Umbilical Cord Care: Soap May Be Risky

Jan. 8, 2003 -- The purplish remains of a newborn's umbilical cord may be unsightly on baby's belly, but the antibacterial dye that causes that discoloration may be the best protection against potentially dangerous bacteria. New research shows abandoning use of the triple-dye solution in favor of soap-and-water cleansing could increase the risk of infection of the baby's cord stump.

The study, published in the January issue of Pediatrics, shows that babies whose cord stumps were cleaned with soap and water rather than the antibacterial cleanser were much more likely to become colonized by bacteria such as E. coli and staph (such as Staphylococcus aureus), which could lead to serious infection and illness.

The use of the triple-dye solution became standard in the U.S. after epidemics of staph infections in hospital nurseries in the 1950s, but researchers say some Canadian hospitals have discontinued the use of the antibacterial in favor of alcohol and/or soap and water cleansing of the cord stump.

They say the change came after animal studies suggested that the dye solution may have toxic effects or cause cancer in animals. And some argue that recent changes in maternity care that allow newborns to stay in the same room as the mother reduce the risk of exposure to infection from other babies and caregivers and may make the treatment unnecessary.

Study author Patricia Janssen, PhD, assistant professor in the department of health care and epidemiology at the University of British Columbia in Canada, says parents have also complained about the unsightly appearance of the brittle, purple cord stumps on newborns who were treated with the triple-dye solution.

In their study, researchers compared the effects of standard treatment of two applications of the triple dye to the umbilical cord stump on the day of birth and continued alcohol swabbing until the stump fell off with dry care of the stump among 766 newborns. Dry care consisted of spot cleaning soiled skin in the umbilical area with soap and water and wiping it with a dry cotton swab or cloth and allowing the area to air dry.

The cord stumps were swabbed and tested after treatment, and the researchers found that infants in the dry care group were much more likely to have evidence of E. coli (34% vs. 22%) and staph (31% vs. 3%) than those who were treated with the antibacterial cleanser.

One infant in the dry care group was also diagnosed with a rare umbilical region infection known as omphalitis, which can lead to a rapidly spreading and deadly infection of the tissue under the skin -- a condition called necrotizing fasciitis.

"We don't want to terrify parents with this," says Janssen. "We just want to say that omphalitis still exists and has to be recognized. It has to be treated, and if it isn't then the baby can go on to become seriously ill."