Document Detail

Impact of 4.0% Chlorhexidine Cord Cleansing on the Bacteriological Profile of the Newborn Umbilical Stump in Rural Sylhet District, Bangladesh: A Community-Based, Cluster-Randomized Trial.
MedLine Citation:
PMID:  22189523     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Randomized trials from South Asia indicate umbilical cord chlorhexidine cleansing reduces mortality and omphalitis. No community-based data are available on bacteriological profile of the cord, early neonatal colonization dynamics, or impact of cord cleansing on colonizing organisms. Such data could clarify the design of scaled chlorhexidine interventions. METHODS:: Umbilical swabs were collected at home (days 1, 3, 6) after birth from infants participating in a trial of three cord care regimens (no chlorhexidine, single cleansing, multiple cleansing) in Sylhet, Bangladesh. Overall and organism-specific positivity rates were estimated by cord care regimen, and by day of collection. RESULTS:: Between September 2008 and October 2009, 1923 infants contributed 5,234 umbilical swabs. Positivity rate was high (4,057 of 5,234, 77.5%) and varied substantially across groups. Immediate (day 1) reductions in cord colonization were observed in single (PRR=0.75, 95% CI: 0.70 - 0.81) and multiple (PRR=0.71 [0.66-0.77]) cleansing groups. Reductions persisted and increased in magnitude through day 6 only if babies received multiple applications. On days 1, 3, and 6, respectively, multiple cleansing consistently reduced invasive organisms such as E. coli (49%, 64% and 42% lower), K. pneumoniae (46%, 53% and 33% lower), and S. aureus (34%, 84%, 85% lower). CONCLUSIONS:: Cord cleansing with 4.0% chlorhexidine immediately after birth reduces overall and organism-specific colonization of the stump. Reductions are greater and sustained longer with daily cleansing through the first week of life, suggesting that programs promoting chlorhexidine cleansing should favor multiple over single applications.
Luke C Mullany; Samir K Saha; Rasheduzzaman Shah; Mohammad Shahidul Islam; Mostafiz Rahman; Maksuda Islam; Radwanur Rahman Talukder; Shams El Arifeen; Gary L Darmstadt; Abdullah H Baqui
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-20
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  -     ISSN:  1532-0987     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 2Child Health Research Foundation, Dhaka, Bangladesh 3Department of Microbiology, Dhaka Shishu Hospital, Dhaka Bangladesh 4Shimantik (a Bangladeshi NGO), Sylhet, Bangladesh 5International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh 6Bill and Melinda Gates Foundation, Seattle, Washington, USA (Current Address).
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