Use of Chlorhexidine on Umbilicus in Prevention of Neonatal Sepsis

Objectives: The main objective of the study is to analyse the use of chlorhexidine on umbilicus in prevention of neonatal sepsis. Materials and Methods: This cross sectional study was conducted in Sheikh Zaid hospital Rahim Yaar Khan during March 2020 till September 2020. The data was collected through non-probability consecutive sampling technique. The data was collected from 100 infants. Arrangements with a grouping of 4.0% free chlorhexidine were set up by weakening 20% chlorhexidine digluconate to the proper fixation with cleaned water. Results: The data was collected from 100 neonates. All the demographic values which include age, gender, gestational age and mode of delivery were calculated. According to baseline values the birth weight of chlorhexidine group was 1.87 ± 0.463 kg and dry cord group was 1.69 ± 0.421 kg. Umbilical sepsis is observed in only 1 patient in group I and in 3 patients in group II. Only single mortality was observed in group I and in 6 neonates in group II. Conclusion: It is concluded that chlorhexidine umbilical cord care is more appropriate than the currently WHO recommended dry cord care.

A ten-year review of neonatal tetanus cases managed at a tertiary health facility in a resource poor setting: The trend, management challenges and outcome

Background Neonatal Tetanus (NNT) is a vaccine preventable disease of public health importance. It is still being encountered in clinical practice largely in developing countries including Nigeria. NNT results from unhygienic delivery practices and some harmful traditional cord care practices. The easiest, quickest and most cost-effective preventive measure against NNT is vaccination of the pregnant women with the tetanus toxoid (TT) vaccine. The case-fatality rate from tetanus in resource-constrained settings can be close to 100% but can be reduced to 50% if access to basic medical care with adequate number of experienced staff is available. Materials and methods This retrospective study reviewed the admissions into the Special Care Baby Unit (SCBU) of the Ekiti State University Teaching Hospital, Ado-Ekiti from January 2011 to December 2020. The folders were retrieved from the records department of the hospital; Information obtained from folders were entered into a designed proforma for the study. Results During the study period, NNT constituted 0.34% of all neonatal admissions with case fatality rate of 52.6%. Seven [36.8%] of the babies were delivered at Mission home/Traditional Birth Attendant’s place while 5 [26.3%] were delivered in private hospitals. Cord care was with hot water compress in most of these babies16 [48.5%] while only 9% of the mothers cleaned the cord with methylated spirit. Age at presentation of less than one week was significantly associated with mortality, same with presence of autonomic dysfunction. Low family socio-economic class 5 was significantly associated with poor outcome, so also maternal age above 24 years. Conclusion This study revealed that neonatal tetanus is still being seen in our clinical practice with poor outcome and the risk factors are the same as of old. Increased public health campaign, promotion of clean deliveries, safe cord care practices, affordable and accessible health care provision are recommended to combat NNT scourge.

Impact of postnatal counseling on care of newborn

Background: Newborn care is an integral aspect of child health care practices. Globally 2.4 million children died in the neonatal period in 2019. Currently in India around 7.47 lakh neonates die annually. Advocating and adopting proper postnatal care of newborn in aspects of breastfeeding, immunization, warmth care, cord care, eye care etc will help in reducing neonatal morbidity and mortality.Methods: This was an hospital based cross sectional study of 100 postnatal mothers of babies admitted in NICU, in a tertiary care hospital. The knowledge of the mothers on various aspects of postnatal care was assessed by a pretest, followed by counseling and reassessment with a post test.Results: The study found that postnatal mothers had better awareness regarding breastfeeding, warmth care, cord care and oil massage. Poor knowledge was seen regarding eye care, immunization, recognition of danger signs and maternal nutrition and supplementation. Health care workers focused more on breastfeeding and warmth care practices than other aspects of postnatal care during antenatal counseling which could be a reason for this. A wide gap exists between contact with health workers and antenatal counseling. Knowledge gaps of the mothers improved significantly after counseling irrespective of their parity, education and location as seen by the increase in mean scores.Conclusions: Neonatal morbidity and mortality due to avoidable causes like hypoglycemia, hypothermia, sepsis can be achieved by practicing appropriate post-natal care practices. WHO recommendations on these practices should be widely propagated through frequent antenatal and post-natal counseling by health care workers.

Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya

Background Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya. Methods We employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions. Results The model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. Conclusions Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust.

Cord Care Methods in Neonates

Background: Proper cord care methods in neonates have been known to reduce infections, sepsis, and death. This study intends to document the frequency of cord care methods. Methods: A questionnaire-based study was done in 6 months in a tertiary care hospital with a level 3 nursery and NICU (Fatima Memorial Hospital, Lahore). We interviewed mothers and female companions of neonates in wards and outpatient clinics. Answers were added to SPSS in socio-demographic categories and cord care methods. Result: A total of 778 females were interviewed. The mean age is 28 + 8.1 years, mostly educated (90%) and resided in urban areas (83%). 39.4% of the participants had personal experience of newborn care. Most were housewives (74.4%). 36.8% would not apply anything to the cord, but the other majority would apply some agent to the newborn cord, methylated spirit being the favourite (48.5%), remaining being mostly antibiotics and antimicrobial agents. Chlorhexidine was used only by one participant. Doctors and nurses had counselled 70% of the participants, but 10% listened to the advice of relatives and grandmothers. 18.5% declined any knowledge of safe practices. Conclusions: Our study emphasizes the need to educate our hospital staff (doctors, nurses and midwives) as well as family members of neonates with standardised cord care methods. Keywords: Neonates, Cord care, Umbilical cord,Methylated spirit.

Teknik Perawatan Tali Pusat terhadap Pelepasan Tali Pusat

The incidence of infection in newborns (BBL) in Indonesia is 24%-34%. Infection in BBL is the number 2 cause of neonatal death by 49%-60%. Neonatal mortality in developing countries is 50% due to umbilical cord infection, sepsis and neonatal tetanus. The purpose of this study was to analyze the effectiveness of umbilical cord care in newborns using dry open technique and sterile gauze against umbilical cord rupture. The type of research was pre-experimental post-test only design and the sample of this study was 30 newborns at the Puskesmas with purposive sampling technique. The study was conducted for 3 months. The results showed that the umbilical cord care technique with the dry open method made the umbilical cord detach faster than the sterile gauze method. The time for releasing the umbilical cord with the dry open method took 123.8 hours and the time for releasing the umbilical cord with sterile gauze took 170.8 hours. The results of the analysis showed the significance value of 0.004 and the Levin test result of 138%. Conclusion there is no more effective between sterile gauze and dry open umbilical cord treatment against umbilical cord detachment. Suggestions for midwives and health workers can socialize postpartum mothers in umbilical cord care for newborns using open techniques and sterile gauze.

Differences in the delivery of the corner in a baby who was bathed in warm water with a baby whipped in a wet tool at batara siang hospital of Pangkep District

WHO (2000), recommends umbilical cord care based on aseptic and dry principles and no longer recommended to use alcohol but with open care. The umbilical cord should also not be tightly closed with anything, because it will make it moist. In addition to slowing the release of the umbilical cord, it also poses a risk of infection. Even if you have to close. according to Taylor (2003, dalam Nopriyarti, 2013) cover or tie loosely at the top of the umbilical cord with sterile gauze. The research used quasi-experimental research. The design of this study used the Experimental Design- Equivalent Time Sample method, which is a quasi-experimental design by treating the experimental group (X1), namely taking a warm bath and the control group (X0), which was wiped with a wet towel, alternately with random determination (Suharsaputra, 2012). The mandatory output in this research is publishing international journals, while the additional output is publishing national journals it can be seen that the average length of umbilical cord detachment of infants who were bathed in warm water (experimental group) was 110.8 hours, while the average length of time to release the umbilical cord of infants who were wiped with a wet towel (control group) was 76.9 hours or 6.6 days. The average difference between the two groups is 24,72 hours. The results of the statistical test obtained a P-value (<0.001), meaning that at alpha 5% there was a significant difference in the average length of umbilical cord detachment between babies who were wiped with a wet towel, which was 2.01 days and babies who were bathed in warm water, which was 4,01 day. So that the treatment of babies who are wiped with a wet towel is more effective and the umbilical cord is removed faster than the care of babies who are bathed in warm water. There was a significant difference between the In umbilical cord care, there was a significant difference in the average length of umbilical cord detachment between babies who were wiped with a wet towel and babies who were bathed in warm water.

Perbedaan Lama Pelepasan Tali Pusat pada Metode Perawatan Tali Pusat Teknik Terbuka dan Tertutup di PMB “SF” Palangka Raya

Tetanus neonatorum is a disease in neonates caused by Clostridium Tetani spores that enter through the umbilical cord. Various attempts were made to reduce infection in the umbilical cord, one of which is the method of treatment performed on the umbilical cord. This study aims to determine the differences in the old cord release in cord care with open and closed techniques in PMB SF Palangka Raya City. This research design is a descriptive quantitative analytic method with the approach of the type of research used is "True Experiment" real experimental research using observation sheets. The samples used were babies born in SF PMB with 26 babies; the sampling technique used was the non-probability sampling technique, purposive sampling, while the analysis used was Chi-Square. From the study results, it was found that there was a significant difference in the length of umbilical cord release in the umbilical cord treatment method with open and closed techniques with an Exact Sig. (2-tailed) value of 0.011. So the Exact Sig. Value (2-tailed) 0.011 <0.05, then Ho is rejected. And umbilical cord care with the open method is 19 times more effective at accelerating the release of the umbilical cord than the closed umbilical cord treatment method.