Topical umbilical cord care at birth

 

Abstract

Background

Umbilical cord infection caused many neonatal deaths before aseptic techniques were used.

Objectives

To assess the effects of topical cord care in preventing cord infection, illness and death.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group trials register (September 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2003). We also contacted experts in the field.

Selection criteria

Randomized and quasi-randomized trials of topical cord care compared with no topical care, and comparisons between different forms of care.

Data collection and analysis

Two reviewers assessed trial quality and extracted data.

Main results

Twenty-one studies (8959 participants) were included, the majority of which were from high-income countries. No systemic infections or deaths were observed in any of the studies reviewed. No difference was demonstrated between cords treated with antiseptics compared with dry cord care or placebo. There was a trend to reduced colonization with antibiotics compared to topical antiseptics and no treatment. Antiseptics prolonged the time to cord separation. Use of antiseptics was associated with a reduction in maternal concern about the cord.

Authors' conclusions

Good trials in low-income settings are warranted. In high-income settings, there is limited research which has not shown an advantage of antibiotics or antiseptics over simply keeping the cord clean. Quality of evidence is low.

 

Plain language summary

Topical umbilical cord care at birth

No evidence that applying sprays, creams or powders are any better than keeping the baby's cord clean and dry at birth.

The umbilical cord connects the baby to its food and oxygen supply in the womb, and is clamped and cut at birth. The cord stump dries, shrivels and becomes black before falling off the baby's belly button, five to 15 days after birth. Without proper care, the baby may become infected through the stump. Usually the cord is kept clean and dry by loosely covering it with clean clothes. Hand washing is critical. The review found that not enough trials had been done to show if antiseptics or antibiotics were any better at keeping infection away. More research is needed.

 

摘要

背景

生產時的局部臍帶護理

在使用殺菌技術之前，臍帶的感染曾引起許多新生兒死亡的案例。

目標

要評估局部臍帶護理在預防臍帶感染、發病，以及死亡等方面的功效。

搜尋策略

我們搜尋了the Cochrane Pregnancy and Childbirth Group trials register(2003年9月)以及the Cochrane Central Register of Controlled Trials(The Cochrane Library，Issue 2，2003年)。我們也與該領域的專家們取得了聯繫。

選擇標準

這些隨機與半隨機試驗，在局部臍帶護理與不採取臍帶護理之間進行了比較，也在不同的護理型式之間進行了比較。

資料收集與分析

有2位審稿者評估了試驗的品質，並擷取出資料。

主要結論

其中共收集了21份研究(8959名參與者)，其中大部分的研究都是來自於高收入的國家。在這些被檢視的研究當中，沒有任何1份曾發現到全身性感染或是死亡的情況。以抗菌劑來處理臍帶，與乾式的臍帶護理或是使用安慰劑進行比較，均沒有顯示出任何差異。使用抗生素與局部使用抗菌劑或是不採取治療比較起來，有減少細菌菌落數的趨勢。抗菌劑讓臍帶分離的時間延長。使用抗菌劑，母親對於臍帶方面的顧慮，就因此而降低了。

作者結論

良好的試驗需要在低收入的國家中。在高收入的國家，依有限的研究顯示，抗生素或是抗菌劑跟簡單地讓臍帶保持乾淨比較起來，並沒有比較好。這些證據的品質並不高。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在生產當中，讓嬰兒的臍帶保持乾淨與乾燥，跟使用噴霧、乳膏或是粉末比較起來，並沒有證據顯示能夠帶來什麼更佳的結果。在子宮裡面，臍帶是用來讓嬰兒取得由子宮供應的食物與氧氣，在生產的時候予以封閉及剪斷。在生產過後的5到15天間，臍帶殘餘的部分會乾掉、枯萎，並且變成黑色。然後,從嬰兒的肚臍眼上掉落。若是沒有適當的護理，該名嬰兒可能會透過臍帶殘餘的部分而受到感染。使用乾淨的布料來寬鬆地覆蓋著臍帶，通常就能藉由這種方式. 就可以保持臍帶的乾淨與乾燥。重要的是一定得洗手。本篇回顧發現，針對避免感染這方面，並沒有完成足夠的試驗可以證實抗菌劑或是抗生素是否能夠帶來任何更佳的助益。還需要有更多的研究。