Document Detail

Risk of mortality subsequent to umbilical cord infection among newborns of southern Nepal: cord infection and mortality.
MedLine Citation:
PMID:  19034065     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Neonatal sepsis may stem from local umbilical cord infections. Signs of cord infection are common in low-resource settings, yet the risk of mortality subsequent to these signs has not been quantified in either developed or developing countries. We compared the risk of mortality between infants with and without signs of umbilical cord infection during a community-based trial of chlorhexidine interventions in southern Nepal.
METHODS: Newborns were evaluated for signs of umbilical cord infection (pus, redness, swelling). A nested case-control approach was used to estimate the odds of mortality between infants with and without umbilical cord infection as defined by various levels of severity. For each death in the parent trial, 10 controls were selected, matched on sex, treatment group, and number of cord assessments. The main outcome measures were all-cause and sepsis-specific mortality.
RESULTS: Among 23,246 assessed infants, there were 392 deaths. Odds of all-cause mortality were 46% (8-98%) higher among infants with redness extending onto the abdominal skin. A nonsignificant increased odds of mortality [odds ratio (OR): 2.31; 95% confidence interval (CI): 0.66-8.10] was observed among infants with severe redness and pus. Infections occurring after the third day of life were associated with subsequent risk of all-cause (OR: 3.11; 95% CI: 1.68-5.74) and sepsis-specific (OR: 4.63; 95% CI: 2.15-9.96) mortality.
CONCLUSIONS: This study provides evidence that common local signs of cord infection are associated with increased risk of mortality. Where exposure of the umbilical cord to potentially invasive pathogens is high, interventions to increase hygienic care of the cord should be promoted and including hand washing, avoiding harmful topical applications, and topical cord antisepsis.
Luke C Mullany; Gary L Darmstadt; Joanne Katz; Subarna K Khatry; Steven C Leclerq; Ramesh K Adhikari; James M Tielsch
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  28     ISSN:  0891-3668     ISO Abbreviation:  Pediatr. Infect. Dis. J.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-30     Completed Date:  2009-11-03     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  17-20     Citation Subset:  IM    
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MeSH Terms
Bacterial Infections / microbiology,  mortality*
Case-Control Studies
Infant, Newborn
Nepal / epidemiology
Risk Factors
Time Factors
Umbilical Cord / microbiology*
Grant Support
HD38753/HD/NICHD NIH HHS; HD44004/HD/NICHD NIH HHS; R01 HD038753/HD/NICHD NIH HHS; R01 HD038753-01/HD/NICHD NIH HHS; R01 HD038753-02/HD/NICHD NIH HHS; R01 HD038753-03/HD/NICHD NIH HHS; R01 HD038753-03S1/HD/NICHD NIH HHS; R01 HD038753-04/HD/NICHD NIH HHS; R01 HD044004/HD/NICHD NIH HHS; R01 HD044004-01/HD/NICHD NIH HHS; R01 HD044004-02/HD/NICHD NIH HHS; R01 HD044004-03/HD/NICHD NIH HHS; R03 HD049406/HD/NICHD NIH HHS

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