When I was a Young pediatrician there where many different but strong beliefs on the market, how to care for the Navel. In this time powder was used and bandages. Umbilical infections were not uncommon and in the older Textbooks of Pediatrics one could find Special chapters about umbilical infections. Since 30 years we let the Navel alone. We keep it dry and let it outside the Pamper. Since that time we cannot remember any case of umbilical infection. In my opinion it does not make any sense to begin a randomised study if strict no-treatment or treatment of the Navel with powder, ointments and bandages is preferable nore it is ethically justifiably.

Volker C.H. von Loewenich, MD, Prof. emeritus of Pediatrics. former Chief Dept. Neonatology, University Hospital Frankfurt am Main, Germany

I strongly support this prof. von Loewenich's statement since I have the same experience in my Unit in Croatia. We have about 3200 deliveries per year and treating the umbilical cord the same way which means keeping it clean and dry outside the diaper. About five years ago we used to disinfect the stump, and than we introduced no treatment. Now we have observed that umbilical infections as well as all other problems with umbilicus disappeared. Our community nurses are still reluctant concerning this way of no treatment, regardless of the fact that we give to all the mothers written recommendation of procedure with umbilical stump.

Thanks all for fruitful thoughts.

Do we have evidence for this advice "Use cotton wool moistened with boiled water and surgical spirits to clean the cord and surrounding area at each nappy change"

I advise the parents to minimize 'handling' of the cord - even if it has dried and ready to fall off. Care of the cord as far as possible should be preferably limited to keeping it exposed to air, not applying any sort of medication/ lotions or creams on the cord and keeping the surrounding area clean.

In case of an oozing stump - A simple touch with a crystal of rock salt (at home) is often the practice followed in this part of the country.

Me advise the parents to keep the umbilicus dry and not to apply any thing, in some parts of our country, due to spiritual reasons ash is applied and we strong discourage application of any thing because we often see cases of umbilicus infection leading to neonatal sepsis

The ideal is to leave the umbilical stump alone and keep it outside the pamper! However as a practitioner in a low resource country, with strong cultural beliefs and practices on cord care (some of them really dangerous) I still see and manage cases of umbilical sepsis. In view of strong culture by mothers to apply something, we have been encouraging mothers to use something safe: saline and emphasising the importance of hand washing before handling the baby. I work in a National referral facility with 33,000 deliveries a year but many women still deliver at home! So we still get cases of umbilical sepsis coming in from home.

One of the first things ALL carers should be doing is allowing the cord to stop pulsating before clamping and cutting it (this is evidence-based but so many hospitals are still clamping and cutting immediately after birth). Once that happens, and the Wharton's jelly hits the air, it "shrink-wraps" the vessels and no infectious material can ascend. For cord care after birth, just plain water has been shown to be sufficient and taking care not to catch the stump on anything which will traumatise it and cause it to bleed. Using any sort of disinfectant is not only not evidence-based, but can retard the decomposition of the stump so that it remains in situ for longer.

While in first world countries where most deliveries are in hospitals, the practice of "no care" is considered safe and supported by evidence, there is convincing evidence that in developing countries this is not the case.  

The Lancet, Volume 379, Issue 9820, Pages 1022 - 1028, 17 March 2012

doi:10.1016/S0140-6736(11)61848-5

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961848-5/abstract

For those of us who work in resource limited setting with a high risk of neonatal sepsis we need to be careful. For us in Kenya, after reviewing articles done in similar setting we agreed to advise application of chlorhexidine. It has since been put in the national guidelines.

In a Cochrane Systematic Review (Imdad et al 2013), the authors' conclusions were that: ' There is significant evidence to suggest that topical application of chlorhexidine to umbilical cord reduces neonatal mortality and omphalitis in community and primary care settings in developing countries. It may increase cord separation time however, there is no evidence that it increases risk of subsequent morbidity or infection.There is insufficient evidence to support the application of an antiseptic to umbilical cord in hospital settings compared with dry cord care in developed countries. '

Links:

Article Umbilical cord antiseptics for preventing sepsis and death a...

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008635.pub2/full