Umbilical cord cleansing lowers mortality

The neonatal mortality rate in the United States is significantly lower than in many countries across the globe. Based on data from 2009 collected by the Maternal and Child Health Bureau, an average of 4.19 infants out of every 1000 dies before becoming 28 days old in our country (this represents 0.42 percent of all births).
However, this is not the case for many families in low-income regions around the world. In an effort to identify methods of lowering neonatal mortality, researchers from the Hopkins University Bloomberg School of Public Health, led by Dr. Abdullah Baqui, set out to test the effect umbilical cord cleansing could have on mortality rates.
When a child is first born, umbilical cord infection can account for up to 50 percent of neonatal deaths in areas researchers call "resource-poor settings." The umbilical cord blood vessels are exposed to the environment for several days following birth, making it a prime location for pathogens to find their way into an infant host. This is especially true in rural areas where good hygiene is difficult to maintain.
To that end, the World Health Organization recommends the best method for reducing infection in high risk locations is to keep the umbilical area clean without the application of any topical cleanser, a method called "dry cord care." However, understanding the fact that cleanliness is not always possible, the WHO also recommends that washing with a solution of chlorohexidine can offer protection from infection for newborns.
Although the name sounds like some rare and complex molecule from your Organic Chemistry course, chlorohexidine is actually a relatively cheap and easy-to-use disinfectant found in many household products, such as mouthwash and skin cleansers. As a neonatal care product, it provides a way for lower-income regions to prevent infection and protect newborn babies. As a result, the cleaner was the focal point of study for Baqui and his team.
The work had its genesis in an early study done in Nepal where researchers found that infants who received anywhere from one to seven cord cleansings with chlorohexidine in the first 10 days of birth reduced infection of the umbilical cord area by 32 percent. Furthermore, cleansing within the first 24 hours of birth led to a 24 percent lower mortality rate.
From this, experts then raised the question "would a simpler cleaning regimen (cord cleansing only once after birth) be equally beneficial?" To answer that question, the Hopkins team went to the three sub-districts of Beanibazar, Zakiganj and Kanaighat in Bangledesh.
In total, the team broke down these rural regions into 133 random clusters which were assigned to one of three possible cleansing regimens: single cleansing with chlorohexidine immediately after birth, daily cleansing for seven days after birth and the typical dry cord care which implemented no form of antiseptic as a means of comparison.
From June 2007 to September 2009, and with the help of local community helpers, the researchers enrolled 29,760 babies in the study with 10,329 having multiple cleanings, 9,324 undergoing a single cleaning and 10,008 utilizing dry cord care. From these trials, the researchers carefully monitored child health over the course of a month, looking for any signs of umbilical cord infection.
After compiling the data and breaking down the numbers, the researchers found an interesting twist in the data. As expected, even a single cleaning with antiseptic significantly prevented mortality compared with dry cord care.
However, when comparing dry cord care with multiple cleanings, contrary to expectation, there was no significant difference in mortality rates. These results contradicted the previous study done in Nepal which showed that cleansing anywhere from one to seven days lowered infant mortality. While the study offers several possible explanations for this apparent aberration, the simple fact is that more research needs to be done in order to understand chlorohexidine's fullest impact on neonatal mortality.
Despite the deviation in data from multiple cleanings, Baqui and his group emphasize the fact that chlorohexidine "has an excellent safety record and it is simple and inexpensive to deliver." By increasing awareness to implement these methods of cleansing, Baqui hopes to improve neonatal survival in the places that need it most.