It is very important that a baby’s umbilical cord is well cared for, as infections of the umbilical cord stump have historically been a major cause of disease and death in newborn babies.
These infections can include funisitis (foul smelling, purulent discharge from the umbilical cord stump), omphalitis (infection of the umbilical cord stump), omphalitis with necrotizing fasciitis (more severe infection with sepsis and shock), and neonatal tetanus.
History of Umbilical Cord Care
Over the years, many things have been used to try and keep a newborn baby’s umbilical cord free of bacterial colonization until it falls off.
“To achieve the goal of preventing omphalitis worldwide, deliveries must be clean and umbilical cord care must be hygienic.”
AAP Umbilical Cord Care in the Newborn Infant – 2016
These substances include:
- triple dye
- isopropyl alcohol or rubbing alcohol
- povidone-iodine or iodopovidone (Betadine)
- chlorhexidine
- hexachlorophane
- antimicrobial ointments, such as neomycin and bacitracin
Remember when your baby came home from the nursery with his or her cord covered in purple dye? That was triple dye. It is rarely used anymore.
Umbilical Cord Care Recommendations
So what is used now that we don’t use triple dye?
Although many parents are still tempted to use alcohol, the main advice is now to ‘do nothing’ and just let the cord fall off.
That is not a universal recommendation though.
“Ensuring optimal cord care at birth and during the first week of life, including use of chlorhexidine, especially in settings having poor hygiene, is a crucial strategy to prevent life-threatening sepsis and cord infections and avert preventable neonatal deaths.”
Chlorhexidine Working Group
Why the different recommendations?
Because, in some countries, 10 to 20% of live births are still complicated by umbilical cord infections.
But if antiseptics can help keep the umbilical cord stump free of infections, why not just use them?
It is thought that using these antiseptics when they aren’t necessary, like when a baby is born in a hospital under hygienic conditions in a “high-resource country,” then they may:
- lead to the development of resistance and selection of “more virulent bacterial strains”
- cause the cord to take longer to fall off – especially if you applied alcohol to the stump at each diaper change
- waste money and resources
That’s why, when appropriate, it is now recommended that we practice dry cord care. And that’s great news, as it still seems like most parents don’t want to ever touch their baby’s umbilical cord stump!
Dry Cord Care
With dry cord care, you simply:
- keep the umbilical cord stump clean and dry (sponge baths only until the cord comes off)
- leave the umbilical cord stump exposed to air or loosely covered by a clean cloth (fold your baby’s diaper down, which will also help prevent the cord from getting soaked with urine)
- clean the umbilical cord stump with soap and sterile water if it does get soiled
- watch for signs and symptoms of omphalitis, including a foul smelling discharge, red skin around the umbilical cord, or if the cord or skin around it becomes tender
Keep in mind that dry cord care is likely not appropriate if your baby was born at home, was born in a “resource limited country” or community, or if you are putting any non-sterile products on the cord to ‘help’ it come off more quickly.
These natural products to avoid include clay, cord care powders, dried herbs, honey, and oils.
When should your baby’s cord come off? While the average time is about two weeks, it is usually not considered delayed unless it hasn’t fallen off by the time your baby is three or four weeks old.
What To Know About Umbilical Cord Care
Taking care of your baby’s umbilical cord stump is now easier than ever for most parents. Just keep it clean and dry and watch for signs of infection until it falls off.
More Information on Umbilical Cord Care
- AAP – Umbilical Cord Care
- Chlorhexidine for umbilical cord care
- Study – Topical Umbilical Cord Care for Prevention of Infection and Neonatal Mortality
- Study – Umbilical cord antiseptics for preventing sepsis and death among newborns
- Study – Impact of different antiseptics on umbilical cord colonization and cord separation time
Last Updated on March 26, 2017 by Vincent Iannelli, MD
