Cutting the Cord: A New Way to Save Newborn Lives

Written by Gary Darmstadt,Saul Morris and Wendy Prosser for Impatient Optimists. Photo: Nepal, the ONE campaign and Living Proof.

According to two new studies released in The Lancet today, there’s one more way to save the lives of newborns in our poorest countries. And it’s as simple as cleaning the umbilical cord with a specific antiseptic called chlorhexidine.

First, here’s some background. The umbilical cord is nothing short of a “lifeline,” delivering nutrients and oxygen to help keep a fetus healthy. But, following a baby’s birth after it’s been cut, the cord can also be a very vulnerable site for infection, particularly in low-income settings where deliveries often take place at home under unsanitary conditions. In fact, infection in a newborn can lead to his or her death within the first month of life.

Each year almost one million newborns die as a result of infections, and what is completely unacceptable is that most of these deaths occur in low- and middle-income countries - and are preventable.

So why don’t all babies have the same chance at life?

Many countries recommend letting the umbilical stump heal on its own while keeping it clean but applying nothing. This method was proven effective in numerous studies. However, those studies were all done in hospital settings and in high-income countries. They were not done in rural areas with unhygienic conditions where the majority of women deliver their babies at home with a birth attendant that has had only very basic training.

Essentially, these studies were not done where most of the newborns are dying.

The results of the new studies may change the way we care for newborn umbilical cords in these settings. Studies in Pakistan and Bangladesh showed a significant reduction in neonatal mortality by cleansing the umbilical cord with the antiseptic called chlorhexidine. These community-based interventions used frontline health workers to deliver this product to new moms and babies in their homes.

In Pakistan, the study found that when the umbilical cord was cleansed with chlorhexidine, in contrast to the more traditional “dry cord care,” the death rate decreased by 38 percent. Bangladesh found similar results. This percentage still represents too many babies dying, especially if your baby is one of them. However, the news is encouraging—here’s an extremely inexpensive and simple practice that can help lower the risk of infection substantially.

The results of these studies confirm a previous study in Nepal, which also showed that using chlorhexidine for cord cleansing reduces infection (up to about 75 percent) and neonatal mortality (by 24 percent).

The findings could also have substantial implications for newborn care in other areas of the globe that share similar cultural, social, and economic characteristics—such as India. Further studies on this intervention are going on now in sub-Saharan Africa now.

Chlorhexidine is already used as an antiseptic for general skin cleansing, pre-operative skin preparation, and as a substance in oral rinses. It’s even on the World Health Organization’s “Essential Medicine List.” With the results of these new studies, it’s now time to consider including it for umbilical cord stump care in South Asia, where it’s been shown to work.

We may be one policy change away from saving millions of newborn lives.