KARACHI: A new Cochrane review shows that applying the antiseptic chlorhexidine to newborns’ umbilical cords can reduce infection rates by about 29% in low- and middle-income countries (LMICs) and may also lower newborn deaths.
Umbilical cord care is a vital part of newborn hygiene, helping prevent infections and supporting healthy healing. According to the World Health Organization (WHO), roughly 2.3 million newborns died in 2023, with the highest burden in LMICs.
Cord care practices vary globally, influenced by local culture, healthcare systems, and available resources. In areas with strong obstetric care and low neonatal mortality, WHO recommends “dry cord care,” keeping the stump clean and dry without antiseptics. In higher-risk settings, the guidelines suggest applying 4% chlorhexidine daily for one week.
The review examined 18 randomized controlled trials involving 143,150 newborns. It assessed antiseptics including 4% chlorhexidine, 70% alcohol, silver sulfadiazine, and povidone iodine to see their effects on infection, death, and cord separation.
Findings indicate that chlorhexidine likely reduces infections from 87 to 62 per 1,000 newborns and may lower deaths from 18 to 15 per 1,000 in LMICs. It also slightly delays cord separation by one to two days. Evidence from high-income countries was limited, so no clear conclusions could be drawn for these settings.
Lead author Dr. Aamer Imdad from the University of Iowa said, “In many parts of the world, newborns are born into environments with poor hygiene. Simple and accessible cord-care interventions can significantly reduce infections, which is critical given the large share of neonatal deaths linked to infection.”
Evidence for alcohol use in LMICs was uncertain. In high-income countries, moderate evidence suggests alcohol delays cord separation by around 1.6 days but showed no effect on infections or mortality.
Professor Zulfiqar Ahmed Bhutta, senior author from the Centre for Global Child Health in Canada and Aga Khan University in Pakistan, emphasized that cord care should reflect local conditions. “These interventions are not universal solutions. What works best depends on the realities families and health systems face,” he said.
The authors also noted that more data sharing from individual studies could strengthen scientific understanding and inform better policy decisions.
