Umbilical cord infection is a serious concern of neonatologists in both developed and developing countries. Variety of strategies has been experimented to control umbilical cord associated adverse effects. Dry cord care is the most common one even has been recommended by WHO. Moreover, numerous chemicals have been utilized to prevent or control these adverse effects 1,13. Whereas harmful traditional routes of umbilical cord-care are still prevalent 1, introduce safe and effective control ways seems necessary.
In the current study, we have compared outcomes of mother’s own milk use versus routine dry cord care on umbilical cord associated adverse effects. Breast milk as the best feeding resource of new-borns is consisted numerous immunologic and disinfecting factors protecting neonates from different infections 14. Two groups of the study were not statistically different regarding body birth weight, age of delivery and gender distribution. Therefore, probable confounding variables that may influence outcomes of this study were eliminated.
We found that required time for cord separation, time to reach full enteral feeding and duration of hospitalization were not statistically different two groups.
Previous studies have conducted their studies using variety of chemicals for cord infection prevention. Studies in literature have presented 4 to 16 days as usual duration of cord separation 15,16. Meanwhile, mean time for cord separation applying nothing was 9 days that was somewhat fewer than our study 17. While most of them have presented superiority of routine dry cord care, some other studies found controversial outcomes as followed. Acharya et al. compared povidone versus dry care and presented that dry care was accompanied with shorter required time for separation 18. The other study by Luke et al. compared outcomes of chlorhexidine, soap and water and routine dry cord care. Outcomes of this study presented superior results of both dry cord care and soap and water versus chlorhexidine 12. The other study by Quattrin et al. compared 70% alcohol use with dry care and as previous studies found shorter time required for cord separation in dry cord care in comparison to local 70% alcohol for cord caring 19. In 2015, Abbaszadeh et al. in a similar study to ours, utilized mother’s own milk for cord care and compared its outcomes with use of chlorhexidine. They found that required time for cord separation in group under mother’s own milk treatment was significantly less than what was found in those treated with chlorhexidine 20.
Umbilical cord associated adverse effects was assessed as well. Regarding adverse effects including omphalitis, bad odour, exudates secretion, granulation tissue, sepsis and death, no statistical differences were found between two groups under treatment with mother’s own milk and dry cord care. Further studies in this regard have been published using various chemicals, as in a study of Mullany et al. use of chlorhexidine led to fewer incidence of umbilical cord adverse effects 21. This finding was confirmed by Nankabirwa et al. in a study conducted in Sub-Saharan, Africa 22. Another study by Yulanda et al. tried to compare outcomes of mother’s own milk application with ethanol and dry cord care. In their similar to us study, they presented superiority of mother’s own milk use considering fewer required time of cord separation and also less incidence of cord related infections 23. Golshan et al. compared umbilical adverse effects following topical administration of ethanol, breast milk and dry cord care. Although they presented superiority of breast milk considering cord separation, cord associated complications occurrence were not statistically different in three groups 24.
The last assessment of this study was about bacterial/fungal colonization of cords in two groups. Cultures were non-colonized in 83.1% of case and 79.7% of controls at study initiation. Two other cultures were obtained from study population that showed no difference between two groups. Staphylococcus aureus was the most common microorganism in both groups and in all derived cultures, followed by Enterobacter, E. coli and Klebsiella respectively.
Stewart et al. in a comprehensive study tried to assess cord colonization in general. Similarly, to our study they declared Staphylococcus aureus as the predominant organism derived from cultures. Further organisms with less prevalence included Group A and B Streptococci, gram negative germs including E. coli, Klebsiella and Pseudomonas species 25. These organisms were presented by other authors as well 7,26.
In a study by Lyngdoh et al. they presented that chlorhexidine could considerably reduce cord colonization followed by breast milk to some extends and dry cord care respectively. In this study total of 105 subjects randomized into 3 groups (chlorhexidine, breast milk and dry care) and topical application was done daily until the cord separated. Cord swab was done at the birth, day 3 and day 5 after birth. Obtained samples of their study were colonized with similar microorganisms found in our study 27.
The other study by Mahrous et al. presented outcomes inconsistent with ours as they detected significantly less colonization found in those underwent breast milk cord care 28. Fewer sample size and applying breast milk in the 2–4 first hours of birth, were the two major differences in this study.