BACKGROUND: Neonatal sepsis may stem from local umbilical cord infections. Signs of cord infection are common in low-resource settings, yet the risk of mortality subsequent to these signs has not been quantified in either developed or developing countries. We compared the risk of mortality between infants with and without signs of umbilical cord infection during a community-based trial of chlorhexidine interventions in southern Nepal. METHODS: Newborns were evaluated for signs of umbilical cord infection (pus, redness, swelling). A nested case-control approach was used to estimate the odds of mortality between infants with and without umbilical cord infection as defined by various levels of severity. For each death in the parent trial, 10 controls were selected, matched on sex, treatment group, and number of cord assessments. The main outcome measures were all-cause and sepsis-specific mortality. RESULTS: Among 23,246 assessed infants, there were 392 deaths. Odds of all-cause mortality were 46% (8-98%) higher among infants with redness extending onto the abdominal skin. A nonsignificant increased odds of mortality [odds ratio (OR): 2.31; 95% confidence interval (CI): 0.66-8.10] was observed among infants with severe redness and pus. Infections occurring after the third day of life were associated with subsequent risk of all-cause (OR: 3.11; 95% CI: 1.68-5.74) and sepsis-specific (OR: 4.63; 95% CI: 2.15-9.96) mortality. CONCLUSIONS: This study provides evidence that common local signs of cord infection are associated with increased risk of mortality. Where exposure of the umbilical cord to potentially invasive pathogens is high, interventions to increase hygienic care of the cord should be promoted and including hand washing, avoiding harmful topical applications, and topical cord antisepsis.
BACKGROUND:Neonatal sepsis may stem from local umbilical cord infections. Signs of cord infection are common in low-resource settings, yet the risk of mortality subsequent to these signs has not been quantified in either developed or developing countries. We compared the risk of mortality between infants with and without signs of umbilical cord infection during a community-based trial of chlorhexidine interventions in southern Nepal. METHODS: Newborns were evaluated for signs of umbilical cord infection (pus, redness, swelling). A nested case-control approach was used to estimate the odds of mortality between infants with and without umbilical cord infection as defined by various levels of severity. For each death in the parent trial, 10 controls were selected, matched on sex, treatment group, and number of cord assessments. The main outcome measures were all-cause and sepsis-specific mortality. RESULTS: Among 23,246 assessed infants, there were 392 deaths. Odds of all-cause mortality were 46% (8-98%) higher among infants with redness extending onto the abdominal skin. A nonsignificant increased odds of mortality [odds ratio (OR): 2.31; 95% confidence interval (CI): 0.66-8.10] was observed among infants with severe redness and pus. Infections occurring after the third day of life were associated with subsequent risk of all-cause (OR: 3.11; 95% CI: 1.68-5.74) and sepsis-specific (OR: 4.63; 95% CI: 2.15-9.96) mortality. CONCLUSIONS: This study provides evidence that common local signs of cord infection are associated with increased risk of mortality. Where exposure of the umbilical cord to potentially invasive pathogens is high, interventions to increase hygienic care of the cord should be promoted and including hand washing, avoiding harmful topical applications, and topical cord antisepsis.
Authors: L C Mullany; G L Darmstadt; J Katz; S K Khatry; S C LeClerq; R K Adhikari; J M Tielsch Journal: Arch Dis Child Fetal Neonatal Ed Date: 2005-10-13 Impact factor: 5.747
Authors: James V Freeman; Parul Christian; Subarna K Khatry; Ramesh K Adhikari; Steven C LeClerq; Joanne Katz; Gary L Darmstadt Journal: Paediatr Perinat Epidemiol Date: 2005-07 Impact factor: 3.980
Authors: James M Tielsch; Gary L Darmstadt; Luke C Mullany; Subarna K Khatry; Joanne Katz; Steven C LeClerq; Shardaram Shrestha; Ramesh Adhikari Journal: Pediatrics Date: 2007-01-08 Impact factor: 7.124
Authors: Luke C Mullany; Gary L Darmstadt; Subarna K Khatry; Joanne Katz; Steven C LeClerq; Shardaram Shrestha; Ramesh Adhikari; James M Tielsch Journal: Lancet Date: 2006-03-18 Impact factor: 79.321
Authors: Sarah Saleem; Dwight J Rouse; Elizabeth M McClure; Anita Zaidi; Tahira Reza; Y Yahya; I A Memon; N H Khan; G Memon; N Soomro; Omrana Pasha; Linda L Wright; Janet Moore; Robert L Goldenberg Journal: Obstet Gynecol Date: 2010-06 Impact factor: 7.661
Authors: Hannah Blencowe; Simon Cousens; Luke C Mullany; Anne C C Lee; Kate Kerber; Steve Wall; Gary L Darmstadt; Joy E Lawn Journal: BMC Public Health Date: 2011-04-13 Impact factor: 3.295
Authors: Aamer Imdad; Luke C Mullany; Abdullah H Baqui; Shams El Arifeen; James M Tielsch; Subarna K Khatry; Rasheduzzaman Shah; Simon Cousens; Robert E Black; Zulfiqar A Bhutta Journal: BMC Public Health Date: 2013-09-17 Impact factor: 3.295
Authors: Luke C Mullany; Shams El Arifeen; Peter J Winch; Rasheduzzaman Shah; Ishtiaq Mannan; Syed M Rahman; Mohammad R Rahman; Gary L Darmstadt; Saifuddin Ahmed; Mathuram Santosham; Robert E Black; Abdullah H Baqui Journal: BMC Pediatr Date: 2009-10-21 Impact factor: 2.125
Authors: Aamer Imdad; Resti Ma M Bautista; Kathlynne Anne A Senen; Ma Esterlita V Uy; Jacinto Blas Mantaring; Zulfiqar A Bhutta Journal: Cochrane Database Syst Rev Date: 2013-05-31