Refika GENÇ KOYUCU, Yıldız TOSUN, Fadime ÇINAR

YENİDOĞAN GÖBEK BAKIMINDA KLORHEKSİDİN, İYOT VE ALKOLÜN KARŞILAŞTIRILMASI

Öz ÖZETAmaç:Her yıl 4 milyon bebek neonatal dönemde kaybedilmektedir. Bunların %30’dan fazlasında sebep infeksiyonlardır. Ev doğumları ve kötü hijyen şartları taşıyan kliniklerde gerçekleşen doğumlarda umbilikal güdüğün invaziv patojenler ile maruziyetinde artmış risk vardır. Bu çalışmada umbilikal güdük bakımında klorheksidin, alkol ve iyot uygulamalarının bakteriyel kolonizasyon ve göbek düşme zamanı üzerine etkilerinin değerlendirilmesi amaçlanmıştır.Yöntem:Bu randomize çalışma Nisan-Temmuz 2007 tarihleri arasında Taksim Eğitim ve Araştırma Hastanesi’nde gerçekleştirilmiştir. Termde doğumları gerçekleşen 90 yenidoğan klorheksidin, %70 alkol ve povidon iyodin gruplarına randomize edilmiştir. <37 hafta doğan yenidoğan vakalar çalışmaya alınmamıştır. Vakaların demografik verileri, kolonizasyon ve infeksiyon oranları, göbek düşme zamanları değerlendirilmiştir.Bulgular: 1.gün kolonizasyon oranları ve kordon düşme zamanları arasında farklılık izlenmemiştir. Beşinci günde göbek güdüğü kolonizasyon oranları klorheksidin grubunda anlamlı oranda düşüktür..Sonuç: Yüksek neonatal ölüm oranları olan bölgelerde ve ev doğumlarında hayatın ilk haftasında yenidoğan göbek bakımında klorheksidin uygulaması uygun seçenek olarak görülmektedir.Anahtar Kelimeler: Göbek bakımı; neonatal sepsis; omfalit; klorheksidinABSTRACTComparison of Chlorhexidine, Alcohol and Iyodin on Newborn Umbilical Cord CareAim: Each year an estimated four million babies die in the neonatal period. Of these more than 30% are caused by infections. There is an increased risk of serious neonatal infection arising through exposure of the umbilical cord to invasive pathogen in home and facility births where hygienic practices are difficult to achieve. The purpose of this study was to evaluate the effects of application of chlorhexidine (CHX), 70% alcohol and povidon iodine on cord colonization rates and umbilical cord fall off duration. Methods: This randomized study was conducted between April-July 2007 in Istanbul Taksim Training and Research Hospital Gynecology and Obstetrics Clinic. Neonates at term birth (90) randomized to chlorhexidine (CHX), 70% alcohol and povidon iodine groups. Infants who were delivered at < 37 weeks’ gestation were excluded. Demographic data, colonization rates and patterns of umbilical cord and infection rates were evaluated in these cases.Results: There were no statistically significant difference was detected in colonization rates at first day and mean cord seperation times. Significantly lower colonization rates were observed in CHX group at fifth days. Conclusion: To conclude, we recommend daily chlorhexidine application to the umbilical cord stump during the first week of life for newborns who are born at home in settings with high neonatal mortality.Keywords: Umblical cord care; neonatal sepsis; omphalitis; chlorhexidin

PDF

___

Ahn, Y., Sohn, M., Jun, Y., Lee, E. , Lee, S. Two methods of cord care in high-risk newborns: Their eff ects on hydration, temperature, ph, and fl oras of the cord area. J Child Health Care, 2013, 12: 2-10.
Arifeen SE, Mullany LE, Shah R, Mannan I, Rahman SM , Talukder MR, et all. The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: community based, cluster-randomised trial. Lancet 2012; 379 (9820): 1022-8.
Aydemir, H., Alpaslan, Ö., Demirel, Y. Comparison of the effects of 70% alcohol, 10% povidone-iodine and 0.4% chlorhexidine which are used in umbilical care on colonization and umbilical cord separation time. African Journal of Microbiology Research, 2012; 6(13): 3112-3118.
Blackburn ST. Immun System and Host Defence Mechanisms. In Blackburn ST ed. Maternal&Neonatal Physiology :A Clinical Perspective. 3rd ed. Missouri; Saunders Elsevier; 2007.p.497
Covas Mdel C, Alda E, Medina MS, Ventura S, Pezutti O, Paris de Baeza A, Sillero J, Esandi ME. Alcohol versus bath and natural drying for term newborns' umbilical cord care: a prospective randomized clinical trial. Arch Argent Pediatr. 2011 Aug;109(4):305-13
Gathwala, G., Sharma, D., Bhakhri, B. K. Eff ect of topical application of clorhexidine for umblical cord care in comparison with conventional dry cord care on the risk of neonatal sepsis: A randomized controlled trial. J Trop Pediatr, 2013; 59: 209-213.
Golshan, M., Hossein, N. Impact of ethanol, dry care and human milk on the time for umblical cord seperation. J Pak Med Assoc,2013, 63: 1117-1119
Golombek SG, Brill PE, Salice AL. Randomized trial of alcohol versus triple dye for umbilical cord care. Clin Pediatr (Phila). 2002 Jul-Aug;41(6):419-23.
James SR, Murray SS, Nelson K, Ashwill J. Health Promotion for the Infant. In McKinney ES ed. Maternal-Child Nursing, 4th Edition. WB Saunders,2012. p:403-8
Kapellen TM, Gebauer CM, Brosteanu O, Labitzke B, Vogtmann C, Kiess W. Higher rate of cord-related adverse events in neonates with dry umbilical cord care compared to chlorhexidine powder. Results of a randomized controlled study to compare efficacy and safety of chlorhexidine powder versus dry care in umbilical cord care of the newborn. Neonatology. 2009;96(1):13-8.
Kul M, Gürsel O, Gülgün M, Kesik V, Sarıcı SÜ, Alpay F. Sağlıklı term yenidoğanlarda farklı göbek bakımı uygulamalarının göbek düşme zamanı ve diğer klinik sonuçlar üzerine etkilerinin değerlendirilmesi. Türk Pediatri Arşivi 2005; 40(3): 227- 31
London ML, Ladewig PW, Ball, JW, Bindler RC. Umbilical Cord Care. Maternal & Child Nursing Care. 2nd ed. Pearson education inc. Upper Saddle River, New Jersey: 2007, p:2032.
Lawn JE, Cousens S, Zupan J. Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why? Lancet 2005;365(9462):891- 900.
Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000. Lancet 2012;379(9832):2151-61
Mahrous, S. E., Darwish, M. M., Dabash, A. S., Marie, I., Abdelwahab, F. S. Topical application of human milk reduces umbilical cord separation time and bacterial colonization compared to ethanol in newborns. Translatıonal Bıomedıcıne, 2012, 3: 1-8.
Maternal&Neonatal Physiology :A Clinical Perspective. Susan Tucker Blackburn. 3rd edition. Saunders Elsevier. Missouri. 2007
McConnell TP, Lee CW, Couillard M, Sherrill WW. Trends in umbilical cord care: Scientific evidence from practice. Newborn and Infant Nursing Reviews 2004;4(4): 211-22.
Mullany LC, Darmstadt GL, Khatry SK, Katz J, LeClerq SC, Shrestha S et al. Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial. Lancet 2006a March 18; 367(9514): 910-8.
Mullany LC, Darmstadt GL, Khatry SK, LeClerq SC, Katz J, Tielsch JM. Impact of umbilical cord cleansing with 4.0% chlorhexidine on time to cord separation among newborns in southern Nepal: a cluster-randomized, community-based trial. Pediatrics. 2006b Nov;118(5):1864-71.
Mullany LC, Shah R, El Arifeen S, Mannan I, Winch PJ, Hill A, Darmstadt GL, Baqui AH. Pediatrics. Chlorhexidine cleansing of the umblical cord and seperation time: A cluster-randomized trial.2013 Apr;131(4):708-15
Mullany LC, Darmstadt GL, Katz J, Khatry SK, LeClerq SC, Adhikari RK, et al. Risk factors for umbilical cord infection among newborns of southern Nepal. Am J Epidemiol. 2007 Jan 15;165(2):203-11.
Truque NJ, Tedeschi S, Saye EJ, McKenna BD, Langdon W, Wright JP, Alsentzer A, Arnold S, Saville BR, Wang W, Thomsen I, and Creech CB. Relationship Between Maternal and Neonatal Staphylococcus aureus Colonization. Pediatrics. 2012 May; 129(5): e1252-e1259.
Nourian, M., Allaii, F., Heidari, A. Comparison of the effect of alcohol 70% versus dry cord care on cord bacterial colonization & cord separation time among newborns. Pak J Med Sci, 2009, 25(1): 103-107.
Pezzati M, Rossi S, Tronchin M, Dani C, Filippi L, Rubaltelli FF. Umbilical cord care in premature infants: the effect of two different cord-care regimens (salicylic sugar powder vs chlorhexidine) on cord separation time and other outcomes. Pediatrics. 2003 Oct;112(4):e275.
Sharma, D., Gathwala, G. Impact of clorhexidine cleansing of the umblical cord on cord seperation time and neonatal mortality in comparison to dry cord carea nursery-based randomised conttrolled trial. Journal of Maternal-Fetal and Neonatal Medicine, 2013; 27(12): 1262-1265.
Soofi S, Cousens S, Imdad A, Bhutto N, Ali N, Bhutta ZA. Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based, cluster-randomised trial. Lancet 2012;379(9820):1029-36.
Suliman AK, Watts H, Beiler J, King TS, Khan S, Carnuccio M, et al. Triple dye plus rubbing alcohol versus triple dye alone for umbilical cord care. Clin Pediatr (Phila). Clin Pediatr (Phila). 2010 Jan;49(1):45-8.
Taplak AŞ, Bayat M. Yenidoğanlarda Göbek Bakımında Kanıta Dayalı Uygulamalar: Derleme. Evidence Based Practices for Umbilical Cord Care in Newborns: Review. F.N. Hem. Derg, 2015; 23(3): 252-261)
Türkiye Nüfus ve Sağlık Araştırması. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, Ankara, Türkiye, 2013. http://www.hips.hacettepe.edu.tr/tnsa2013/analiz.shtm l. Son erişim tarihi: 01.03.2017
Vural, G, Kisa, S. Umbilical cord care: A pilot study comparing topical human milk, povidone - iodine, and dry care. J Obstet Gynecol Neonatal Nurs. 2006 Jan-Feb;35(1):123-8.
World Health Organization, 2013. WHO Recommendations on Postnatal Care of the Mother and Newborn. 2013. http://apps.who.int/iris/bitstream/10665/97603/1/9789 241506649_eng.pdf
Zupan, J. Garner, P. Omari, A. Topical umbilical cord care at birth. Cochrane Database of Systematic Reviews, The Cochrane Library 19 JUL 2004. DOI: 10.1002/14651858.CD001057.pub2
Zenciroğlu A, Özbaş S. Yenidoğanın Göz, Göbek ve Ağız Bakımı. Temel Yenidoğan Bakımı. TC.Sağlık Bakanlığı, Türkiye Halk Sağlığı Kurumu, Çocuk ve Ergen Sağlığı Daire Başkanlığı, Ankara 2015, p:67-70