Umbilical cord separation time, predictors and healing complications in newborns with dry care


Autoři: María Dolores López-Medina aff001;  Ana Belén López-Araque aff003;  Manuel Linares-Abad aff001;  Isabel María López-Medina aff001
Působiště autorů: Department of Nursing, Faculty of Health Sciences, Universidad de Jaén, Jaén, Spain aff001;  San José Health Center, Northern Jaén Sanitary District, Linares, Jaén, Spain aff002;  Hospital of Jaén, Andalusian Health Service, Jaén, Spain aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0227209

Souhrn

Objective

The objective of this study was to explore the umbilical cord separation time, predictors, and healing complications from birth until the newborn was one month old.

Design

A quantitative longitudinal observational analytical study by stratified random sample was adopted.

Setting

Public health system hospitals in southern Spain and at newborns’ homes.

Participants

Between April 2016 and December 2017, the study included 106 neonates born after 35–42 weeks of gestation whose umbilical cord was cured with water and soap and dried later as well as newborns without umbilical canalisation whose mothers enjoyed a low-risk pregnancy.

Methods

The data collection procedure comprised two blocks: from birth to the time of separation of the umbilical cord and from cord separation to the first month of life of the newborn. Umbilical cord separation time was measured in minutes; socio-demographic and clinical characteristics were measured by means of questionnaires, and the external diameter of the umbilical cord was measured using an electronic stainless-steel calliper and trailing roller.

Results

The mean umbilical separation time: 6.61 days (±2.33, IC 95%:6.16–7.05). Incidence of omphalitis was 3.7%; granuloma was 8.6%. Separation time predictors were wetting recurrence, birth weight, intrapartum antibiotics, birth season, and Apgar < 9 (R2 = 0.439 F: 15.361, p <0.01).

Conclusion

The findings support the World Health Organization recommendations: dry umbilical cord cares is a safe practice that soon detaches the umbilical cord, taking into account the factors studied that will vary the length of time until the umbilical cord is separated.

Klíčová slova:

Antibiotics – Birth – Birth weight – Labor and delivery – Neonatal care – Neonates – Umbilical cord – Omphalitis


Zdroje

1. Zupan J, Garner P, Omari AA. Topical umbilical cord care at birth. Cochrane Database of Systematic Reviews. 2004; doi: 10.1002/14651858.CD001057.pub2 15266437

2. World Health Organization. Newborn deaths decrease but account for higher share of global child deaths [Internet]. 2011 [cited 20 Mar 2018]. Available: http://www.who.int/mediacentre/news/releases/2011/newborn_deaths_20110830/en/

3. World Health Organization. Newborns: reducing mortality [Internet]. 2018 [cited 20 Mar 2018]. Available: http://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality

4. Cámara-Roca L, Bru-Martin C, Rodríguez-Rivero A, Soler-Gaiton M U-PF. La cura en seco del cordón umbilical en el recién nacido: revisión de la evidencia. Matronas Profesión. 2009;10: 20–24. Available: http://www.federacion-matronas.org/wp-content/uploads/2018/01/vol10n3pag20-24.pdf

5. Pantoja-Ludueña M. Onfalitis. In: Espinoza-Osorio F., editor. La neonatología en la atención primaria de salud. La Paz: Grupo Impresor; 2005. pp. 591–593.

6. Imdad A, Bautista RMM, Senen KAA, Uy ME V, Mantaring JB, Bhutta ZA. Umbilical cord antiseptics for preventing sepsis and death among newborns. The Cochrane database of systematic reviews. 2013; CD008635. doi: 10.1002/14651858.CD008635.pub2 23728678

7. Gallagher PG, Shah S. Omphalitis [Internet]. 2019 [cited 10 Jun 2019]. Available: http://www.emedicine.com/ped/topic1641.htm

8. Álvaro-Iglesias E, Fernández-Calvo F, Recio-Pascual V. Patología umbilical frecuente. In: Neonatología AE de P and SE de, editor. Protocolos Diagnóstico Terapéuticos de la AEP: Neonatología. Madrid: AEP; 2008. pp. 398–404.

9. Pérez-Moneo AB, Pérez-Butragueño M, Molina-Amores C. Onfalitis neonatal. Guía-ABE Infecciones en pediatría guía rápida para la selección del tratamiento antimicrobiano empírico. Madrid; Aug 2012. Available: http://www.guia-abe.es/temas-clinicos-onfalitis-neonatal

10. Karumbi J, Mulaku M, Aluvaala J, English M, Opiyo N. Topical Umbilical Cord Care for Prevention of Infection and Neonatal Mortality. The Pediatric Infectious Disease Journal. 2013;32: 78–83. doi: 10.1097/INF.0b013e3182783dc3 23076382

11. World Health Organization. Care of the Umbilical Cord: A Review of the Evidence [Internet]. Organization WH, editor. Geneva; 1998. Available: http://bvsper.paho.org/videosdigitales/matedu/ICATT-AIEPI/Data/Care of the umbilical cord/fd38a9b4-bfa1-4735-9a9a-e7dbb0faa720.pdf

12. Arifeen S El, Mullany LC, Shah R, Mannan I, Rahman SM, Talukder MRR, et al. The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial. The Lancet. 2012;379: 1022–1028. doi: 10.1016/S0140-6736(11)61848-5

13. Fraser N, Davies BW, Cusack J. Neonatal omphalitis: A review of its serious complications. Acta Paediatrica. 2006;95: 519–522. doi: 10.1080/08035250600640422 16825129

14. Stewart D, Benitz W. Umbilical Cord Care in the Newborn Infant. Pediatrics. 2016;138: e20162149–e20162149. doi: 10.1542/peds.2016-2149 27573092

15. Liu M-F, Lee T-Y, Kuo Y-L, Lien M-C. Comparative effects of using alcohol, natural drying, and salicylic sugar powder on umbilical stump detachment of neonates. The Journal of perinatal & neonatal nursing. 2012;26: 269–74. doi: 10.1097/JPN.0b013e318261ca33 22843010

16. National Institute for Health and care Excellence. Postnatal care up to 8 weeks after birth, physical health and wellbeing [Internet]. 2015 [cited 6 Jun 2018]. Available: https://www.nice.org.uk/guidance/cg37

17. Healthy children. Umbilical Cord Care. American Academy of Pediatrics. [Internet]. 2015 [cited 6 Jul 2018]. Available: https://www.healthychildren.org/english/ages-stages/baby/bathing-skin-care/pages/umbilical-cord-care.aspx

18. Sánchez Luna M, Pallás Alonso CR, Botet Mussons F, Echániz Urcelay I, Castro Conde JR, Narbona E. Recomendaciones para el cuidado y atención del recién nacido sano en el parto y en las primeras horas después del nacimiento. Anales de Pediatría. Spain; 2009;71: 349–361. doi: 10.1016/j.anpedi.2009.07.012

19. Andalusia RG of. Unique Registry of deliveries and births in Andalusia [Internet]. Sevilla; 2015. Available: https://ws001.juntadeandalucia.es/rupyna/

20. Hernández-Sampieri R, Fernández-Collado C, Baptista-Lucio P. Selección de la muestra. In: McGraw-Hill, editor. Metodología de la Investigación. México; 2014. pp. 170–191.

21. Network NHS. The NHSN Patient Safety Component Manual [Internet]. 2017 [cited 8 Jun 2018]. Available: https://www.cdc.gov/nhsn/pdfs/validation/2017/pcsmanual_2017.pdf

22. Afifi A, Clark V. Computer-aided multivariate analysis. Hall C&, editor. New York.; 1990.

23. IBM Corp. Released. IBM SPSS Statistics for Windows. New York.: IBM Corp.; 2016.

24. World Medical Association. WMA Declaration of Helsinki—Ethical Principles for Medical Research Involving Human Subjects [Internet]. 2018 [cited 6 Jun 2018]. Available: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/

25. Ozdemir H, Bilgen H, Topuzoglu A, Coskun S, Soyletir G, Bakir M, et al. Impact of different antiseptics on umbilical cord colonization and cord separation time. Journal of infection in developing countries. Italy; 2017;11: 152–157. Available: https://jidc.org/index.php/journal/article/view/28248676 doi: 10.3855/jidc.7224 28248676

26. N AA. The Effect of Topical Application of Mother Milk on Separation of Umbilical Cord for Newborn Babies. American Journal of Nursing Science. 2015;4: 288. doi: 10.11648/j.ajns.20150405.16

27. Covas M del 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]. Archivos argentinos de pediatria. 2011;109: 305–13. doi: 10.1590/S0325-00752011000400005 21829871

28. Golshan M, Hossein N. Impact of ethanol, dry care and human milk on the time for umbilical cord separation. JPMA The Journal of the Pakistan Medical Association. 2013;63: 1117–9. Available: http://jpma.org.pk/full_article_text.php?article_id=4628 24601188

29. Aghamohammadi A, Zafari M, Moslemi L. Comparing the effect of topical application of human milk and dry cord care on umbilical cord separation time in healthy newborn infants. Iranian journal of pediatrics. Iran; 2012;22: 158–162. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3446059/ 23056880

30. 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. Iran; 2006;9: 33–38. Available: https://www.ncbi.nlm.nih.gov/pubmed/?term=16649375 16649375

31. Ekici B, Ergin AB ŞP. Comparison of the effectiveness of methods used in umbilical cord care for newborns. J Child. 2007;7: 191–196.

32. Salariya EM, Kowbus NM. Variable umbilical cord care. Midwifery. 1988;4: 70–76. doi: 10.1016/s0266-6138(88)80004-4 3386543

33. Khairuzzaman M, Mannan M, Matin A, Sarker MMA, Sarker NR, Mowla MG, et al. Chlorhexidine Cleansing of the Umbilical Cord and Cord Separation Time: A Hospital Based Study in Bangladesh. Journal of Science Foundation. 2016;13: 27. doi: 10.3329/jsf.v13i2.27929

34. Mullany LC, Shah R, El Arifeen S, Mannan I, Winch PJ, Hill A, et al. Chlorhexidine cleansing of the umbilical cord and separation time: a cluster-randomized trial. Pediatrics. 2013;131: 708–15. doi: 10.1542/peds.2012-2951 23509175

35. Gras-Le Guen C, Caille A, Launay E, Boscher C, Godon N, Savagner C, et al. Dry Care Versus Antiseptics for Umbilical Cord Care: A Cluster Randomized Trial. Pediatrics. United States; 2017;139: e20161857. doi: 10.1542/peds.2016-1857 28008096

36. Quattrin R, Iacobucci K, De Tina AL, Gallina L, Pittini C, Brusaferro S. 70% Alcohol Versus Dry Cord Care in the Umbilical Cord Care. Medicine. 2016;95: e3207. doi: 10.1097/MD.0000000000003207 27057849

37. Ahn Y, Sohn M, Jun Y, Lee E, Lee S. Two methods of cord care in high-risk newborns: their effects on hydration, temperature, pH, and floras of the cord area. Journal of child health care: for professionals working with children in the hospital and community. England; 2015;19: 118–129. doi: 10.1177/1367493513503580 24092869

38. 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. Germany; 2003. pp. 350–351. doi: 10.1007/s00431-003-1174-2 12692719

39. Bhalla JN, Nafis N, Rohatgi P, Singh. Some observations on separation of the umbilical stump in the newborn. Indian journal of pediatrics. India; 1975;42: 329–334. doi: 10.1007/bf02829329 1228101

40. Shoaeib FMNE, All SAE-FA, El-Barrawy MA. Alcohol or traditional methods versus natural drying for newborn’s cord care. The Journal of the Egyptian Public Health Association. 2005;80: 169–201. Available: http://www.ncbi.nlm.nih.gov/pubmed/16922152 16922152

41. Singh N, Sharma S, Singh R. Umbilical cord fall in preterm and term newborns in vaginal and caesarean deliveries. Indian pediatrics. India; 1999;36: 588–590. 10736589

42. 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. Neonatology. 2009;96: 13–18. doi: 10.1159/000200165 19202343

43. Novack AH, Mueller B, Ochs H. Umbilical cord separation in the normal newborn. American journal of diseases of children (1960). 1988;142: 220–3. Available: http://www.ncbi.nlm.nih.gov/pubmed/3341328

44. Frazier JP, Cleary TG, Pickering LK, Kohl S, Ross PJ. Leukocyte function in healthy neonates following vaginal and cesarean section deliveries. The Journal of pediatrics. United States; 1982;101: 269–272. Available: https://www.jpeds.com/article/S0022-3476(82)80138-8/pdf 7097427

45. Oudesluys-Murphy AM, den Hollander JC, Hop WCJ. Umbilical Cord Separation: Histological Findings and Perinatal Factors. Neonatology. 1990;58: 236–240. doi: 10.1159/000243273 2271718

46. Vural G, Kisa S. Umbilical Cord Care: A Pilot Study Comparing Topical Human Milk, Povidone‐Iodine, and Dry Care. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2006;35: 123–128. doi: 10.1111/j.1552-6909.2006.00012.x 16466360

47. Källman J, Schollin J, Håkansson S, Andersson A, Kihlström E. Adherence of group B streptococci to human endothelial cells in vitro. APMIS: acta pathologica, microbiologica, et immunologica Scandinavica. 1993;101: 403–8. Available: http://www.ncbi.nlm.nih.gov/pubmed/8329202

48. Brook I. Cutaneous and subcutaneous infections in newborns due to anaerobic bacteria. Journal of Perinatal Medicine. Germany; 2002;30: 197–208. doi: 10.1515/JPM.2002.028 12122901

49. Pezzati M, Biagioli 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. Neonatology. 2002;81: 38–44. doi: 10.1159/000047182 11803175

50. Sawardekar KP. Changing spectrum of neonatal omphalitis. The Pediatric Infectious Disease Journal. 2004;23: 22–26. doi: 10.1097/01.inf.0000105200.18110.1e 14743041

51. Silva-Barajas AP, McGee-La A, Vidal-Esteba A, Aybar-García L, Valencia-Martín J. Estudio descriptivo de casos de onfalitis en un hospital universitario. Gaceta Sanitaria. 2016;30: 51–52. Available: https://www.seepidemiologia.es/documents/dummy/gaceta_Sanit_Reunion_SEE_2016.pdf

52. 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: JOGNN. 1998;27: 621–7. Available: https://www.jognn.org/article/S0884-217(15)33603-0/fulltext doi: 10.1111/j.1552-6909.1998.tb02631.x 9836156

53. Janssen PA, Selwood BL, Dobson SR, Peacock D, Thiessen 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. Available: http://www.ncbi.nlm.nih.gov/pubmed/12509548 doi: 10.1542/peds.111.1.15 12509548

54. Gallina L, De Tina AL, Basso T, Brusaferro S, Quattrin R. Umbilical Cord Care After the First Day From Birth: A Case Control Study in a Northeastern Italian Hospital. Pediatrics and Neonatal Nursing—Open Journal. 2016;3: 4–9. doi:10.17140/PNNOJ-3-118

55. 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: 103–107. Available: https://www.cabdirect.org/cabdirect/abstract/20093091169

56. Farahani LA, Mohammadzade A, Tafazzoli M, Esmaeli H, Ghazvini K. Effect of topical application of breast milk and dry cord care on bacterial colonization and umbilical cord separation time in neonates. Journal of Chinese Clinical Medicine. 2008;3: 327–332.

57. Chamnanvanakij S, Decharachakul K, Rasamimaree P, Vanprapar N. A randomized 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 = Chotmaihet thangphaet. Thailand; 2005;88: 967–972. Available: https://www.ncbi.nlm.nih.gov/pubmed/?term=16241027 16241027

58. Aygun C, Subasi A, Kucukoduk S. Timing of umbilical cord separation and neonatal intensive care unit practices. American journal of perinatology. United States; 2005;22: 249–251. doi: 10.1055/s-2005-870661 16041634

59. Scasso S, Laufer J, Rodriguez G, Alonso JG, Sosa CG. Vaginal group B streptococcus status during intrapartum antibiotic prophylaxis. International Journal of Gynecology & Obstetrics. 2015;129: 9–12. doi: 10.1016/j.ijgo.2014.10.018 25577036

60. Zareba-Szczudlik J, Romejko-Wolniewicz E, Lewandowski Z, Rozanska H, Malinowska-Polubiec A, Dobrowolska-Redo A, et al. Evaluation of the amoxicillin concentrations in amniotic fluid, placenta, umbilical cord blood and maternal serum two hours after intravenous administration. Neuro endocrinology letters. 2016;37: 403–409. Available: http://www.ncbi.nlm.nih.gov/pubmed/28231686 28231686

61. Hershkovich-Shporen C, Bardenstein R, Blickstein I, Shinwell ES, Flidel-Rimon O. Maternal intrapartum antibiotic treatment continues to exert a bactericidal effect on the umbilical cord and peripheral venous blood of newborn infants. Acta paediatrica (Oslo, Norway: 1992). 2017;106: 1767–1771. doi: 10.1111/apa.13982 28695642


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