimore) assessed the effectiveness of two regimens of cord-cleansing with the promotion of dry cord care in the prevention of neonatal mortality in Sylhet, Bangladesh.

The study area was divided into 133 clusters, that were randomly assigned to one of the two cleansing regimens (single cleansing as soon as possible after birth; daily cleansing for seven days after birth) or promotion of dry cord care. Around 10,000 babies were allocated to each group.

It was found that neonatal mortality was lower in the single-cleansing group (22?5 per 1000 livebirths) than it was in the dry cord care group (28?3 per 1000 births).

Compared with the dry cord care group, the team recorded a significant decline in the occurrence of severe cord infection in the multiple cleansing group, but not in the single-cleansing group.

"These data provide evidence that chlorhexidine cleansing reduces risk of neonatal mortality and omphalitis; further randomised trials in sub Saharan-African settings are needed," the authors concluded.

Commenting on the findings, Dr David Osrin and Dr Zelee Hill of UCL Institute for Global Health in London, said: "On balance, we think that sufficient evidence has accrued to claim proof-of-principle that application of four per cent chlorhexidine to the cord stump can prevent omphalitis and neonatal mortality in high-mortality settings."

Families and birth attendants should be considered in use of this intervention, since in many remote locations it is family members that are assisting during homebirths, they added.