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AAP outlines recommendations for umbilical cord care in newborns

The American Academy of Pediatrics Committee on Fetus and Newborn offered guidance on umbilical cord care for newborn infants in a clinical report published in Pediatrics.

“Despite significant global progress in recent decades, bacterial infections continue to account for approximately 700,000 neonatal deaths each year, or nearly one-quarter of the 3 million neonatal deaths that occur worldwide,” Dan Stewart, MD, FAAP, in the department of pediatrics at the University of Louisville, and colleagues wrote. “Although the magnitude of its contribution to these deaths remains uncertain, the umbilical cord may be a common portal of entry for invasive pathogenic bacteria, with or without clinical signs of omphalitis. Neonatal mortality associated with bacterial contamination of the umbilical stump may therefore rank among the greatest public health opportunities of the 21st century.”

After birth, the devitalized umbilical cord can grow bacteria and provides direct access to the infant’s bloodstream, the committee wrote. Bacterial colonization of the cord can lead to omphalitis and associated thrombophlebitis, cellulitis or necrotizing fasciitis. Various topical substances are used around the world to lessen the risk for infection. In high-resource countries, treatment has shifted toward dry umbilical cord care.

In the report, the researchers made the following recommendations:

• When infants are born at home in a low-resource country, physicians may apply antimicrobial agents to the umbilical cord;
• Infants born in hospitals or in high-resource countries should not have antimicrobial agents applied to the umbilical cord;
• When the infant is born outside of a birthing center or hospital and in resource-limited populations, physicians should apply prophylactic topical antimicrobial agents to the umbilical cord;
• At time of discharge, physicians should consider educating the parents about the signs and symptoms of omphalitis; and
• Physicians should be diligent in reporting infections associated with umbilical cord care and establish a local reporting system to health care providers regarding omphalitis occurrence.

“The incidence of omphalitis reported in different communities varies greatly, depending on prenatal and perinatal practices, cultural variations in cord care, and delivery venue,” the authors wrote. “These disparate observations in different settings have resulted in divergent recommendations for cord care by the WHO, which advocates dry cord care for infants born in a hospital or in settings of low neonatal mortality and application of chlorhexidine solution or gel for infants born at home or in settings of high neonatal mortality.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.