Ensuring optimal umbilical cord care at birth and during the first week of life is a crucial strategy to prevent life-threatening sepsis and cord infections and avert preventable neonatal deaths.

The World Health Organization (WHO) recommends clean, dry umbilical cord care for all newborns, including those born in facilities, at home, and in humanitarian settings. Proper cord care includes using clean, sterile blades and ties, keeping the stump clean using soap and water, and drying thoroughly with a clean cloth after getting wet. In most settings, proper clean, dry umbilical cord care is sufficient to prevent infection.

However, in settings where harmful traditional substances are placed on the cord, WHO recommends using chlorhexidine digluconate in addition to clean, dry cord care. Chlorhexidine digluconate (CHX) is a broad-spectrum antiseptic that is available in a range of concentrations, and has been safely used for over 40 years for a variety of health-related applications. Its specific use for umbilical cord care was originally tested in three clinical trials in Nepal, Bangladesh, and Pakistan, in the form of 4% chlorhexidine, delivered through a 7.1% chlorhexidine digluconate gel. In 2013 the WHO added CHX to its Model List of Essential Medicines; and in 2014 the WHO issued guidelines on umbilical cord care, which included a formal recommendation on the use of chlorhexidine. This guidance was subsequently updated in 2022, reflecting the current recommendation for CHX use in certain settings.

CHX is the primary recommendation for settings where harmful traditional substances, such as oils, compresses, native plants, or other organic substances, are commonly placed on the umbilical cord. It was previously recommended for settings with high rates of home birth and neonatal mortality, where mothers, traditional birth attendants, and community health workers can be trained to administer CHX; as a result, this may be included as a recommendation in some national protocols.

In humanitarian settings, clean and dry umbilical cord care is the standard, but the use of chlorhexidine digluconate is also included as a recommendation in the Inter-Agency Field Manual for Reproductive Health in Humanitarian Settings (IAFM), the gold-standard for sexual and reproductive care in fragile and humanitarian settings. The IAFM includes CHX for cord care as a recommendation during the onset of emergencies, as part of the Minimum Initial Service Package (MISP), and as part of comprehensive maternal and newborn health (MNH) services. Additionally, chlorhexidine digluconate is included as a supplementary commodity in the Inter-Agency Reproductive Health Kits (RH Kits), which provide the supplies necessary to implement the MISP at the onset of a humanitarian response.

2.4m

Newborn lives claimed worldwide in 2020

7%

Of deaths caused by sepsis and other infectious conditions of the newborn in 2020*

*Represents the most recent data available. Please visit our Newborn Numbers page and download the Excel spreadsheet to explore the data further. 

Cautionary note

As with all medications, care must be taken to ensure that the product is used appropriately. 7.1% chlorhexidine digluconate for umbilical cord care should be kept out of eyes and ears and should be applied only to the umbilical stump.

Since 2015, there have been over 40 reported cases of incorrect administration of CHX in nine countries in sub Saharan Africa, specifically when CHX in both liquid and gel form have been mistaken for eye medication. In these reported cases, 7.1% chlorhexidine digluconate in both liquid and gel forms for umbilical cord care was mistakenly applied to the eyes, causing eye injury.   Chlorhexidine has been in use for over 40 years and has a well–characterized safety profile when used as directed. The formulation of chlorhexidine digluconate used for cord care (7.1% w/v), when used as directed, is effective in preventing neonatal sepsis due to bacterial exposure through the fresh umbilical stump.  However, it can cause serious harm if applied to the eyes and should also not be put into the ear canal. It is important that persons and organizations responsible for chlorhexidine for umbilical cord care programs and for the distribution of the chlorhexidine for umbilical cord care product to caregivers ensure that instruction is provided on the appropriate use of the product, including appropriate warnings.

Memorandum: Safety Concerns Over Misuse of Chlorhexidine (CHX)

Alert No. 133: Chlorhexidine 7,1% digluconate (CHX): Reports of serious eye injury due to errors in administration