Trends in Umbilical Cord Care: Scientific Evidence for Practice

Current Cord Practice

Today, cord care practices vary greatly from institution to institution in the United States. According to the AAP, no single method of cord care has proven superior in limiting bacterial colonization and disease.^[20] Methods of cord care that are currently used include triple dye, alcohol, antibiotic ointments, povidone-iodine (Betadine), soap and water, or no treatment at all.^[4] In general, the umbilical stump is expected to be kept clean and uncovered to promote healing, drying, and cord separation.^[20] For decades, the use of alcohol daily and as often as each diaper change has been recommended to decrease infection and shorten cord separation time. However, there is an absence of studies that show the benefits of using alcohol.^[4]

It is important to note that the exposed necrotic tissue of the umbilical stump is readily colonized and infected by pathogenic bacteria. Ready access of the bacteria into the systemic circulation places neonates at high risk for infection. In developing countries, hygienic umbilical care is believed to reduce umbilical colonization, infection, tetanus, and sepsis, but the role of antiseptic cord care in reducing infections is unclear. Although studies in these less developed countries addressing cord care are lacking, historical controls and studies have demonstrated the decrease in infection during epidemic outbreaks in the 1950s. Recurrent epidemics of streptococcal infections have also been reported with the use of dry treatment or the use of alcohol alone, suggesting these regimens are insufficient.^[28]

In the United States, the incidence of omphalitis (inflammation or infection of the umbilical stump) is rare.^[2] This has been assumed to be related to hand washing, standard precautions, knowledge of transmission, and antiseptic treatments of the umbilical stump.^[1] The thought that bacterial colonization of the umbilical stump is beneficial to the healing process and cannot necessarily be correlated with infection is also being explored by some investigators.^[1,2,4] These investigators have compared cleaning solutions and natural healing, and all recommend that no treatment at all may be more beneficial than the routine and historic use of topical antimicrobials.^[1,2,4]

NAINR. 2004;4(4):211-222. © 2004 W.B. Saunders