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September 25, 2005
Newborn umbilical cords

Someone once told me, "never accept anything someone tells you, always look things up for yourself." In that spirit...

A two week old infant came into the office for a routine exam. During the physical exam, the physician took a look at the umbilical cord stump, said it looked fine, and advised the mother to keep it clean and dry, and to swab it with alcohol each time she changed the diaper. I remember being told while on the newborn service in peds that we no longer advise parents to swab the cord stump with alcohol...and thus arose the question of whether or not to swab?

Alcohol has long been recommended for both dessication and antibacterial purposes. If parents use Google for their information source, they'll find this page in Medline Plus from the NIH, which advises parents to swab the cord with alcohol, emphasizing the importance of squeezing the alcohol around the base of the stump. However, this study from the Journal of Perinatology found that among  infants randomized to either alcohol swabbing or natural drying, none suffered from local infection. Those whose cords were allowed to dry without the use of alcohol actually fell off a few days earlier as well (an average of 13 days postnatally compared to 16 days in the alcohol group.)

So what? So, this is one less thing we have to remind parents to do at their 2 week visit and it's one less thing parents have to worry about when bringing a newborn home.

Posted At : 3:01 PM. | Link | Rotation 1 05-06 | Comments (8)

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As a medical informatics student, I think this is a signficiant challenge in the field. How do we current information of evidence based medicine into the hands and minds of healthcare providers and patients?

I'm suprised you didn't mention <a href="http://jognn.awhonn.org/cgi/content/abstract/27/6/621">this study from the Journal of Obstetric, Gynecologic and Neonatal Nursing</a> that had 1811 participants (and similar results).

With these studies showing that alcohol is not necessary and actually seems to hinder results in terms of cord separation time, why is our trusted source of medical information still telling us otherwise? I am going to submit a comment recommending that they have a physician review the studies and the advice on that page.

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