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Complications of treatment

Conclusions

Other variables tested on these days:

  • Cord separation time was significantly higher in the alcohol care group (mean=8.13 days) compared to 7.03 days in the dry care group.

  • No case of omphalitis was encountered.

  • No significant difference between the two groups in the other variables except for tenderness

  • Mothers age
  • Mothers education
  • Mothers work
  • Housing condition
  • APGAR score
  • All were Breast feed.
  • All singleton

  • Fever
  • Odor
  • Granuloma
  • Rash
  • Blisters
  • Conjunctivitis
  • Necrotizing fasciitis
  • Pustioles

No real differences

Umbilical Cord Care Study

Dry vs. Alcohol Cord Care

Prospective controlled study

2014 - 2015

Research Team

Dr. Hatem Khammash. (1)

Dr. Maher Shahrour. (1)

Dr. Motee Abu Awwad. (2)

Dr. Noor El Huda Sawalha. (2)

Dr. Murad Al Masri. (1)

Dr. Sundus Shalabi. (1)

Dr. Mohammad Salah Al-Din (1).

Dr. Ala’ Lafi. (1)

Dr. Helmi Tamimi. (1)

Dr. Mohammed Ayasa. (1)

Dr. Taha Jo’be. (1)

Dr. Ebtihal Jawabreh. (2)

Dr. Sa’eed Natshe. (2)

(1) Makassed Hospital – Jerusalem.

(2) PRCSH (Palestinian Red Crescent Specialized Hospital – Hebron).

Results & Analysis

Age of separation of cord

among groups

Age of separation of umbilical cord

P value 0.010

P value 0.0001

Group means were significantly different

(independent-samples t-test, t(690)=2.39, p<0.001, two tailed).

Methodology

Prospective Controlled study

Recommendations

Why

We recommend the routine use of Dry cord care, if hygienic practice is being applied.

Alcohol Cord Care

is it Significant To

Answer The Question?

Dry or Alcohol ?

  • Swabbing of:

1. U.C stump.

2. Periumbilical area

  • With: 70% Alcohol
  • Frequency: with changing every Diaper
  • Until: Cord separation.
  • Allowing the area to air to dry.

Dry Cord Care

Time of UC separation

  • Cleaning of soiled skin in the periumbilical area & wiping it with a dry cotton swab
  • Without application of topical antiseptics
  • Allowing the area to air to dry.

  • Normal separation time: ONE WEEK after birth
  • Delayed Separation time:10 days - 21 days or more

(44) (Mullany L C, Darmstadt G L,Khatry S K, LeClerq S C, Katz J, Tielsch J M, 2006).

(45). Hess JH, Lundeen EC)

(Janssen PA, Selwood BL, Dobson SR, Peacock D, Thiessen PN,2003)

Working Plan

Significance of study

  • Since our country in-between (developed & developing)

  • No clear recommendations based on Local Area studies

  • If we use clear recommendations based on local area studies & suitable for our hospitals that will decrease neonatal morbidity & mortality

Dry Cord Care

Place

Follow up

(Filling the checklist form)

Study Setting

1. At Normal Nursery:

At age of 48 hours just before discharge.

2. At OPC on the regular follow up:

5-7 days after delivery.

3.By Phone call:

7-10 days, 10-15 days, till separation of the cord.

  • Advantages:

1. Less time for cord separation

2. Decrease load on mother

3. Decrease Cost

  • Disadvantages:

1. Increases Bacterial colonization at U.C stump

2. ++ risk of Omphalitis.

Parents

By: Dr. Noor Alhuda Sawalha, Dr. Maher Shahrour

Dr. Hatem Khammash, Dr. Motee Abu Awwad

Time

Selection Of the method

  • Explain the methods.
  • Clear instructions.
  • Written Consent forms

March - October 2014

  • Two groups randomly selected by using alternative weeks

(2006 Mullany L C,Darmstadt G L, Khatry S K, LeClerq S C, Katz J and Tielsch J M)

  • Inclusion Criteria
  • Variables

Alcohol Cord Care

Variables

Inclusion Criteria

Advantages:

Reduce colonization, Omphalitis, infant morbidity and mortality

Disadvantages:

1. Longer time for the cord to separate

2. ++ Load of care on mother

  • Born at our hospitals
  • GA >37 Weeks
  • No major congenital anomalies
  • No anomalies may affect by any Degree the results
  • No risk factors for sepsis
  • Not receiving antibiotics at birth
  • Not admitted to N.I.C.U.
  • Hospital stay not exceeding 72 Hours

Dependent Variable:

Age of separation of umbilical cord -- Primary Outcome

Independent:

  • Mode of delivery:

NSVD, Assisted VD,C/S (Urgent/Elective).

  • Mother:

-Age

-Parity

  • Omphalitis
  • U.C Granuloma
  • Necrotizing Fascitis
  • Skin Infection
  • Others:

- Discharge, Change in the color, Redness

- Hotness

- Tenderness

- Foul odor

- Blisters

- Conjunctivitis

Subject Area

In the 1940s,

Thank You

The nurseries were introduced in the hospitals.

  • ++ colonization & Infection of the U.C stump
  • Application of different cord-care programs (Alcohol, …).

( AU - Pezzati M; Biagioli EC; Martelli E; Gambi B; Biagiotti R; Rubaltelli FF,2002)

  • Sample Size (n):

- 692 Newborns;

- Control group: 344

- Experimental group: 348

  • Margin of error: 4%

  • Power of the study: 90%

2. WHO/RHT/MSM/98.4 Care of the Umbilical Cord: A review of evidence. Geneva, Switzerland: World Health Organization; 1998.

Background

Study Question

Background

Historical timeline

Dry Cord Care or Alcohol Cord Care ?

Cord Stump is:

-First site of bacterial colonization of the NB.

-Direct rout of the bacteria to inside the body.(5)

-Cord stump infection:

  • +++ morbidity & mortality
  • Prevented by simple measures.(2)

American Academy Of Pediatrics

2011

[Alcohol vs. bath & Natural Drying Of umbilical cord care]

(a prospective randomized clinical trial)

Appropriate Care of U.C Stump

The Controversy Continues

(Cochrane library, 2002, issue 4)

Randomized controlled trial in a tertiary care hospital in Alberta, Canada

1997

Conclusions:

  • keeping the cord clean appears to be safe and effective as using ABTs or Antiseptics

CONCLUSIONS:

- Bathing with neutral soap & drying of UC:

  • --- time of U.C separation.
  • +++ colonization rate.
  • Didn’t affect risk of skin and conjunctival infection.

  • Sterile water/Dry cord care VS alcohol

-- the time of cord separation.

  • No differences in colonization rates & infections

Medves JM,O'Brien BA. Cleaning solutions and bacterial colonization in promoting healing and early separation of the umbilical cord in healthy newborns. Can J Public Health 1997 Nov/Dec;88:380–2.

By Robert S. Baltimore, MD. Published in Journal Watch Infectious diseases Feb, 2013

Arch Argent Pediatr.  2011 Aug;109(4):305-13. doi: 10.1590/S0325-00752011000400005.

2. WHO/RHT/MSM/98.4 1998.

5.1985;2 :1075– 1080 medlineWeb of science.

Stanford University Hospital Cohort Study

2003

World Health Organization (WHO)

Recommended

To dye or not to dye

Randomized clinical trial of:

Triple dye/Alcohol V.S Dry Cord Care

In 1998:

1. Hand washing (1,2)

2. Dry cord care under routine conditions

3. Usage of antiseptics is helpful when unhygienic practices are used

Untill now same recommendations

CONCLUSION:

  • Cessation of bacteriocidal care of the U.C must be associated with attention to the signs and symptoms of omphalitis.

1. WHO/RHT/MSM/98.4 Care of the Umbilical Cord: A review of evidence. Geneva, Switzerland: World Health Organization; 1998.

2. Scanlon JW, Leikkanen M. The use of fluorescin powder for evaluating contamination a newborn nursery. J Pediatr. 1973;82:966–971.

3. World Health Organization. Care of the umbilical cord. WHO/FHE/MSM-cord care. Geneva: WHO, 1998.

4. Garner P, Lai D, Baea M, Edwards K, Heywood P. Avoiding neonatal death: an intervention study of umbilical cord care. J Trop Pediatr. 1994;40:24–8. [PubMed]

5. World Health Organization. Care of the Umbilical Cord. Geneva,Switzerland: World Health Organization; 1998.

(Pediatrics 2003;111.1.15 DOL :10.1542/Peds.111.1.15)

Outline

  • Background & Introduction
  • Significance of the problem
  • Study Questions
  • Subject Area
  • Study Settings
  • Methodology
  • Results
  • Conclusions
  • Recommendations
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