Application of Antiseptic to Umbilical Stump Reduces Risk of Neonatal Infection and Mortality

Infants in the hand washing–alone group were less likely than those in the control group to develop omphalitis (relative risk, 0.7), though mortality rates did not differ. Moreover, neither infection risk nor mortality risk was reduced in analyses that compared the two hand-washing groups with the two other groups. The researchers note that the study's limitations include the use of community health workers, rather than physicians, to identify omphalitis (although this compromise reflects reality in most developing countries), and the inability of health workers to attend most births (and hence to supervise birth at-tendants' cord cleansings and instructions to family members). They conclude that application of chlorhexidine can " reduce the incidence of neonatal omphalitis and neonatal mortality, " but that promotion of hand washing alone, especially where water is scarce, " might not be enough " to prevent infection. One issue not addressed by the study is whether a single application of chlorhexi-dine is sufficient to reduce infection risk. This question was examined in the second trial, conducted in 2007–2009 in rural areas of Bangladesh's Sylhet district. The trial compared the effectiveness of three approaches: dry cord care, a single chlorhexidine cleansing as soon as possible after birth and daily cleansing during the first week. Researchers divided the study area into 133 clusters of 2,100–5,600 residents and randomly assigned to the clusters one of the three treatments. In each cluster, a community health worker and four village health workers provided birth kits and neonatal care counseling to all pregnant women and asked the family to notify them at the onset of labor. Village health workers visited the mother and infant daily during the week after birth, and the community health worker made visits on days 1, 3, 6, 9, and 15 to assess the infant's health. Visits were identical in all three intervention groups, except that a village health worker applied chlorhexidine to the cords of infants in the two cleansing groups accord-gave birth, the attendant showed the family how to cleanse the infant's cord stump with the antiseptic and instructed them to do the same once a day for 14 days. Family members were also advised to wash their hands with soap before handling the infant. In the second intervention group, the kits contained soap but no chlorhexidine; in the third, chlorhexi-dine but no soap. The final group served as controls; families were advised to practice dry cord …