Simple Intervention Reduces Infant Mortality

Diana Phillips

March 05, 2015

The use of chlorhexidine as a cleansing agent on the skin or umbilical cord stumps of babies born outside of a hospital is a cost-effective option for reducing the risk for newborn infection and death, a study has shown. The low-cost broad-spectrum antiseptic agent, which is active against common organisms causing perinatal infections, could help reduce infant mortality in developing countries by 12% and reduce omphalitis (umbilical cord stump infection) by 50%, according to the authors of a systematic literature review published March 4 in the Cochrane Database of Systematic Reviews.

To evaluate the efficacy of neonatal skin or cord care with 4% chlorhexidine vs routine care or no treatment for the prevention of infections in infants born in hospital and community settings, Anju Sinha, PhD, from the Division of Reproductive and Child Health, Indian Council of Medical Research in Ansari Nagar, and colleagues systematically screened the literature for cluster and individual patient randomized controlled trials, identifying seven hospital-based and five community-based studies that met the inclusion criteria.

The studies included in the analyses were conducted in low-, middle-, and high-income countries in Southeast Asia (seven studies), Africa (two studies), Europe (two studies), and South America (one study) and involved a total of 87,046 neonates and 13,613 pregnant women, the authors report.

Of the 12 trials, the five carried out in community settings (including home births) involving 72,030 newborns provided the highest-quality evidence, the authors write. Four of the studies included maternal vaginal wash with chlorhexidine in addition to neonatal skin and cord care.

The results of meta-analyses by setting showed chlorhexidine cord and skin care reduced the newborn infection rate by 23% in hospital-based studies, reduced neonatal mortality by 12% in community-based studies, and reduced the incidence of umbilical cord stump infection (omphalitis) by 52% in the community setting. In the meta-analysis of the studies using maternal vaginal wash in addition to neonatal skin or cord care, nonsignificant effects on infection rates were noted.

"Our review findings indicate that there is high-quality evidence that the risk of omphalitis and neonatal mortality is lower with chlorhexidine intervention compared with usual care in the community setting," the authors write.

"There is some uncertainty as to the effect of chlorhexidine applied to the umbilical cords of newborns in hospital settings on neonatal mortality. The quality of evidence for the effects on infection [is] moderate for cord application and low for application to skin," they add.

Regarding maternal vaginal chlorhexidine compared with usual care, the intervention "probably leads to no difference in neonatal mortality in hospital settings," they conclude.

Results from ongoing studies in Africa will help substantiate the evidence around chlorhexidine, according to the authors, who note that additional research is needed to ascertain optimum frequency of application.

The authors have disclosed no relevant financial relationships.

Cochrane Database Syst Rev. 2015;3:CD007835.

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