The umbilical cord stump may be exposed to pathogens from the cutting instrument, the hands of the caregiver, the mother, or other environmental factors. In such cases, local cord infection (omphalitis) may develop into a potentially life threatening systemic infection. Some cultures expose the cord to pathogen carrying substances such as mud, ash, or dung which are traditionally thought to reduce the time until the cord falls off, but often cause infection.
Mechanism of Action
The primary method of umbilical cord care is clean cord care. This involves clean hands, a clean tool to cut and clamp the cord, and a clean surface. After this, dry cord care may be done to encourage the cord to fall off. Alternatively, antibacterial solutions may be used to clean the umbilical cord. Chlorhexidine is an often used solution in low-resource settings. It is a chemical antiseptic which disrupts the membranes of both gram-positive and gram-negative microbes. Widely available from chemical suppliers, it is typically diluted with purified water to 4% free chlorhexidine. Although it is a colorless liquid, it may be mixed with a dye or perfume at this point. For cord care, a caregiver dabs a cotton ball moistened with the solution onto the umbilical cord stump, and a second moistened cotton ball to clean the areas around the stump. Trials are underway to determine the optimal frequency of use. Data from Nepal and Bangladesh suggests that chlorhexidine use may reduce severe omphalitis when compared with dry cord care.
Current Use in High-Resource Settings
Most high-resource settings practice dry cord care, meaning that they simply allow the umbilical cord to dry and fall off on its own. In high-resource settings, the stump is kept clean and protected by clothes or bandages. Furthermore, many facilities have mothers and neonates together to encourage non-pathogenic bacteria from the mother to outcompete other bacteria at the cord. Where antiseptics are used, they include ethanol, silver sulfadiazine, triple dye, gentian violet, povidone iodine, and chlorhexidine.
Application in Low-Resource Settings
The WHO recommends dry cord care, although acknowledges the utility of antiseptics in communities where the cord stump may be intentionally exposed to mud, ash, dung, or other harmful substances. Even in the absence of harmful practices, there is a growing body of evidence that cleansing with a 4% chlorhexidine solution may greatly reduce the incidence of infection, hospitalization, and neonatal mortality. Despite these findings, chlorhexidine cord care is not yet common. Efforts are underway to establish commercial products specifically designed to make chlorhexidine cord care more popular.