TABLE 28.

Umbilical Cord Antisepsis

SourceLocation and Type of TrialInterventionPerinatal/Neonatal Outcome
Parashar et al381Bangladesh; rural setting; CCSFor each neonatal tetanus case identified (n = 359), 3 living infants matched for gender, residence and date of birth were selected as controls.Application of antibiotics to the umbilical stump at delivery decreased neonatal tetanus by 79% (OR: 0.21; P = .019). Hand-washing by the delivery attendant and prior immunization with TT were protective in multivariate analyses, decreasing tetanus rates by 36% (OR: 0.64; P = 0.005) and 50% (OR: 0.50; P < .001), respectively.
Bennett et al388Pakistan; rural setting; CCSCases (n = 211) were uncircumcised infants diagnosed as having definite or probable neonatal tetanus. 3 controls who survived the neonatal period and whose mothers had not received TT were selected per case (n = 633).Reported hand-washing by the delivery attendant was highly protective against neonatal tetanus, decreasing rates by 56% (OR: 0.44; CI: 0.29–0.67; P < .0002). Continuous use of antimicrobial agents (antibiotics and antiseptics) on the cord at delivery and during the first few days after delivery was highly protective in univariate testing (matched OR: 0.2; CI: 0.11–0.64; P = .003), and remained significantly protective when other delivery and cord-care practices were controlled for.
Garner et al463Papua New Guinea; rural setting; QTNewborns (n = 132) were divided into 3 groups. Infants in the control group (n = 64) were born to mothers without birth kits. Infants born the initial part of the intervention phase (n = 33) were born to mothers who had been supplied with a new razor blade and acriflavine 10% in spirit. Infants born during the later part of the intervention phase (n = 34) were born to mothers who had been supplied with a razor blade, acriflavine 10%, and plastic umbilical cord clamps which the women had been instructed how to use.Of the 9 cases of neonatal sepsis, 8 were in the control group and 1 was in the intervention group (P < .02).
Traverso et al387Pakistan; rural setting; CCSTetanus cases (n = 102) were identified at an urban hospital and 3 controls (n = 306) were selected from the village of each case.Delivery conducted by formally trained personnel was associated with a decreased risk of neonatal tetanus (OR: .28; CI: 0.08–1.0). Use of a topical antibiotic was also associated with a protective effect, decreasing neonatal tetanus rates by 66% (OR: 0.34; CI: 0.18–0.65).