Alcohol On Umbilical Cord: Safe Or Not?

The use of alcohol to clean and dry the umbilical cord stump of newborns has been a traditional practice. However, recent studies have compared the effectiveness of alcohol application with dry cord care, which involves keeping the umbilical stump clean and dry without applying any antiseptics, dyes, or antibiotics. While alcohol application may prolong the cord separation time, dry cord care is found to be a safe, straightforward, and cost-effective method, especially in high-income hospital settings. The choice between alcohol and dry cord care has implications for neonatal health, economic considerations, and parental satisfaction.

Alcohol application is associated with longer cord separation time

Alcohol has traditionally been used to clean newborns' umbilical cords. However, recent studies have shown that alcohol application is associated with longer cord separation time.

A case-control study conducted in Italy compared two umbilical cord care procedures: dry cord care and 70% alcohol. Dry cord care involves keeping the umbilical stump clean and dry without applying any antiseptics, dyes, or antibiotics. The study found a significant difference in the mean cord separation time between the two groups, with the dry cord care group having a shorter separation time of 10.1 days (standard deviation of 4.0) compared to 12.0 days (standard deviation of 4.2) for the 70% alcohol group.

Another systematic review and meta-analysis of randomized and non-randomized studies also found that alcohol application was significantly associated with longer cord separation time. The results showed that cord separation time was longer when 70% alcohol was topically applied compared to dry cord care.

The longer cord separation time associated with alcohol application may pose some challenges. Delayed cord separation can result in increased frequency of domiciliary midwife visits, mothers' dissatisfaction or anxiety, and potential economic and social implications. Additionally, the risk of cord infection and irritation increases with delayed cord detachment.

While alcohol application has been associated with longer cord separation time, it is important to note that the risk of developing omphalitis and sepsis is similar with both alcohol application and dry cord care. However, dry cord care may be associated with a higher risk of E-coli colonization and the presence of foul odor. Ultimately, the decision to use alcohol or dry cord care depends on various factors, including medical advice, personal preference, and cultural practices.

Dry cord care is cheaper and simpler

Dry cord care is a simple and effective way to shorten CST (cord separation time), especially in countries with limited resources. It is a procedure in which the umbilical stump is kept clean and dry without applying anything – no dye, antiseptic, or antibiotic. In a study, a sterile gauze was applied only on the first day of life to absorb bloody secretions. This method was found to be superior to alcohol use, shortening CST when compared to chlorhexidine application (4.24 days versus 5.32 days).

Dry cord care is also associated with lower costs. Alcohol application can delay cord separation, increasing the frequency of domiciliary midwife visits to the home. This can result in economic and social implications, as well as mothers' dissatisfaction and anxiety.

In terms of safety, dry cord care is a safe method for handling the umbilical cord in healthy newborn infants born in a high-income hospital setting. There were no significant differences found in the risk of omphalitis between dry cord care and alcohol application. However, dry cord care was associated with a higher risk of E-coli colonization and the presence of a foul odour.

Overall, dry cord care is a simpler, cheaper, and effective alternative to alcohol application for umbilical cord care in newborns. It is a straightforward method that can shorten CST and is safe for healthy newborns in high-income settings. While there is a higher risk of foul odour and E-coli colonisation, the absence of antiseptics or other substances means it is already approved by the scientific community.

Alcohol use may increase the risk of cord infection

While there is a long-standing tradition of cleaning a newborn's umbilical cord with rubbing (isopropyl) alcohol, studies suggest that alcohol use may not be necessary and may even increase the risk of cord infection.

In a case-control study in Italy, researchers compared two umbilical cord care procedures: dry cord care and 70% alcohol. Dry cord care involves keeping the umbilical stump clean and dry without applying any antiseptics, dyes, or antibiotics. The study found that while alcohol application was associated with a longer cord separation time, there was no significant difference in the risk of omphalitis between the two groups.

Another systematic review and meta-analysis of randomized and non-randomized studies compared the use of alcohol and dry cord care in newborns. The results showed that alcohol use was associated with a longer cord separation time compared to dry cord care and other preparations, such as triple dye and 1% basic fuchsin. However, the risk of developing omphalitis and sepsis was similar between the two groups.

It is important to note that inadequate cord care is a significant modifiable risk factor for cord stump infection, sepsis, and neonatal death, especially in countries with limited resources. While alcohol application has been traditionally used, dry cord care has been found to be a less expensive, effective, and straightforward approach to enhancing cord separation and reducing the risk of infection.

Additionally, alcohol has been shown to lower the body's ability to fight infections. Even a single drink can temporarily decrease immune function, making individuals more susceptible to infections. Therefore, the use of alcohol on the umbilical cord may further increase the risk of cord infection and potentially lead to adverse health outcomes in newborns.

Dry cord care is associated with foul odour and E-coli colonisation

The umbilical cord connects the baby and placenta in the uterus (the womb) and is made of blood vessels and connective tissue. It is covered by a membrane that is normally bathed in amniotic fluid. After birth, the cord is physically cut, separating the mother and baby. The cord stump dries, falls off, and the wound heals. The cord usually separates between 5 and 15 days after birth, although this can be as early as a few days after birth and as late as 6 weeks.

Traditionally, it was common to clean a newborn's umbilical cord with rubbing (isopropyl) alcohol. However, studies suggest that alcohol use may not be necessary and that dry cord care is a safe and effective method of cord care. Dry cord care involves keeping the umbilical stump clean and dry without applying anything to it, including antiseptics, dyes, or antibiotics. A sterile gauze may be applied to the base of the cord on the first day of life to absorb bloody secretions.

A study comparing 70% alcohol application to dry cord care found that alcohol application was associated with a longer cord separation time (12.0 days compared to 10.1 days for dry cord care). The study also found no significant difference in the occurrence of adverse events between the two groups. Another study found that dry cord care was superior to alcohol use in shortening cord separation time when compared to chlorhexidine application (4.24 days versus 5.32 days).

While dry cord care is generally considered safe and effective, it is important to note that it has been associated with a higher risk of E-coli colonisation and the presence of a foul odour. This may be due to the increased risk of cord infection and irritation associated with delayed cord detachment. Inadequate cord care can lead to serious complications such as intra-abdominal abscesses, thrombophlebitis, peritonitis, and bowel ischemia. Therefore, it is crucial to follow proper cord care procedures and seek medical advice if there are any concerns or signs of infection, such as redness, tenderness, or warmth around the cord stump area.

Alcohol application may reduce the risk of omphalitis and sepsis

The umbilical cord connects the baby and mother during pregnancy and is cut after birth. The cord stump then dries and falls off, generally within five to 15 days. However, delayed cord separation may pose economic and social implications and increase the risk of cord infection. In low-income countries, cord infections occur in approximately 8% of infants born in hospitals, increasing to 22% in infants born at home, with an estimated sepsis rate of 2% in Pakistan.

In the past, it was traditional to clean a newborn's umbilical cord with rubbing (isopropyl) alcohol. However, studies show that alcohol application does not make a difference in the risk of omphalitis compared to dry cord care. Dry cord care is a method in which the umbilical stump is kept clean and dry without applying anything, including antiseptics, dyes, or antibiotics.

While alcohol application does not reduce the risk of omphalitis, it is advantageous in reducing the risk of bacterial colonisation by Enterococcus coli compared to dry cord care. Alcohol application also increases cord separation time, which may be beneficial in reducing the risk of sepsis.

Overall, the decision to use alcohol application on the umbilical cord is a matter of personal preference, as it may offer some benefits but is not essential.

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