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Umbilical cord antiseptics for preventing sepsis and death among newborns

The umbilical cord connects the baby and mother during pregnancy. The cord is cut after birth. The cord stump then dries and falls off, generally within five to 15 days. Infection of the umbilical cord stump (omphalitis), caused by skin bacteria, is a significant cause of illness and death in newborn babies in developing countries. This review evaluated all studies that assessed antiseptics applied topically to the umbilical cord to determine if they reduce the risk of cord infection and death. Thirty‐four randomised controlled studies were included involving 69,338 babies. There were 22 different interventions studied. The most commonly studied antiseptics in the included studies were 70% alcohol, triple dye and chlorhexidine. Three studies were conducted in community settings in developing countries; the remainder were conducted in hospital settings, mostly in developed countries. Studies conducted in community settings were large and contributed about 78% of all the participants included in this review. Hospital‐based studies were small and had limitations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Community‐based intervention packages for preventing maternal and newborn illness and death so that newborn outcomes are improved

While maternal, newborn and under‐five child death rates in developing countries have decreased in the past two to three decades, newborn death rates have hardly changed. It is now recognised that almost half of newborn deaths can be prevented by tetanus toxoid immunisation of the mothers; clean and skilled care at the birth; newborn resuscitation; clean umbilical cord care; exclusive breastfeeding; and management of infections in the newborns. In developing countries, almost two‐thirds of births occur at home and only half are attended by a trained birth attendant. A large proportion of these maternal and newborn deaths and diseases can potentially be addressed by developing community‐based packaged interventions to integrate with local health systems.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Chlorhexidine skin care for prevention of mortality and infection in neonates

Infections are the single most important cause of neonatal deaths worldwide and are responsible for almost a third of all neonatal mortality. Affordable, feasible and efficacious interventions to reduce neonatal infections and improved neonatal survival are needed. Chlorhexidine, a broad spectrum antiseptic agent, is active against common organisms causing perinatal infections. Use of chlorhexidine on neonatal skin or cord, or both, for prevention of infection is a possible strategy to improve neonatal survival. In this review we assessed the effects of neonatal skin or cord care with chlorhexidine compared to routine care or no treatment on neonatal survival and infections in newborn infants born in the hospital or community.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Oxytocin in high versus low doses for augmentation of delayed labour

Women have different lengths of labour, with first labours lasting on average eight hours (and unlikely to last more than 18 hours) and second and subsequent labours lasting an average of five hours and unlikely to last more than 12 hours. Assessment of progress in labour takes into account not just cervical dilatation, but also descent and rotation of the fetal head and the strength, duration and frequency of contractions. Some evidence suggests that up to one‐third of women in their first labour experience delay. They are often given a synthetic version of the hormone oxytocin  to increase uterine contractions and shorten labour. Surprisingly for such a routine treatment, the ideal dose at which it should be given is not known, although some comparisons suggest that higher‐dose regimens of oxytocin could shorten labour and reduce the chance of caesarean section with an increase in the numbers of women having a spontaneous vaginal birth compared with lower‐dose regimens. However, there are potentially harmful side effects as oxytocin may cause the uterus to contract too quickly, and the baby to become distressed. Clinicians attempt to mitigate these side effects by adjusting the dose of oxytocin with the contractions to reduce the chances of the baby being distressed in labour.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

When should antibiotics be given to prevent infectious complications after cesarean birth?

People who undergo surgery are at risk of developing infections, which complicate their recovery. In order to prevent these infections and reduce complications, antibiotics are sometimes given as a preventative (or prophylactic) treatment. The antibiotics are generally given approximately 60 minutes before the operation so that adequate tissue concentrations are reached before the skin is cut. For cesarean deliveries however, the effect of the antibiotic on the baby has to be considered, and for this reason antibiotics have been administered to women after the baby’s umbilical cord is clamped. This may not allow for adequate tissue penetration in the mother for the prevention of surgery‐related infections; additionally deferring antibiotics may not benefit the newborn.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

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