The umbilical cord is the lifeline of the fetus and newborn in the first few minutes after birth. However, after birth, it becomes a potential route of infection that could claim a baby’s life. VERA ONANA writes about the methods a mother can adopt in ensuring the baby’s safety during the period of cord care.
According to researchers, a substantial proportion of neonatal deaths occur from infections; neonatal tetanus inclusive of the umbilical cord. Cord care practices may directly contribute to infections in the newborn which accounts for the 26 per cent of global under five deaths, experts say. Evidence from studies also show that the prevalence of cord infection in newborns ranges from 3 to 5.5 per cent in most developing countries.
Cord care starts shortly after birth and practices vary in different communities and culture but good cord care practice is an important community based intervention to save and protect the lives of newborns. Currently, the World Health Organization (WHO) recommendation for care of the new born cord is to apply nothing after cutting except in certain circumstances. However, the use of sterile cotton wool soaked in either Methylated spirit or water at body temperature or gentian violet on the cord is still being practised nationwide.
Correct care of the umbilical cord of a newborn goes a long way in determining the immediate health and survival of the newborn. Sadly however, a lot of wrong practices based on tradition that may predispose a newborn to infection are still engaged in, experts lament.
Paediatricians have, over time, discouraged the use of concoctions, heat from lanterns, breast milk, cow urine and other unorthodox methods in the care of infant cord. However, some mothers still engage in those unsanitary practices, especially in rural areas.
Dr. Tahir Lawal, a pediatrician at the National Hospital (NHA) Abuja in an interaction with a media outlet emphasised the need for mothers to stick to the recommended and acceptable practices for cord care and desist from other unorthodox methods.
He explained that the umbilical cord is the connecting tissue between the baby, placenta and the mother. “Two arteries and the veins are present in the umbilical cord. Now after delivery, the cord should be tied with a cord clamp and then cut. The expected thing is that it should dry up and subsequently fall off. But I know that in our environment, there are a lot of funny things happening. I have seen mothers use engine oil, lantern, hot water, tooth paste and all sorts of things on the umbilical cord.
“None of those applications are sterile and because the cord is a vessel containing arteries and a vein, it simply means that those contaminated applications can cause infections that will go from the cord into the bloodstream.
“If the mother uses water also, she will leave the area wet and the wet surface would encourage the growth of bacteria and ultimately, an infection. All that is needed is to clean the area with methylated spirit,’’ Lawal said.
Chlorhexidine is today’s standard for proper cord care
In October 2013, the WHO recommendations on post natal care of the mother and newborn on cord care stated that “daily chlorhexidine (7.1 per cent chlorhexidine digluconate aqueous solution or gel, delivering 4 per cent chlorhexidine) application to the umbilical cord stump during the first week of life is recommended for newborns who are born at home in settings with high neonatal mortality (30 or more neonatal deaths per 1000 live births). Clean, dry cord care is recommended for newborns born in health facilities and at home in low neonatal mortality settings. Use of chlorhexidine in these situations may be considered only to replace application of a harmful traditional substance, such as cow dung, to the cord stump.”
Nigeria’s commitment to scaling up use of Chlorhexidine Gel Based on the WHO recommendations, the use of Chlorhexidine Gel is now being widely practised in Nigeria. In November of last year, the Government of Nigeria launched three new policies aimed at promoting newborn health. One of these, the National Strategy to Scale Up Chlorhexidine (CHX), seeks to increase use of the low-cost antiseptic gel that, when applied to the umbilical cord, can significantly reduce newborn deaths by taking care of the formation of sepsis or any other infection that arises from the cord.
During the November 2016 World Prematurity and Pneumonia Day press briefing held in Abuja, the Minister of Health, Professor Isaac Adewole, said “the National Chlorhexidine Scale Up Strategy document highlights the government’s drive to ensure that CHX is readily available and used across the country for umbilical cord care. This is one of the 13 life-saving commodities stipulated by the U.N. Commission on Life-Saving Commodities for Women and Children and adopted for accelerated access and use in Nigeria.”
President of Paeadiatric Association of Nigeria (PAN), Dr Stella Ibeziako, in an interaction with a national daily said that in the past, parents were instructed to swab the stump with rubbing alcohol after every diaper change but that has changed.
“Researchers now say the stump might heal faster if left alone. The application of Chlorhexidine Gel is the gold standard now.
“All a mother needs do is to apply the gel immediately the child is cleaned after deliver just once in a day. It works for 24 hours. One application is all that is required as it takes care of formation of any sepsis or other infections,” explained Dr Ibeziako.
She said one should expose the stump to air to help dry out the base. “Keep the front of your baby’s diaper folded down to avoid covering the stump. In warm weather, dress your baby in a diaper and T-shirt to improve air circulation.
“Sponge baths might be most practical during the healing process. When the stump falls off, you can bathe your baby in a baby tub or sink. Please, let the stump fall off on its own. Resist the temptation to pull off the stump yourself. Do not give the child drinks including Gripe water which is already banned by NAFDAC. Just continue to breast feed the baby for six months on exclusive breast milk. No water. No herbal solutions or concoctions,” she advised.
A mother’s testimony
While speaking with Beatrice Spadacini, the senior communications adviser in the Bureau for Global Health at USAID recently, a Northern mother explained the ease and effectiveness of the gel. “I have used chlorhexidine on two of my grandchildren,” said Alhaja M. T. Badmus, a grandmother of 12. “I found it easy to apply compared with methylated spirit [alcohol]. Their umbilical cords healed within seven days.”
CHX was first introduced in Nigeria through USAID’s Targeted States High Impact Project (TSHIP) on maternal and newborn health in Sokoto and Bauchi states back in 2012. These two northern states were targeted because of their high child and maternal mortality rates.