When I took my maternal/child class, ATI and our textbook taught us that alcohol is still applied to newborns' umbilical cord stumps to keep them clean and prevent infection.
However, my theory teacher taught us that recent research studies have shown that the umbilical cord stumps actually fall off sooner if alcohol is NOT applied, and that alcohol is not necessary to keep the stump clean. In the hospital, it seemed that the obstetric nurses all had different views on this topic. :smackingf
What are all of you taught in school on this topic? RNs: what do you practice in your hospital?
Specializes in Gerontological, cardiac, med-surg, peds.
as nurses providing competent care, we need to follow the latest research evidence, as well as the advice from expert clinicians, and avoid merely following tradition or the anecdotal advice of others. this is called evidence-based practice and is the gold-standard for the care that we provide. that said, you should always follow what your facility's policy and procedure manual states.
here is an excellent article from medscape which discusses some research findings on this topic:
isopropyl alcohol (alcohol) is widely used for cord care. it usually evaporates before it is absorbed by normal skin. cases of acute alcohol toxicity in infants up to 21 days old have been reported after generous applications of alcohol to the umbilical stump and one case where the parents placed a dressing of alcohol under an occlusive barrier (occlusion) over the umbilical stump.[color=#004276][29] toxicities from alcohol absorption include hemorrhagic skin necrosis, dysfunction of the central nervous system, metabolic acidosis, and hypoglycemia.[color=#004276][30] physicians and nurse practitioners should limit or avoid the use of alcohol for cord care if possible despite its comfortable familiarity.[color=#004276][29,30]
in one study of an alcohol cord care regimen, umbilical cord cultures showed a dramatic increase in bacterial colonization almost immediately after a perinatal unit initiated the new alcohol cord care regimen. approximately 6 months after implementation of the new alcohol cord care regimen, physicians in the community, who were unaware of the change in hospital practices, reported an increase in the number of infant skin infections. all cases cultured positive for staphylococcus aureus .[color=#004276][24] ....
despite the fact that several researchers recommend natural healing over antimicrobial treatment of the umbilical stump,[color=#004276][1,2] it is important to be certain that the risks of not using prophylactic treatment for infection are not forgotten. at this time, it seems premature to completely abandon the use of all antimicrobials without further research. yet, it is imperative to be sure that current practices are based on evidence rather than historical practice. many aspects of the health care setting have changed since the practice of umbilical cord care was established in the 1950s. regardless of the current cord care practice in use, it is important to educate clients on the proper topical application and care of the umbilical stump, as well as the risks and benefits of any cleansing agent used and symptoms of adverse or toxic effects associated with the cleansing agent. teaching should also include education regarding the normal appearance of the umbilical stump (especially if a "drying" agent is not utilized), local and general signs and symptoms of infection, and expected length of time for cord separation to occur. to provide evidence-based evaluation of practices related to umbilical cord care, additional research is recommended to include comparisons of current cord care practices, natural healing, as well as outcome studies following implementation of teaching strategies.
conclusion: triple dye delayed time to cord separation and was less satisfactory. the authors conclude that using alcohol or dry clean could be alternative ways of umbilical cord care at home.
objective: to compare the incidence of omphalitis among three groups, each using a different type of newborn cord care: povidone-iodine, dry care, and topical human milk.
design: case control.
setting: a large urban university hospital in turkey and participant homes after discharge.
participants: 150 healthy, full-term newborns and their mothers.
interventions: umbilical cord care consisted of one of three methods: topical application of povidone-iodine twice daily, topical application of mother's milk twice daily, or dry care (keeping the cord dry and clean).
main outcome measure: outcome was measured in terms of the presence or absence of omphalitis and the number of days elapsed before cord separation. an ongoing questionnaire was administered by telephone every other day after the participants left the hospital. in addition to demographic information, the cord separation day and any signs of omphalitis were recorded in the questionnaire.
results: there were no significant differences between the three groups in terms of omphalitis occurrence. two cases of omphalitis were observed (one in the human milk group, one in the povidone-iodine group). interestingly, babies in the dry care or topical human milk group had shorter cord separation times than those in the povidone-iodine group.
conclusion: the cultural practice of applying human milk to the umbilical cord stump appears to have no adverse effects and is associated with shorter cord separation times than are seen with the use of antiseptics. jognn, 35, 123-128; 2006. doi: 10.1111/j.1552-6909.2006.00012.x
VickyRN, MSN, DNP, RN
49 Articles; 5,349 Posts
as nurses providing competent care, we need to follow the latest research evidence, as well as the advice from expert clinicians, and avoid merely following tradition or the anecdotal advice of others. this is called evidence-based practice and is the gold-standard for the care that we provide. that said, you should always follow what your facility's policy and procedure manual states.
here is an excellent article from medscape which discusses some research findings on this topic:
trends in umbilical cord care: scientific evidence for practice: benefits and risks of cleansing agents
http://www.medscape.com/viewarticle/497030
another more recent research article on the subject of umbilical cord care:
a randomized study of 3 umbilical cord care regimens at home in thai neonates: comparison of time to umbilical cord separation, parental satisfaction and bacterial colonization
http://74.125.155.132/scholar?q=cache:dlwqacgoldwj:scholar.google.com/+umbilical+cord+care&hl=en&as_sdt=0,34
and yet another:
umbilical cord care: a pilot study comparing topical human milk, povidone-iodine, and dry care
http://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.2006.00012.x/full