Even though there are a multitude of studies regarding cord care, it is clear that many of the historical practice decisions were based on reactionary responses to epidemics rather than evidence-based research. Due to the reactionary nature of these studies, most have focused on individual facets of the technique and it is unclear which technique is the most beneficial. Table 4 summarizes the type of research, issues addressed, population addressed, and relevance of the literature reviewed. Of the current cleansing agents, a one-time application of triple dye seems to have the fewest adverse reactions and is associated with a significant decrease in staphylococcal colonization.
Alcohol, on the other hand, seems to offer more adverse effects than benefits. Several studies demonstrated it as inferior with regard to decreasing colonization. Some studies could not even demonstrate a significant difference in alcohol and water or no treatment. Alcohol was also significantly proven to prolong cord separation time. In light of alcohol's limited effect on decreasing colonization, and its deleterious effect of prolonging cord separation time, it is not recommended as a routine treatment for umbilical cord care.
While some researchers have proposed that the minimal benefits of alcohol on colonization can be generalized to other antimicrobials, other studies demonstrated a significant difference in a variety of other topical treatments and the effect of umbilical colonization. It is difficult to equate alcohol with all other antimicrobials when it was shown to be inferior many times.
Alcohol has been proven to prolong the length of cord attachment. It is also reasonable to generalize that other antimicrobials lengthen the time of cord attachment. Further research in this area would also be beneficial, although it is not as difficult to believe that findings would be similar to those with alcohol.
Despite the fact that several researchers recommend natural healing over antimicrobial treatment of the umbilical stump,[1,2] it is important to be certain that the risks of not using prophylactic treatment for infection are not forgotten. At this time, it seems premature to completely abandon the use of all antimicrobials without further research. Yet, it is imperative to be sure that current practices are based on evidence rather than historical practice. Many aspects of the health care setting have changed since the practice of umbilical cord care was established in the 1950s. Regardless of the current cord care practice in use, it is important to educate clients on the proper topical application and care of the umbilical stump, as well as the risks and benefits of any cleansing agent used and symptoms of adverse or toxic effects associated with the cleansing agent. Teaching should also include education regarding the normal appearance of the umbilical stump (especially if a "drying" agent is not utilized), local and general signs and symptoms of infection, and expected length of time for cord separation to occur. To provide evidence-based evaluation of practices related to umbilical cord care, additional research is recommended to include comparisons of current cord care practices, natural healing, as well as outcome studies following implementation of teaching strategies.
Address reprint requests to Tammy P. McConnell, MSN, RN, Nursing Instructor, 331 Ruth A. Nicholson, Nursing/Science Building, Greenville Technical College, School of Nursing, Greenville, SC, 29606 USA
NAINR. 2004;4(4):211-222. © 2004 W.B. Saunders
Cite this: Trends in Umbilical Cord Care: Scientific Evidence for Practice - Medscape - Dec 01, 2004.