| Sumario: | Question: Are topical agents for umbilical cord care effective for preventing cord infection, illness, and death in newborn infants in developed countries? Data sources: Studies were identified using the Cochrane Pregnancy and Childbirth Group Controlled Trials Register, the Cochrane Library, Medline, and contact with the World Health Organisation and experts in the field. Study selection: Randomised controlled trials were included if they studied newborn infants of any gestation using any of the following cord care interventions: topical antiseptic applications (alcohol, triple dye, silver sulphadiazine, acraflavine, iodine, chlorhexidine, or gentian violet), antibiotic applications (bacitracin, nitrofurazone, or tetracycline), powders with or without antiseptics, single or multiple applications to the cord area, washing the whole baby or dry care, and care of the cord compared with no care. Data extraction: Data were extracted on study quality; country of study; infant characteristics and numbers; interventions; primary outcomes of cord infection (redness, swelling, or smell), disseminated bacterial infection (fever, meningitis, or septic foci), or death; and secondary outcomes of time to separation, bacterial colonisation, and maternal satisfaction with intervention. Main results: 10 studies met the selection criteria. All included healthy term infants and were done in developed countries (USA, Norway, Canada, Israel, and UK). Cord infection was not affected by use of antiseptics (alcohol, benzine, or 2 strengths of chlorhexidine) (4 studies) or dosed dressing compared with open care (I study compared hydrophobic gauze bandage with daily application of weak chlorhexidine). No systemic bacterial infections or deaths were seen in any of the studies reviewed. Times to separation of cord were approximately 7 days for powder (I study), 8 days for no intervention (2 studies), 10 days for alcohol (2 studies), 12 days for antibiotics (2 studies), 8-16 days for triple dye, and 11- 14 days for silver sulphadiazine. Meta-analysis showed that bacterial colonisation was unaffected by benzine and weak solution of chlorhexidine and was reduced by strong chlorhexidine solution, silver sulphadiazine, and triple dye (OR 0.28, 95% CI 0.22 to 0.36) (4 studies). No statistically significant differences were shown in colorusation when comparing antibiotics with antiseptics (1 study), dosed dressing compared with open care (I study), and total body wash compared with dry care (I study). Maternal satisfaction was higher with use of antiseptics (OR 0.45, CI 0.31 to 0.66) (1 study). Conclusion: Data are inconclusive for determining whether topical agents are safe and effective for umbilical cord care in healthy infants in developed countries. [Original article accession number: 1999023323]
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