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.

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.

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.

Community Tradition about Center Rope Care Using Powder and Oil For New-Born Babies

Newborn care is a process of deeds, ways of caring for and nurturing. The most important care of the umbilical cord is to make sure the umbilical cord and the area around it is always clean and dry and avoid infection. Always wash your hands using clean water and soap, before cleaning the umbilical cord. This study aims to analyze in depth the care of the umbilical cord using powder and oil in newborns in the Ajangale Community Health Center, Bone Regency. This type of research used in this research is qualitative research. Qualitative research is a study aimed at describing and analyzing phenomena, events, social activities, attitudes, beliefs, perceptions, thoughts of people individually or in groups. This research was conducted in the work area of ​​Arenaale Public Health Center, Bone District. The number of research subjects was 10 people. The results showed that the people of Ajangale Subdistrict in the care of newborns, especially the tradition of umbilical cord care using powder, were still practiced by several people who were believed to be able to accelerate dryness and detachment of the umbilical cord. There are still people in Ajangale who perform umbilical cord care using powder and oil which are considered to be able to accelerate the dryness of the umbilical cord and quickly release it.

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

Background: Umbilical-cord infection (omphalitis) is a major cause of neonatal mortality in Kenya. Chlorhexidine 7.1% digluconate gel, (CHX), delivering 4% chlorhexidine was identified as a life-saving commodity for newborn cord care by the United Nations and is included on the World Health Organization and Kenyan Essential Medicines Lists. Methods: We employed a cost-consequence model to assess resource saving and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Economic outcomes associated with omphalitis cases avoided were then 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). Treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Costs and other inputs were sourced from the literature and supplemented by expert clinical opinion/informed inputs, making assumptions as necessary. Reports: 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 of 5.43 USD/course when also 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 the impacts of upscaling CHX use more robust.

Chlorhexidine for facility-based umbilical cord care: EN-BIRTH multi-country validation study

Background Umbilical cord hygiene prevents sepsis, a leading cause of neonatal mortality. The World Health Organization recommends 7.1% chlorhexidine digluconate (CHX) application to the umbilicus after home birth in high mortality contexts. In Bangladesh and Nepal, national policies recommend CHX use for all facility births. Population-based household surveys include optional questions on CHX use, but indicator validation studies are lacking. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study assessing measurement validity for maternal and newborn indicators. This paper reports results regarding CHX. Methods The EN-BIRTH study (July 2017–July 2018) included three public hospitals in Bangladesh and Nepal where CHX cord application is routine. Clinical-observers collected tablet-based, time-stamped data regarding cord care during admission to labour and delivery wards as the gold standard to assess accuracy of women’s report at exit survey, and of routine-register data. We calculated validity ratios and individual-level validation metrics; analysed coverage, quality and measurement gaps. We conducted qualitative interviews to assess barriers and enablers to routine register-recording. Results Umbilical cord care was observed for 12,379 live births. Observer-assessed CHX coverage was very high at 89.3–99.4% in all 3 hospitals, although slightly lower after caesarean births in Azimpur (86.8%), Bangladesh. Exit survey-reported coverage (0.4–45.9%) underestimated the observed coverage with substantial “don’t know” responses (55.5–79.4%). Survey-reported validity ratios were all poor (0.01 to 0.38). Register-recorded coverage in the specific column in Bangladesh was underestimated by 0.2% in Kushtia but overestimated by 9.0% in Azimpur. Register-recorded validity ratios were good (0.9 to 1.1) in Bangladesh, and poor (0.8) in Nepal. The non-specific register column in Pokhara, Nepal substantially underestimated coverage (20.7%). Conclusions Exit survey-report highly underestimated observed CHX coverage in all three hospitals. Routine register-recorded coverage was closer to observer-assessed coverage than survey reports in all hospitals, including for caesarean births, and was more accurately captured in hospitals with a specific register column. Inclusion of CHX cord care into registers, and tallied into health management information system platforms, is justified in countries with national policies for facility-based use, but requires implementation research to assess register design and data flow within health information systems.