Chlorhexidine and newborn omphalitis and mortality - Authors' reply.

appreciable reductions in newborn mortality in low-income and middle-income countries. We said that two recent trials 9,10 did not provide evidence to alter current WHO guidelines, 7 which recommend it for infants born at home in environments with neonatal mortality rates of more than 30 per 1000 livebirths. We stand by this. DO does not work with but has been a co-author of six publications in the past 5 years with Robert Black, a named author of the paper from Tanzania. The publications were produced by large working groups and DO and TC both either contributed data from their research programmes or were members of a distributed expert group. Opiyo N. Chlorhexidine skin or cord care for prevention of mortality and infections in neonates. of cord-related adverse events in neonates with dry umbilical cord care compared to chlorhexidine powder: results of a randomized controlled study to compare effi cacy and safety of chlorhexidine powder versus dry care in umbilical cord care of the newborn. Sunakawa K. Double-blind comparative study on the care of the neonatal umbilical cord using 80% ethanol with or without chlorhexidine. ect of topical application of chlorhexidine for umbilical cord care in comparison with conventional dry cord care on the risk of neonatal sepsis: a randomized controlled trial. The eff ect of umbilical cord cleansing with chlorhexidine on omphalitis and neonatal mortality in community settings in developing countries: a meta-analysis. Stephen Hodgins says that cord application of chlorhexidine protects infants against omphalitis equally after birth at home or in hospital, and that we were incorrect to say that it was not eff ective for infants born in hospital. The first point is well taken. The 2015 Cochrane review 1 suggests that risk ratios (RR) for omphalitis were similar in hospital (RR 0·48, 95% CI 0·28–0·84) and community trials (0·48, 0·40–0·57). The 2013 Cochrane review 2 included nine relevant hospital studies of chlorhexidine application. For omphalitis, one study 3 suggested a benefi t versus dry cord care (0·28, 0·06–1·35); another study 4 found no benefit versus alcohol (2·77, 0·12–66·49), and another 5 found no benefi t over hydrophobic gauze (1·36, 0·55–3·36). Imdad and colleagues 2 suggested that, " …compared with dry cord care, no antiseptic was convincingly advantageous to reduce the incidence of omphalitis. " The 2015 Cochrane review addressed cord cleansing, more extensive skin cleansing, and maternal vaginal washing. 1 One trial 6 in India suggested that, …