title: Impact of 4.0% chlorhexidine cord cleansing on the bacteriologic profile of the newborn umbilical stump in rural Sylhet District, Bangladesh: a community-based, cluster-randomized trial.
abstract: BACKGROUND
  Randomized trials from South Asia indicate umbilical cord chlorhexidine cleansing reduces mortality and omphalitis. No community-based data are available on bacteriological profile of the cord, early neonatal colonization dynamics, or impact of cord cleansing on colonizing organisms. Such data could clarify the design of scaled chlorhexidine interventions.
  
  
  METHODS
  Umbilical swabs were collected at home (days 1, 3, 6) after birth from infants participating in a trial of 3 cord-care regimens (no chlorhexidine, single cleansing, multiple cleansing) in Sylhet, Bangladesh. Overall and organism-specific positivity rates were estimated by cord-care regimen and by day of collection.
  
  
  RESULTS
  Between September 2008 and October 2009, 1923 infants contributed 5234 umbilical swabs. Positivity rate was high (4057 of 5234, 77.5%) and varied substantially across groups. Immediate (day 1) reductions in cord colonization were observed in single- (prevalence rate ratio = 0.75, 95% confidence interval: 0.70-0.81) and multiple- (prevalence rate ratio = 0.71, 95% confidence interval: 0.66-0.77) cleansing groups. Reductions persisted and increased in magnitude through day 6 only if babies received multiple applications. On days 1, 3, and 6, respectively, multiple cleansing consistently reduced invasive organisms such as Escherichia coli (49%, 64%, and 42% lower), Klebsiella pneumoniae (46%, 53%, and 33% lower), and Staphylococcus aureus (34%, 84%, and 85% lower).
  
  
  CONCLUSIONS
  Cord cleansing with 4.0% chlorhexidine immediately after birth reduces overall and organism-specific colonization of the stump. Reductions are greater and sustained longer with daily cleansing through the first week of life, suggesting that programs promoting chlorhexidine cleansing should favor multiple over single applications.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. lmullany@jhsph.edu
authors.forename: Luke C
authors.initials: LC
authors.lastname: Mullany
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: Rasheduzzaman
authors.initials: R
authors.lastname: Shah
authors.forename: Mohammad Shahidul
authors.initials: MS
authors.lastname: Islam
authors.forename: Mostafiz
authors.initials: M
authors.lastname: Rahman
authors.forename: Maksuda
authors.initials: M
authors.lastname: Islam
authors.forename: Radwanur Rahman
authors.initials: RR
authors.lastname: Talukder
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
mesh_terms: D000287:Administration, Topical; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D001459:Bangladesh; D002710:Chlorhexidine / Q000008:administration & dosage*; D003150:Community Health Workers; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D012424:Rural Population; D013048:Specimen Handling / Q000379:methods; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D016896:Treatment Outcome; D014470:Umbilical Cord / Q000382:microbiology*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine