Karachi: A commonly available antiseptic, chlorhexidine, can significantly reduce life-threatening infections in newborns and may also lower neonatal deaths in low- and middle-income countries, according to a large review of clinical trials, offering a simple intervention for settings where hygiene conditions remain poor.
A new review by the Cochrane has found that applying chlorhexidine to the umbilical cord stump likely reduces infection rates by around 29 percent and may also decrease newborn deaths, reinforcing existing recommendations for its use in high-risk settings.
Newborn infections remain a major public health challenge, particularly in developing countries. The World Health Organization estimates that around 2.3 million newborns died globally in 2023, with infections accounting for a substantial proportion of these deaths, especially in countries with limited access to clean delivery and postnatal care.
The researchers analysed 18 randomized controlled trials involving more than 143,000 newborns to assess whether antiseptic cord care could prevent infections and deaths compared to dry cord care or no treatment. The review included several antiseptics, including chlorhexidine, alcohol, povidone iodine and silver-based formulations.
The findings showed that chlorhexidine use could reduce infections from about 87 cases per 1,000 newborns to around 62 per 1,000, while deaths may decline from approximately 18 to 15 per 1,000 births in low-resource settings. However, the antiseptic was also found to slightly delay the natural separation of the umbilical cord by one to two days.
Experts say umbilical cord care is a critical but often overlooked aspect of newborn health, particularly in communities where deliveries take place at home or in environments with poor hygiene.
“In many parts of the world, newborns are still exposed to unhygienic conditions at birth, and simple, low-cost interventions can make a significant difference,” said Dr Aamer Imdad, the lead author of the review.
Current guidance from the WHO recommends dry cord care in settings with low neonatal mortality and adequate obstetric services, where the cord is kept clean and dry without applying antiseptics. However, in countries with higher neonatal mortality, daily application of 4 percent chlorhexidine for the first week of life is advised to reduce infection risks.
The review found limited and uncertain evidence regarding the effectiveness of other antiseptics such as alcohol, particularly in low-income settings. In higher-income countries, alcohol was found to delay cord separation but there was insufficient data to determine its impact on infections or mortality.
Senior author Zulfiqar Ahmed Bhutta said the findings support existing global guidelines but highlight the importance of tailoring interventions to local realities.
He noted that while dry cord care may be sufficient in well-resourced settings, antiseptic use can play a vital role in reducing infections where clean delivery practices cannot be ensured.
Public health experts say the findings are particularly relevant for countries like Pakistan, where neonatal infections continue to contribute to infant mortality, especially in rural and underserved areas. They emphasize that scaling up simple, evidence-based interventions such as chlorhexidine cord care could help save thousands of newborn lives each year.
The authors also pointed out gaps in data sharing across studies, noting that access to individual patient data could further strengthen evidence and help refine policies aimed at improving newborn survival.
Ends