Trends in Umbilical Cord Care: Scientific Evidence for Practice

Tammy P. McConnell, MSN, RN; Connie W. Lee, EdD, ARNP, IBCLC; Mary Couillard, PhD, RN, CS, FNP; Windsor Westbrook Sherrill, PhD, MBA, MHA

Disclosures

NAINR. 2004;4(4):211-222. 

In This Article

Abstract and Introduction

To provide an increasing body of knowledge related to umbilical cord care, a literature review was conducted to study the evolution of umbilical cord care, to evaluate the scientific evidence used to guide practice changes, and to make recommendations for current practice. Historically, there has been a wide range of inconsistent practices related to umbilical cord care that have included a variety of cleansing agents and techniques. The findings of this literature review indicate that the current standard of umbilical cord care may be based on historic practices and traditions rather than scientific investigation and justification. There appears to be little support for continued alcohol use. Yet, insufficient evidence is available to support an immediate change in the standard of care from topical antimicrobial treatment of the umbilical cord to natural healing. Further research is recommended to evaluate natural healing and to establish evidence-based recommendations for practice.

There is considerable debate among health care professionals about the most effective newborn umbilical cord care. Historically, there has been a wide range of recommended practices related to umbilical cord care that have included a variety of cleansing agents and techniques. Recent research has indicated that, in the context of modern infection control policies, the current standard of umbilical cord care may be based on historic practices and traditions rather than scientific investigation and justification. These studies recommend abandoning the traditional use of antimicrobials for soap and water or natural healing.[1,2]

Originally, cord care addressed concerns for bacterial colonization and subsequent infection; however, the relationship between umbilical colonization and infection was unclear. Delayed cord separation has also been proposed to increase the incidence of infection.[1–3] The use of antimicrobial umbilical cord treatment such as isopropyl alcohol (alcohol) has consistently been proven to lengthen the time of cord separation.[1,2,4] Yet, alcohol continues to be routinely used as an antimicrobial agent for the purpose of cord drying and is recommended by health care providers as an agent to hasten cord separation.[4] Despite many studies of different cord care regimens, the treatment options recommended and practiced in the United States currently continue to vary from hospital to hospital and may include triple dye, isopropyl alcohol (alcohol), povidone-iodine (Betadine), antibiotic ointments, soap and water, or no treatment at all.

The purposes of this article are to examine: 1) the history of umbilical cord care and its evolution over time; 2) the current cord care practices and the evidence that these practices are derived from; 3) the benefits and risks of the various cleansing agents used; 4) the relationship between bacterial colonization and infection; 5) the effects of umbilical cord care on cord separation; and 6) clinical significance. Finally, the appropriateness of current cord care practices and implications for changing the practice of cord care will be discussed.

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