Neonatal care: Handling the umbilical cord

Majority of women rely on rudimentary care methods for their babies after birth. Despite most of them having gone through a successful delivery, studies show that contamination of the umbilical cord stump at a later stage is common and results into infections. Unfortunately, these infections, according to experts, are among the leading causes of neonatal mortality. Why good care is a must Dr Teckle Egziabher, a gynecologist at Rwanda Millitary Hospital, Kanombe, explains that the umbilical cord is one of the most important parts on the foetus, but is highly susceptible to microbial proliferation. “If it is not maintained clean, there is a risk of microbial contamination, therefore, conditions around the cord should be kept sterile,” explains Dr Egziabher. Anatomically the umbilical cord is connected to the foetus to serve as a canal through which a baby feeds while it is still in the womb, but after birth, it is cut to about five centimetres and tied to a ligature. “When the cord is left untied, the baby can bleed to death, more so because vital organs and blood vessels are directly connected to the umbilical cord,” he adds. Whereas the umbilical cord finally falls off after a week or so, health experts insist that hygienic care should continue with a good solution before it dries and falls off. Choice of cleaning solution Using a locally produced sterilised water solution of chlorhexidine for umbilical cord care in home deliveries to prevent life threatening sepsis and other infections is possible. Chlorhexidine has been recently approved in Kenya, becoming the first umbilical cord care solution to be manufactured in Africa. “The solution can be easily applied immediately after cutting the cord, to the tip of the cord, the stump and around the base of the stump,” says Rachael Nyamai, the head of the Child Health Unit at the Ministry of Health in Kenya. However, Dr Rachna Pande, a specialist of internal medicine at Ruhengeri Hospital, explains that different communities have their ways of treating umbilical cords in newborns, but emphasises proper choice for a solution to apply. “A mother should keep the cord clean by washing it with clean water which is cooled after boiling. After cleaning, the area should be maintained dry,” Pande explains. She, however, warns against the use of hot or soapy water as being risky and likely to cause irritation around the area. “Hot water and soap denude the soft skin and this would increase the risk of causing more infection,” she adds. While most mothers find no problem to attach or clean using any material at their disposal, Asina Uhiriwe, a nurse at Kimironko Health Centre, warns about the use of powder and ornaments. “They should apply no powder or attach any kind of ornament and area around should also be maintained free from moisture,” Uhirwa says. WHO recommendations According to the World Health Organisation, neonatal infections are estimated to account for over one million newborn deaths annually, which is almost over a third of the total infant death burden. Even in Rwanda, cases of neonatal mortality still abound and statistics from the Ministry of Health indicate 54 deaths per every 1,000 live births before reaching the age of five countrywide. Because it is a global problem, the WHO recommends using remedies at home for umbilical cord care such as chlorhexidine. Chlorhexidine is usually applied for the first week of life only on newborns at home, but new studies have shown that additional use until the cord falls is beneficial. The chlorhexidine 4 per cent solution, which is available in drop form, can easily be sprinkled on a freshly cut cord, according to the WHO. Dr Pande, however, emphasises using chlorhexidine in situations of infection or if there are signs like redness, swellings or irritability. “Where there are infections or signs of infection, chlorohexadrine can be applied to the area,” Pande advises.