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Umbilical cord antiseptics for preventing sepsis and death among newborns

  1. Aamer Imdad1,
  2. Resti Ma M Bautista2,
  3. Kathlynne Anne A Senen2,
  4. Ma Esterlita V Uy3,
  5. Jacinto Blas Mantaring III2,
  6. Zulfiqar A Bhutta4,*

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 31 MAY 2013

Assessed as up-to-date: 25 MAR 2013

DOI: 10.1002/14651858.CD008635.pub2


How to Cite

Imdad A, Bautista RMM, Senen KAA, Uy MEV, Mantaring III JB, Bhutta ZA. Umbilical cord antiseptics for preventing sepsis and death among newborns. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD008635. DOI: 10.1002/14651858.CD008635.pub2.

Author Information

  1. 1

    SUNY Upstate Medical University, Department of Pediatrics, Syracuse, New York, USA

  2. 2

    University of the Philippines, Section of Newborn Medicine, Department of Pediatrics, Manila, Philippines

  3. 3

    University of the Philippines, National Institutes of Health, Manila, Manila, Philippines

  4. 4

    Hospital for Sick Children, Center for Global Child Health, Toronto, ON, Canada

*Zulfiqar A Bhutta, Center for Global Child Health, Hospital for Sick Children, Toronto, ON, M5G A04, Canada. Zulfiqar.bhutta@sickkids.ca. zulfiqar.bhutta@aku.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions), comment added to review
  2. Published Online: 31 MAY 2013

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
Ahmadpour-Kacho 2006 {published data only}
  • Ahmadpour-Kacho M, Zahedpasha Y, Hajian K, Javadi G, Talebian H. The effect of topical application of human milk, ethyl alcohol 96%, and silver sulfadiazine on umbilical cord separation time in newborn infants. Archives of Iranian Medicine 2006;9:33-8.
Al-Binali 2006 {published data only}
  • Al-Binali AM. Umbilical cord care: comparison between Beniktol spray and alcohol swab. Biomedical Research 2006;17(1):23-5.
Arad 1981 {published data only}
Arifeen 2012 {published data only}
  • Arifeen SE, Mullany LC, Shah R, Mannan I, Rahman SM, Talukder MRR, et al. Impact of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial. Lancet 2012;379(9820):1022-8.
  • Bacqui AH. Impact of umbilical cord cleansing with 4.0% chlorhexidine on neonatal mortality (CHX). ClinicalTrials.gov (http://clinicaltrials.gov/show/NCT00434408) 2010.
  • Mullany LC, El Arifeen S, Winch PJ, Shah R, Mannan I, Rahman SM, et al. Impact of 4.0% chlorhexidine cleansing of the umbilical cord on mortality and omphalitis among newborns of Sylhet, Bangladesh: design of a community-based cluster randomized trial. BMC Pediatrics 2009;9:67.
  • Mullany LC, Khatry SK, Sherchand JB, LeClerq SC, Darmstadt GL, Katz J, et al. A randomized controlled trial of the impact of chlorhexidine skin cleansing on bacterial colonization of hospital-born infants in Nepal. Pediatric Infectious Disease Journal 2008;27(6):505-11.
  • Mullany LC, Saha SK, Shah R, Islam MS, Rahman M, Islam M, et al. Impact of 4.0% chlorhexidine cord cleansing on the bacteriologic profile of the newborn umbilical stump in rural sylhet district, Bangladesh: A community-based, cluster-randomized trial. Pediatric Infectious Disease Journal 2012;31(5):444-50.
Bain 1994 {published data only}
  • Bain J. Midwifery: umbilical cord care in pre-term babies. Nursing Standard 1994;8(15):32-6.
Barrett 1979 {published data only}
Davila 2007 {published data only}
  • Davila GR, Pomar JV, Meza EQ, Villanueva CQ, Serkovic KR, Jordan FR, et al. Umbilical cord care: effect of three different antiseptic solutions (clorhexidine 4 per cent, alcohol 70 per cent and iodo povidone 5 per cent) on bacterial colonization, infection and cord separation time [Cuidados del cordón umbilical: efecto de tres soluciones antisépticas (gluconato de clorhexidina al 4 por ciento, alcohol al 70 por ciento y yodopovidona al 5 por ciento) sobre la colonización bacteriana, infección y separación del muñón umbilical]. Revista Peruana de Pediatria 2007;60(2):81-7.
Dore 1998 {published data only}
  • Dore S, Buchan D, Coulas S, Hamber L, Stewart M, Cowan D, et al. Alcohol versus natural drying for newborn cord care. Journal of Obstetric, Gynecologic and Neonatal Nursing 1998;27(6):621-7.
Evens 2004 {published data only}
  • Evens K, George J, Angst D, Schweig L. Does umbilical cord care in preterm infants influence cord bacterial colonization or detachment?. Journal of Perinatology 2004;24:100-4.
  • Evens KH, George J, Angst DB, Schweig L. Does umbilical cord care in preterm infants influence cord colonization and/or detachment. Pediatric Academic Societies Annual Meeting; 2003 May 1-4; Seattle, Washington, USA. 2003.
Gladstone 1988 {published data only}
  • Gladstone IM, Clapper L, Thorp JW, Wright DI. Randomized study of six umbilical cord care regimens. Comparing length of attachment, microbial control, and satisfaction. Clinical Pediatrics 1988;27:127-9.
Golombek 2002 {published data only}
Hsu 1999 {published data only}
  • Hsu CF, Wang CC, Yuh YS, Chen YH, Chu ML. The effectiveness of single and multiple applications of triple dye on umbilical cord separation time. European Journal of Pediatrics 1999;158:144-6.
Hsu 2010 {published data only}
  • Hsu WC, Yeh LC, Chuang MY, Lo WT, Cheng SN, Huang CF. Umbilical separation time delayed by alcohol application. Annals of Tropical Paediatrics 2010; Vol. 30, issue 3:219-23.
Huang 2001 {published data only}
  • Huang CF, Yeh LC, Chuang MY, Yuh YS. Umbilical separation time delayed by alcohol application. Journal of Perinatal Medicine 2001;29 Suppl 1(Pt 2):648.
Janssen 2003 {published data only}
  • Janssen PA, Selwood BL, Dobson SR, Peacock D, Theissen PN. To dye or not to dye: a randomized, clinical trial of a triple dye/alcohol regime versus dry cord care. Pediatrics 2003;111:15-20.
Kapellen 2009 {published data only}
  • Kapellen TM, Gebauer CM, Brosteanu O, Labitzke B, Vogtmann C, Kiess W. Higher rate of cord-related adverse events in neonates with dry umbilical cord care compared to chlorhexidine powder. Results of a randomized controlled study to compare efficacy and safety of chlorhexidine powder versus dry care in umbilical cord care of the newborn. Neonatology 2009;96(1):13-8.
  • Vogtmann C. A randomised controlled study to compare efficacy and safety of chlorhexidine powder versus dry care in umbilical cord care of the newborn. Current Controlled Trials (http://www.controlled-trials.com/ISRCTN63012285/) (accessed 2010).
Meberg 1985 {published data only}
Meberg 1990 {published data only}
Medves 1997 {published data only}
  • Medves JM, O'Brien BA. Cleaning solutions and bacterial colonization in promoting healing and early separation of the umbilical cord in healthy newborns. Canadian Journal of Public Health 1997;88(6):380-2.
Mugford 1986 {published data only}
  • Mugford M, Somchiwong M, Waterhouse IL. Treatment of umbilical cords: a randomised trial to assess the effect of treatment methods on the work of midwives. MIdwifery 1986;2:177-86.
Mullany 2006 {published data only}
  • Mullany LC, Darmstadt GL, Khatry SK, Katz J, LeClerq SC, Shrestha S, et al. Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial. Lancet 2006;367(9514):910-8.
  • Mullany LC, Darmstadt GL, Khatry SK, LeClerq SC, Katz J, Tielsch JM. Impact of umbilical cord cleansing with 4.0% chlorhexidine on time to cord separation among newborns in southern Nepal: a cluster-randomized, community-based trial. Pediatrics 2006;118(5):1864-71.
Nourian 2009 {published data only}
  • Nourian M, Allaii F, Heidari A. Comparison of the effect of alcohol 70% versus dry cord care on cord bacterial colonization and cord separation time among newborns. Pakistan Journal of Medical Sciences 2009;25(1):103-7.
Oishi 2004 {published data only}
  • Oishi T, Iwata S, Nonoyama M, Tsuji A, Sunakawa K. Double-blind comparative study on the care of the neonatal umbilical cord using 80% ethanol with or without chlorhexidine. Journal of Hospital Infection 2004;58:34-7.
Panyavudhikrai 2002 {published data only}
  • Panyavudhikrai S, Danchaivijitr S, Vantanasiri C, Trakulsomboon S, Kolatat T, Dhiraputra C, et al. Antiseptics for preventing omphalitis. Journal of the Medical Association of Thailand 2002;85:229-34.
Perapoch 1993 {published data only}
  • Perapoch Lopez J, Salcedo Abizanda S, Gallart Catala A, Peguero Monforte G, Casellas Caro M, Barroso Perez C, et al. Umbilical colonization in normal newborns. A comparative study of 4 methods for umbilical antisepsis [Colonizacion umbilical en recien nacidos normales: Estudio comparativo de cuatro metodos de antisepsia umbilical]. Anales Espanoles de Pediatria 1993;39:195-8.
Pezzati 2002 {published data only}
  • Pezzati M, Biagoli EC, Martelli E, Gambi B, Biagiotti R, Rubaltelli FF. Umbilical cord care: the effect of eight different cord-care regimens on cord separation time and other outcomes. Biology of the Neonate 2002;81:38-44.
Pezzati 2003 {published data only}
  • Pezzati M, Rossi S, Tronchin M, Dani C, Filippi L, Rubaltelli FF. Umbilical cord care in premature infants: the effect of two different cord-care regimens (salicylic sugar powder vs chlorhexidine) on cord separation time and other outcomes. Pediatrics 2003;112(4):e275.
Rosenfeld 1989 {published data only}
  • Rosenfeld CR, Laptook AR, Jeffery J. Limited effectiveness of triple dye (TD) in prevention of colonization with methacillin resistant staphylococcus aureus (MRSA) in a special care nursery (SCN). Pediatric Research 1989;25:281A.
Rush 1986 {published data only}
Schuman 1985 {published data only}
Shafique 2006 {published data only}
  • Shafique MF, Ali S, Roshan E, Jamal S. Alcohol application versus natural drying of umbilical cord. Rawal Medical Journal 2006;31(2):58-60.
Soofi 2012 {published data only}
  • Bhutta Z. Topical application of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in rural distract of Pakistan. ClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00682006) (accessed May 2010).
  • Soofi S, Cousens S, Imdad A, Bhutto N, Ali N, Bhutta ZA. Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based,cluster-randomised trial. Lancet 2012;379(9820):1029-36.
Speck 1977 {published data only}
  • Speck WT, Driscoll JM, O'Neill J, Rosenkranz HS. Effect of antiseptic cord care on bacterial colonization in the newborn infant. Chemotherapy 1980;26:372-6.
  • Speck WT, Driscoll JM, Polin RA, O'Neill J, Rosenkraz HS. Staphylococcal and streptococcal colonization of the newborn infant: effect of antiseptic cord care. American Journal of Diseases of Children 1977;131:1005-8.
  • Speck WT, Driscoll JM, Polin RA, Rosenkranz HS. Bacterial colonization in the newborn - effect of cord care. Pediatric Research 1976;10:335.
Suliman 2010 {published data only}
  • Beiler J. Triple dye plus alcohol versus triple dye alone for newborn umbilical cord care. ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 21 March 2006).
  • Suliman AK, Watts H, Beiler J, King TS, Khan S, Carnuccio M, et al. Triple dye plus rubbing alcohol versus triple dye alone for umbilical cord care. Clinical Pediatrics 2010;49(1):45-8.
  • Suliman AK, Watts HN, Beiler JS, King TS, Khan S, Carnuccio MB, et al. Triple dye plus rubbing alcohol versus triple dye alone in umbilical cord care. Pediatric Academic Societies Annual Meeting; 2007 May 5-8; Toronto, Canada. 2007.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
Alda 2000 {published data only}
  • Alda ER, Covas MC, Ventura SS, Baeza AM. Umbilical cord bacterial growth in healthy newborn with two different antiseptics. Pediatric Research 2000;47:385A.
Aldar 1980 {published data only}
  • Alder VG, Burman D, Simpson RA, Fysh J, Gillespie WA. Comparison of hexachlorophane and chlorhexidine powders in prevention of neonatal infection. Archives of Disease in Childhood 1980;55:277-80.
Barclay 1994 {published data only}
  • Barclay L, Harrington A, Conroy R, Royal R, LaForgia J. A comparative study of neonates' umbilical cord management. Australian Journal of Advanced Nursing 1994;11:34-40.
Bhakoo 1969 {published data only}
  • Bhakoo ON, Lall JC, Agarwal KC. Prevention of hospital infections in neonates: an evaluation of no bath regimen. Indian Pediatrics 1969;6:697-700.
Birenbaum 1990 {published data only}
  • Birenbaum HJ, Glorioso L, Rosenberger C, Arshad C, Edwards K. Gowning on a postpartum ward fails to decrease colonization in the newborn infant. American Journal of Diseases of Children 1990;144:1031-3.
Bourke 1989 {published data only}
  • Bourke E. Cord care: too much or too little. Australian Journal of Advanced Nursing 1990;7(2):19-22.
Bradshaw 1993 {published data only}
  • Bradshaw C. An experimental study to compare treatment vs non treatment of the umbilical cord. National Conference on Research in Midwifery; 1993 Sept 14; Birmingham, UK. 1993.
Chamnanvanakij 2005 {published data only}
  • Chamnanvanakij S, Decharachakul K, Rasamimaree P, Vanprapar N. A randomised study of 3 umbilical cord care regimens at home in Thai neonates: comparison of time to umbilical cord separation, parental satisfaction and bacterial colonization. Journal of the Medical Association of Thailand 2005;88(7):967-72.
Coyer 1975 {published data only}
  • Coyer WF. Neonatal skin care and the prevention of staphylococcus aureus (staph) colonization. Pediatric Research 1975;9:339.
Darmstadt 2007 {published data only}
  • Darmstadt GL, Hossain MM, Choi Y, Shirin M, Mullany LC, Islam M, et al. Safety and effect of chlorhexidine skin cleansing on skin flora of neonates in Bangladesh. Pediatric Infectious Disease Journal 2007;26(6):492-5.
Erenel 2010 {published data only}
  • Erenel AS, Vural G, Efe SY, Ozkan S, Ozgen S, Erenoglu R. Comparison of olive oil and dry-clean keeping methods in umbilical cord care as microbiological. Maternal & Child Health Journal 2010;14(6):999-1004.
Gezon 1964 {published data only}
Gluck 1963 {published data only}
  • Gluck L, Wood HF. Staphylococcal colonization in newborn infants with and without antiseptic skin care. A consideration of epidemiologic routes. New England Journal of Medicine 1963;268:1265-8.
Guala 2003 {published data only}
  • Guala A, Pastore G, Garipoli V, Agosti M, Vitali M, Bona G. The time of umbilical cord separation in healthy full-term newborns: a controlled clinical trial of different cord care practices. European Journal of Pediatrics 2003;162(5):350-1.
Guinsburg 1991 {published data only}
  • Guinsburg R, Ikezawa MK, Fogliano RRF, Reichert MCF, Carvalho ES, Cardo DM, et al. Umbilical bacterial colonization (UBC) of normal newborn (NB) infants: effect of four antiseptic regimens. Pediatric Research 1991;29:282A.
Healey 1991 {published data only}
  • Healey E, Greenish K, Armstrong C, Ayers S. A study of the relationship between the delivery to cord clamping interval and the time of cord separation. Midwifery 1991;7:167-76.
Henningsson 1981 {published data only}
Hnatko 1977 {published data only}
Hodgins 2010 {published data only}
  • Hodgins S, Thapa K, Khanal L, Aryal S, Suvedi BK, Baidya U, et al. Chlorhexidine gel versus aqueous for preventive use on umbilical stump: a randomized noninferiority trial. Pediatric Infectious Disease Journal 2010;29(11):999-1003.
Jellard 1957 {published data only}
  • Jellard J. Umbilical cord as reservoir of infection in a maternity hospital. BMJ 1977;1(5024):925-8.
Kumar 2008 {published data only}
  • Kumar V, Mohanty S, Kumar A, Misra RP, Santosham M, Awasthi S, et al. Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial. Lancet 2008;372(9644):1151-62.
Kwong 1973 {published data only}
  • Kwong MS, Loew AD, Anthony BF, Oh W. The effect of hexachlorophene on staphylococcal colonization rates in the newborn infant: a controlled study using a single-bath method. Journal of Pediatrics 1973;82:982-6.
Olowe 1980 {published data only}
Pildes 1973 {published data only}
Pyati 1977 {published data only}
Ronchera-Oms 1994 {published data only}
  • Ronchera-Oms C, Hernandez C, Jimenez NV. Antiseptic cord care reduces bacterial colonisation but delays cord detachment. Archives of Disease in Childhood. Fetal and Neonatal Edition 1994;70:F70.
Saleem 2007 {published data only}
  • Saleem S, Reza T, McClure EM, Pasha O, Moss N, Rouse DJ, et al. Chlorhexidine vaginal and neonatal wipes in home births in Pakistan: a randomized controlled trial. Obstetrics and Gynecology 2007;110(5):977-85.
Saleem 2010 {published data only}
  • Saleem S, Rouse DJ, McClure EM, Zaidi A, Reza T, Yahya Y, et al. Chlorhexidine vaginal and infant wipes to reduce perinatal mortality and morbidity: a randomized controlled trial. Obstetrics and Gynecology 2010;115(6):1225-32.
Shah 2010 {published data only}
  • Shah R, Munos MK, Winch PJ, Mullany LC, Mannan I, Rahman SM, et al. Community-based health workers achieve high coverage in neonatal intervention trials: a case study from Sylhet, Bangladesh. Journal of Health, Population & Nutrition 2010;28(6):610-8.
Smales 1988 {published data only}
Tielsch 2006 {published data only}
  • Tielsch JM. Community trial of newborn skin and umbilical cord cleansing on neonatal mortality in Nepal. ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 2006) 2006.
Tielsch 2007 {published data only}
  • Tielsch JM, Darmstadt GL, Mullany LC, Khatry SK, Katz J, LeClerq SC, et al. Impact of newborn skin-cleansing with chlorhexidine on neonatal mortality in Southern Nepal: a community-based, cluster-randomized trial. Pediatrics 2007;119(2):e330-e340.
Wade 2006 {published data only}
  • Wade A, Osrin D, Shrestha BP, Sen A, Morrison J, Tumbahangphe KM, et al. Behaviour change in perinatal care practices among rural women exposed to a women's group intervention in Nepal. BMC Pregnancy and Childbirth 2006;6:20.
Wald 1977 {published data only}
  • Wald ER, Snyder MJ, Gutberlet RL. Group B beta-hemolytic streptococcal colonization. Acquisition, persistence, and effect of umbilical cord treatment with triple dye. American Journal of Diseases of Children 1977;131:178-80.
Watkinson 1992 {published data only}
Wojciechowska 1989 {published data only}
  • Wojciechowska L. Trial to assess the effects of different treatments of the umbilical cord in newborn infants. Personal communication 1989.

References to studies awaiting assessment

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
Covas 2011 {published data only}
  • Covas MC, Alda ER, Medina MS, Ventura S, Esandi ME, Pezutti O, et al. Alcohol versus bath and natural drying for term newborns' umbilical cord care: a prospective randomized clinical trial. Pediatric Academic Societies Annual Meeting; 2010 May 1-4; Vancouver, Canada. 2010.
  • Covas Mdel C, Alda E, Medina MS, Ventura S, Pezutti O, Paris de Baeza A, et al. Alcohol versus bath and natural drying for term newborns' umbilical cord care: A prospective randomized clinical trial [Spanish]. Archivos Argentinos de Pediatria 2011;109(4):305-13.
Nasrallah 2003 {published data only}
  • Nasrallah BK, Rox AK, Mazer B, Richards L, Chuachingco J, Naqvi M. Comparison of two methods of umbilical cord care: application of 70% isopropyl alcohol vs. natural drying. Pediatric Academic Societies Annual Meeting; 2003 May 1-4; Seattle Washington, USA. 2003.
Sellares Casas 2002 {published data only}
  • Sellares Casas E, Yanez Juan A, Lopez de Aguileta Ibisate A, Peix Sambola MA, Esteva Nuto N, Domenech Terricabras P. Efficacy of one versus three applications of merbromin in achieving umbilical cord detachment [Spanish] [Efficacia de una aplicacion frente a tres de merbromina en el tiempo de caida del cordon]. Acta Pediatrica Espanola 2002;60(9):521-5.
Srinivasan 2003 {published data only}
  • Srinivasan H, Luayon M, Barrios F, Geraldo V, Poladian A, Reyes J, et al. Prospective randomized controlled trial to study the effect of daily application of triple dye to umbilical cord of very low birth weight (VLBW) infants. Pediatric Academic Societies Annual Meeting; 2003 May 1-4; Seattle, Washington. 2003.
Taffazoli 2008 {published data only}
  • Taffazoli M, Farahani LA, Mohammadzadeh A, Esmaeeli H, Ghazvini K. Does topical application of breast milk affect on bacterial colonization in umbilical cord?. Koomesh 2008;10(1):29-35.

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
Hamer 2010 {published data only}
  • Hamer DH. Zambia Chlorhexidine Application Trial (ZamCAT). Clinicaltrials.gov (http://clinicaltrials.gov) (accessed 2010) 2010.
  • Herlihy JM, Semrau K, Mazimba A, Yeboah-Antwi K, Grogan C, Banda B, et al. Chlorhexidine 4% umbilical wash lengthens time to cord separation. Pediatric Academic Societies Annual Meeting 2012 April 29-May 1; Boston, USA. 2012.
Sazawal 2012 {published data only}
  • Sazawal S. Chlorhexidine cordcare for reduction in neonatal mortality and omphalitis (CHX-Pemba). ClinicalTrials.gov 2012.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
AAP 2003
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Aggett 1981
Agrawal 2012
  • Agrawal PK, Agrawal S, Mullany LC, Darmstadt GL, Kumar V, Kiran U, et al. Clean cord care practices and neonatal mortality: evidence from rural Uttar Pradesh, India. Journal of Epidemiology and Community Health 2012;66(8):755-8.
Bennett 1997
  • Bennett J, Macia J, Traverso H, Banoagha S, Malooly C, Boring J. Protective effects of topical antimicrobials against neonatal tetanus. International Journal of Epidemiology 1997;26(4):897-903.
Blencowe 2011
  • Blencowe H, Cousens S, Mullany LC, Lee AC, Kerber K, Wall S, et al. Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect. BMC Public Health 2011;11 Suppl 3:S11.
Darmstadt 2009
  • Darmstadt GL, Lee AC, Cousens S, Sibley L, Bhutta ZA, Donnay F, et al. 60 Million non-facility births: who can deliver in community settings to reduce intrapartum-related deaths?. International Journal of Gynaecology and Obstetrics 2009;107(Suppl 1):S89-S112.
Elhassani 1984
Fairchild 1958
Faridi 1993
  • Faridi MM, Rattan A, Ahmad SH. Omphalitis neonatorum. Journal of the Indian Medical Association 1993;91(11):283-5.
Forshall 1957
Gallagher 2010
  • Gallagher PG. Omphalitis. eMedicine (http://emedicine.medscape.com/) (accessed April 14 2010) 2010.
Higgins 2011
  • Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Johnsson 1987
Lawn 2005
Lehmann 1999
  • Lehmann D, Michael A, Omena M, Clegg A, Lupiwa T, Sanders RC, et al. The bacterial and viral etiology of severe infection in children aged less than three months in the highlands of Papua New Guinea. Pediatric Infectious Disease Journal 1999;18(10 Suppl):S42-S49.
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Mason 1989
McClure 2007
  • McClure EM, Goldenberg RL, Brandes N, Darmstadt GL, Wright LL, Armbruster D, et al. The use of chlorhexidine to reduce maternal and neonatal mortality and morbidity in low-resource settings. International Journal of Gynaecology and Obstetrics 2007;97(2):89-94.
McKenna 1977
Mir 2011
  • Mir F, Tikmani SS, Shakoor S, Warraich HJ, Sultana S, Ali SA, et al. Incidence and etiology of omphalitis in Pakistan: a community-based cohort study. Journal of Infection in Developing Countries 2011;5(12):828-33.
Mullany 2006a
  • Mullany LC, Darmstadt GL, Katz J, Khatry SK, LeClerq SC, Adhikari RK, et al. Development of clinical sign based algorithms for community based assessment of omphalitis. Archives of Disease in Childhood. Fetal and Neonatal Edition 2006;91(2):F99-104.
Mullany 2006b
  • Mullany LC, Darmstadt GL, Khatry SK, LeClerq SC, Katz J, Tielsch JM. Impact of umbilical cord cleansing with 4.0% chlorhexidine on time to cord separation among newborns in southern Nepal: a cluster-randomized, community-based trial. Pediatrics 2006;118(5):1864-71.
Mullany 2007
  • Mullany LC, Darmstadt GL, Katz J, Khatry SK, LeClerq SC, Adhikari RK, et al. Risk factors for umbilical cord infection among newborns of southern Nepal. American Journal of Epidemiology 2007;165(2):203-11.
Mullany 2009
  • Mullany LC, Darmstadt GL, Katz J, Khatry SK, Leclerq SC, Adhikari RK, et al. Risk of mortality subsequent to umbilical cord infection among newborns of southern Nepal: cord infection and mortality. Pediatric Infectious Disease Journal 2009;28(1):17-20.
Mullany 2012
  • Mullany LC, Saha SK, Shah R, Islam MS, Rahman M, Islam M, et al. chlorhexidine cord cleansing on the bacteriologic profile of the newborn umbilical stump in rural Sylhet District, Bangladesh: a community-based, cluster-randomized trial. Pediatric Infectious Disease Journal 2012;31(5):444-50.
Novack 1988
Oudesluys-Murphy 1987
Oudesluys-Murphy 1990
RevMan 2011 [Computer program]
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Sawardekar 2004
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  • Smith CK. Some traditional umbilical cord care practices in developing countries. Midwifery Today With International Midwife 2009;91:12-3.
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References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
Zupan 2004