Neonatal mortality and topical application of chlorhexidine on umbilical cord stump: a meta-analysis of randomized control trials.
OBJECTIVE
To examine the efficacy of topical chlorhexidine as an intervention on neonatal umbilical cord stumps and its association with neonatal mortality and omphalitis.


METHODS
Meta-analysis of randomized controlled trials (RCTs).


METHODS
PubMed, EMBASE, CINAHL, IMSEAR, Google Scholar, Cochrane Central Register of Controlled Trials, Cochrane Pregnancy and Childbirth Group's Trials Register and Clinicaltrials.gov were screened until September 1, 2015 to identify RCTs that met the inclusion criteria. Pooled relative risks (RR) with 95% confidence intervals (CI) were calculated.


RESULTS
Five RCTs, conducted in Italy, Bangladesh, Nepal, Pakistan and India with a total of 55,008 participants were identified. Analysis revealed a significant reduction in the incidence of neonatal mortality among the intervention group as compared to the control group (pooled RR = 0.8; 95% CI: 0.6-1.0; P = 0.04; random effects model, I2= 58%; χ2= 9.5; P = 0.05). Additionally, decreased incidence in omphalitis was seen in the intervention group as compared to the control group (pooled RR = 0.4; 95% CI: 0.3-0.7; P < 0.001; random effects model, I2= 50%; χ2= 8.0; P = 0.09).


CONCLUSIONS
Application of chlorhexidine to newborn umbilical cord stumps, significantly reduce the incidences of both neonatal mortality and omphalitis. However, high-quality trials from different regions and obstetric settings may help form more conclusive judgement on universal application of topical chlorhexidine.
Section of Population Oral Health, Columbia University, College of Dental Medicine, 630W, 168st, 17th floor, suite 306, New York, NY 10032, USA. Electronic address: jas2400@cumc.columbia.edu.
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Shariff
Columbia University, College of Dental Medicine, 630W, 168st, 8th Floor, New York, NY 10032, USA. Electronic address: kcl2136@cumc.columbia.edu.
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Lee
Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, 22nd Floor, New Orleans, LA 70112, USA. Electronic address: aleyton@tulane.edu.
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Leyton
Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA. Electronic address: sabdalal@tulane.edu.
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Abdalal
D000287:Administration, Topical; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001459:Bangladesh / Q000453:epidemiology; D002710:Chlorhexidine / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D009390:Nepal / Q000453:epidemiology; D010154:Pakistan / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D014470:Umbilical Cord
D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
Chlorhexidine; Meta-analysis; Neonatal mortality; Omphalitis