Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Pediatr Infect Dis J. 2012 May;31(5):444-50. doi: 10.1097/INF.0b013e3182468ff0.
Randomized trials from South Asia indicate umbilical cord chlorhexidine cleansing reduces mortality and omphalitis. No community-based data are available on bacteriological profile of the cord, early neonatal colonization dynamics, or impact of cord cleansing on colonizing organisms. Such data could clarify the design of scaled chlorhexidine interventions.
Umbilical swabs were collected at home (days 1, 3, 6) after birth from infants participating in a trial of 3 cord-care regimens (no chlorhexidine, single cleansing, multiple cleansing) in Sylhet, Bangladesh. Overall and organism-specific positivity rates were estimated by cord-care regimen and by day of collection.
Between September 2008 and October 2009, 1923 infants contributed 5234 umbilical swabs. Positivity rate was high (4057 of 5234, 77.5%) and varied substantially across groups. Immediate (day 1) reductions in cord colonization were observed in single- (prevalence rate ratio = 0.75, 95% confidence interval: 0.70-0.81) and multiple- (prevalence rate ratio = 0.71, 95% confidence interval: 0.66-0.77) cleansing groups. Reductions persisted and increased in magnitude through day 6 only if babies received multiple applications. On days 1, 3, and 6, respectively, multiple cleansing consistently reduced invasive organisms such as Escherichia coli (49%, 64%, and 42% lower), Klebsiella pneumoniae (46%, 53%, and 33% lower), and Staphylococcus aureus (34%, 84%, and 85% lower).
Cord cleansing with 4.0% chlorhexidine immediately after birth reduces overall and organism-specific colonization of the stump. Reductions are greater and sustained longer with daily cleansing through the first week of life, suggesting that programs promoting chlorhexidine cleansing should favor multiple over single applications.
来自南亚的随机试验表明，脐带氯己定清洗可降低死亡率和脐炎。目前尚无关于脐带细菌学特征、早期新生儿定植动态或脐带清洗对定植生物影响的社区数据。这些数据可以阐明扩大氯己定干预措施的设计。
在孟加拉国锡尔赫特参与 3 种脐带护理方案（无氯己定、单次清洗、多次清洗）试验的婴儿出生后第 1、3、6 天在家中采集脐带拭子。根据脐带护理方案和采集日期估计脐带总体和特定生物体的阳性率。
2008 年 9 月至 2009 年 10 月，1923 名婴儿共采集 5234 份脐带拭子。阳性率很高（5234 份中 4057 份，77.5%），且各组间差异很大。在单次（流行率比=0.75，95%置信区间：0.70-0.81）和多次（流行率比=0.71，95%置信区间：0.66-0.77）清洗组中，立即（第 1 天）降低了脐带定植。如果婴儿接受多次应用，这种降低仅在第 6 天持续并增加。在第 1、3 和 6 天，多次清洗分别持续降低了侵袭性生物体，如大肠杆菌（分别降低 49%、64%和 42%）、肺炎克雷伯菌（分别降低 46%、53%和 33%）和金黄色葡萄球菌（分别降低 34%、84%和 85%）。
出生后立即用 4.0%氯己定清洗脐带可立即降低脐带残端的总体和特定生物体定植。在出生后第一周每天清洗时，减少的幅度更大且持续时间更长，这表明促进氯己定清洗的项目应优先选择多次清洗而非单次清洗。
