Comparing the effect of Topical Application of Breast Milk, Chlorhexidine and Dry Cord Care Methods on Bacterial Colonization in Umbilical Cord of Preterm Neonates in NICU: a randomized clinical trial

Abstract

Background: Preterm neonates have a higher tendency in developing infections and their umbilical cord serves as a good environment for bacterial growth. Objective: The aim of this study was to compare the topical effects of breast milk, chlorhexidine and dry cord care methods on bacterial colonization of preterm neonates’ umbilical cord in the Neonatal Intensive Care Unit (NICU) Methods: The trial was one-centered, single-blind, and in phase 2 of clinical trials from Vali-e-Asr Educational Hospital, Birjand, Iran from January to June 2017. A sample of 75 preterm infants were recruited by convenience sampling method and assigned into one of the three groups of drying, chlorhexidine, and milk by using a table of random numbers (n=25 per group). Bacterial colonization and its density were assessed in all groups during the first 12 to 24 hours of admission, and again after 72 hours. A total of 25 subjects were entered in each group and the data were analyzed by Chi-square tests (Fisher's exact test), Kruskal–Wallis analysis, Wilcoxon test, McNemar's test, and ANOVA. Results: The bacteria colonized in the newborns of groups I, II, and III before and after intervention were 64% and 36% (p=0.03), 52 and 20% (p=0.008) and 64 and 32 (p=0.02) respectively. After the intervention, colonized bacteria were significantly decreased in all three groups. Conclusion: Based on the results of this study, all three methods of drying approach, use of chlorhexidine, as well as breast milk were effective in controlling bacterial colonization in the umbilical cord of preterm neonates. Although there were no significant differences between the three groups, ultimately the use of these methods could be effective in reducing the need for antibiotics. Trial registration: Prior to the study, the protocol of study was registered at Iran's Clinical Trials Registry (http://www.irct.ir) (Registration ID: IRCT2017090517756N27). Funding: The present study was funded fully by Birjand University of Medical Sciences (grant number: 455078).