Photo of a health worker providing umbilical cord care to a newborn while the mother watches.

Retiring the Chlorhexidine Issue Page: An Update from the HNN Editorial Team

When studies showing the efficacy of chlorhexidine digluconate (CHX), a broad spectrum antibiotic gel routinely placed on the umbilical cord to prevent infections, on reducing neonatal mortality were first released in the early 2000s, it was quickly adopted by the public health community as a “game-changer” for newborn health. Donors, implementing partners, and clinicians alike joined together to scale up the intervention in low- and middle-income countries. The World Health Organization (WHO) added it to its essential medicine list in 2013, and in 2014 included CHX in its guidance on umbilical cord care. National governments followed suit, adding chlorhexidine to their essential medicine lists and national protocols. CHX soon became the standard for umbilical care, especially in situations with high rates of home birth and neonatal mortality, or where harmful traditional substances are placed on the cord.

As part of the Healthy Newborn Network’s (HNN) mission to promote high-efficacy interventions in newborn health, we created a priority issue page for chlorhexidine to provide implementers, clinicians, and policy makers with a dedicated spot for up-to-date information to guide decisions. The issue page includes a tracker to monitor global scale up, as well as country-level data on use, supply chain, and policy status.

Research into chlorhexidine’s efficacy continued, however, and new studies indicated that chlorhexidine might not lower mortality as much as previously thought, especially in contexts with relatively low baseline newborn mortality rates. Additionally, supply chain issues, improper use resulting in eye and ear injuries, and improvements to global hygiene practices further complicated and slowed global scale up. When WHO updated their newborn care recommendations in 2022, CHX was included but only for use in circumstances where harmful traditional substances are placed on the umbilical cord.

While chlorhexidine digluconate is effective at preventing infection, it is just as effective as clean, dry umbilical cord care in most settings. As such, the HNN Team decided to retire the chlorhexidine for cord care page as a priority issue, and instead shift towards a more inclusive umbilical cord care page that incorporates the updated WHO guidance. The previous CHX page will remain active on our site for posterity, but it will not be updated moving forward. All new guidance, resources, and tools pertaining to CHX or umbilical cord care can be found on the new umbilical cord care page.

For more information, please contact the HNN Team.









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