title: Risk of mortality subsequent to umbilical cord infection among newborns of southern Nepal: cord infection and mortality.
abstract: BACKGROUND
  Neonatal sepsis may stem from local umbilical cord infections. Signs of cord infection are common in low-resource settings, yet the risk of mortality subsequent to these signs has not been quantified in either developed or developing countries. We compared the risk of mortality between infants with and without signs of umbilical cord infection during a community-based trial of chlorhexidine interventions in southern Nepal.
  
  
  METHODS
  Newborns were evaluated for signs of umbilical cord infection (pus, redness, swelling). A nested case-control approach was used to estimate the odds of mortality between infants with and without umbilical cord infection as defined by various levels of severity. For each death in the parent trial, 10 controls were selected, matched on sex, treatment group, and number of cord assessments. The main outcome measures were all-cause and sepsis-specific mortality.
  
  
  RESULTS
  Among 23,246 assessed infants, there were 392 deaths. Odds of all-cause mortality were 46% (8-98%) higher among infants with redness extending onto the abdominal skin. A nonsignificant increased odds of mortality [odds ratio (OR): 2.31; 95% confidence interval (CI): 0.66-8.10] was observed among infants with severe redness and pus. Infections occurring after the third day of life were associated with subsequent risk of all-cause (OR: 3.11; 95% CI: 1.68-5.74) and sepsis-specific (OR: 4.63; 95% CI: 2.15-9.96) mortality.
  
  
  CONCLUSIONS
  This study provides evidence that common local signs of cord infection are associated with increased risk of mortality. Where exposure of the umbilical cord to potentially invasive pathogens is high, interventions to increase hygienic care of the cord should be promoted and including hand washing, avoiding harmful topical applications, and topical cord antisepsis.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. lmullany@jhsph.edu
authors.forename: Luke C
authors.initials: LC
authors.lastname: Mullany
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.forename: Steven C
authors.initials: SC
authors.lastname: Leclerq
authors.forename: Ramesh K
authors.initials: RK
authors.lastname: Adhikari
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
mesh_terms: D001424:Bacterial Infections / Q000382:microbiology / Q000401:mortality*; D016022:Case-Control Studies; D006801:Humans; D007231:Infant, Newborn; D009390:Nepal / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D014470:Umbilical Cord / Q000382:microbiology*