Effect of topical application of human breast milk versus 4% chlorhexidine versus dry cord care on bacterial colonization and clinical outcomes of umbilical cord in preterm newborns

Daiahunlin Lyngdoh, Sukhjit Kaur, Praveen Kumar, Vikas Gautam, Sandhya Ghai

Journal of Clinical Neonatology 2018 7(1):25-30

Introduction: The umbilical cord is one of the routes of entry of microorganisms that can cause infection. Hence, affordable, effective, and safe cord care regimens are needed to prevent from such infections. Methods: The study was conducted in Nehru Hospital, PGIMER, Chandigarh, with the objective to assess the effect of two cord care regimens – human breast milk and 4% chlorhexidine on bacterial colonization and other clinical outcomes. A total of 105 newborns were enrolled and randomized into three groups (35 participants in each group) – human breast milk, 4% chlorhexidine, and dry cord care group (control group). The umbilical cord swab baseline sample was taken and cultured from each of the participants. The first application (either breast milk or 4% chlorhexidine) was done immediately after the baseline cord swab sample was taken. In the dry cord care group (control group), nothing was applied on the cord. Cord swab was again taken at 72 ± 12 h and at 120 ± 12 h after birth. Umbilical cord separation time was noted. Results: There was no statistically significant difference in cord colonization at baseline (P = 0.13). At 72 ± 12 h, 34.3%, 5.7%, and 51.4% had colonization in the breast milk, chlorhexidine, and dry cord care, respectively (P < 0.001). At 120 ± 12 h, 22.9% had bacterial colonization in the breast milk group, 71.4% in the dry cord care group whereas only 2.9% in the chlorhexidine group (P < 0.001). The timing of cord separation was 9.09 ± 2.4 days, 12.65 ± 2.9 days, and 10.54 ± 3.1 days in the breast milk, chlorhexidine, and dry cord care, respectively, with maximum separation time with chlorhexidine application and least time taken in the breast milk group (P < 0.001). The main microorganisms detected were Klebsiella pneumoniae, Escherichia coli, Enterococcus faecalis, Acinetobacter baumannii, Enterococcus faecium, Staphylococcus haemolyticus, and Streptococcus. Conclusion: It is concluded that 4% chlorhexidine is very effective in reducing pathogenic bacteria colonization of the cord. Further, human breast milk, to some extent, can reduce bacterial colonization in low-resource settings and is a better alternative to dry cord care.

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