Yenidoğanlarda Göbek Bakımında Kanıta Dayalı Uygulamalar: Derleme

Yenidoğan enfeksiyonları içerisinde önemli bir yere sahip olan göbek güdüğü enfeksiyonlarından, yenidoğanları korumada verilecek göbek bakımı önemlidir. Bu çalışmada yenidoğan göbek bakımında kullanılan uygulamalar ve bu uygulamaların etkinliklerinin karşılaştırılmaları ile ilgili bilgiler bilimsel kanıtlardan yararlanılarak sunulmuştur. Bunun için taramalar "Pubmed, Cohrane Library ve Science Direct' den", "Yenidoğan" sözcüğü için "Neonatale", "Newborn" ya da "Infant" ve "Göbek bakımı" için, "Umblical Cord Care" anahtar kelimeleri kullanılarak gerçekleştirilmiştir. 2008-2013 yılları arasındaki randomize kontrollü, çift kör randomize kontrollü ve küme randomize kontrollü; toplum ya da hastane tabanlı, deneysel ya da yarı deneysel çalışmalar incelenmiş olup toplam 21 araştırma çalışma kapsamına alınmıştır. Bu araştırmalardan yola çıkılarak özellikle son beş yılda göbek bakımında en sık kullanılan uygulamalar (Alkol, Povidon İyot, Klorheksidin, Üçlü Boya, Eozin, Topikal Antibakteriyal Ajanlar, Salisilik Şeker Tozu, Zeytinyağı, Anne Sütü ve Doğal Kurumaya Bırakma) hakkında bilgiler sunulmuştur.Kanıta dayalı araştırma ve rehberler doğrultusunda göbek güdüğü bakımında gelişmiş ülkelerde doğal kuruma yöntemi ve özellikle az gelişmiş ve gelişmekte olan ülkelerde ise Klorheksidin kullanımı etkili bir yöntemdir. Ancak göbek bakımında en etkili, en güvenilir ve daha düşük maliyetli yöntemin tespiti için Klorheksidin'in anne sütü, zeytinyağı gibi yöntemlerle kıyaslandığı çalışmalara gerek vardır. Hemşireler bu alanda çalışmalar yaparak bakımın kalitesine ve hemşireliğin bilimsel birikimine katkı getirebilirler.

Evidence Based Practices for Umbilical Cord Care in Newborns: Review

Umbilical cord care has an important place to protect newborns umbilical cord infections which has an important place among neonatal infections. In the present study, practices in newborn umbilical cord care and information about comparisons of those practices' eff iciency were presented by scientific evidences. Search was done on "Pubmed, Cohrane Library and Science Direct databases with the following keywords; "Neonatal", "Newborn" or "Infant" and "Umbilical Cord Care". Community or hospital based, experimental or quasi-experimental, randomised controlled, double blind randomised controlled and cluster randomised controlled researches conducted between the years of 2008-2013 were reviewed, being totally 21 studies included. Information about the most applied umbilical cord care practices of last five years (Alcohol, Povidone Iodine, Chlorhexidine, Triple Dye, Eosin, Topical Antibacterial Agents, Salicylic Sugar Powder, Olive oil, Breastmilk and Naturally Drying) which were derived from those studies, was presented.Dry cord care is recommended for newborns born in developed countries and Chlorhexidine application to the umbilical cord stump is recommended for newborns who are born at the least developed countries in accordance with Evidencebased research and guidelines, Nurses can make studies in this area to improve the quality of care and to contribute to the scientific accumulation of nursing.

PDF

___

Abd El Hamid, A. A., El Fadil, A. N., Azzam, F. H. (2011). Effect of two different cord care regimens on umbilical cord stump separation time among neonates at Cairo University Hospitals. Journal ofAmerican Science, 7(12): 920-926.
Ahn, Y., Sohn, M., Jun, Y., Lee, E., Lee, S. (2013). Two methods of cord care in high-risk newborns: Their effects on hydration, temperature, ph, and Horas of the cord area. Child Health Care, 12: 2-10.
Ahmadpour--Kacho, M., Zahedpasha, Y., Hajian, K., avadi, G., Talebian, H. (2006). The effect of topical application of human milk, ethyl alcohol 96%, and silver sulfadiazine on umblical cord separation time in newborn infants. Arch Iran Med, 9: 33-38.
Aghamohammadi, A., Zafari, M., Moslemi, L. (2012). Comparing the effect of topical application of human milk and dry cord care on umbilical cord separation time in healthy newborn mfants. Iran Pediatr, 22(2): 158-162.
Arifeen, S. ve ark. (2012). The effect of cord cleansing with clorhexidine on neonatal mortality in rural Bangladesh: communitybased, cluster-randomised trial. Lancet, 379: 1022-1028.
Aydemir, H., Alpaslan, Ö., Demirel, Y. (2012). 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, 6(13): 3112-3118.
Bulut, M. 0. ve ark. (2005). Neonatal sepsisli olguların retrospektif olarak değerlendirilmesi. Cumhuriyet Üniversitesi ip Fakiiltesi Dergisi, 27(2): 63-68.
Chamnanvanakij, S., Desharachakul, K., Rasamimaree, P., Vanpra-- par, N. A. (2005). Randomized study of umbilical cord are regimens at home in Thai neonates: Comparison of time to umbilical cord separation, parental satisfaction and bacterial colonization. Med Assoc Thai, 88(7): 967-972.
Covas-Mdel, C. ve ark. (2011). Alcohol versus bath and natural drying for term newborns umblical cord care: prospective randomized clinical trial. Arch Argent Pediatr 109: 305-313.
Demirtola, A., Özen, 0. (2005). Göbek ve göbek kordonu anomalileri. Sted Dergisi, 14(3): 47-49.
Devecioglu, 0., Önes, Ü., Ünüvar, E. (2005). Pediatride Rutinler 2. basım, Medikal Yayıncılık, İstanbul.
Erenel, S.A. ve ark. (2010). Comparison of olive and dry-clean keeping methods in umblical cord care as microbiological. Matern Child Health J., 14: 999-1004.
Evens, K., George, J., Angst, D. (2004). Does umbilical cord care in preterm infant influence cord bacterial colonization or detachment? Journal ofPerinatology, 24: 100-104.
Ekici, B., Ergin, B. A., Şahiner, P. (2007). Yenidoğanların göbek bakımında kullanılan yöntemlerin etkinliğinin karşılaştırılması. Çocuk Dergisi, 7(3): 191-196.
Farahani, A. L., Mohaınmadzadeh, A., Tafazzoli, M., Esmaeli, H., Ghazvini, K. (2008). Effect of topical application of breast milk and dry cord care on bacterial colonization and umblical cord seperation time in neonates. Journal of Chinese Clinical Medicine, 3(6):327-332.
Gathwala, G., Sharma, D., Bhakhri, B. K. (2013). Effect of topical application of clorhexidine for umblical cord care in comparison with conventional dry cord care on the risk of neonatal sepsis: randomized controlled trial. Trop Pediatr, 59: 209-213.
Golshan, M., Hossein, N. (2013). Impact of ethanol, dry care and human milk on the time for umblical cord seperation. Pak Med Assoc, 63: 1117-1119.
Gurkan, F. ve ark. (1999). Neonatal Tetanus: continuing challege in the southeast of Turkey: Risk factors, clinical features and prognostic factor. Eur] Epidemiol,15(2): 171-174.
Gunay, T., Kılıç, B., Keskinoglu, P., Konakçı, S. K., Pabuccuoglu, O. (2008). Infant mortality rates in narlidere district, Turkey (1999- 2001): Trends in rates and risk factors. Turkish Public Health, 6(l):9-18.
Goldman, A. S. (1993). The immune system of human milk: Antimicrobial, antiinflammatory and immunomodulating properties. Pediatr Infect Dis J, 12: 664-671
Guala, A. ve ark. (2003). The time of umbilical cord separation in healthy full-tenn newborns: controlled clinical trial of different cord care practices. EurJPediatr, 162: 350-351.
Great Ormond Street Hospital Clinical Guidlines (2014). Umblical care, http://www.gosh.nhs.uk/health-professionals/clinicalguidelines/umbilical-care/ (8.1 1.2014).
Healthy Newborn Network (2014). Country Guidance for Umbilical Cord Care, http://www.healthynewbornnetwork.org/topic/ chlorhexidine-umbilical-cord-care (8.1 1.2014).
Hsu, W. C. ve ark. (2010). Umblical seperation time delayed by alcohol application. Ann rop Paediatr, 30(3): 219-223.
Hodgins, S. ve ark. (2010). Chlorhexidine gel versus aqueous for preventive use on umbilical stump. The Pediatric Infectious Disease Journal, 29(11): 999-1003.
Imdat, A. ve ark. (2013). Umblical cord antiseptics for preventing sepsis and death among newborns. Cochrane Database Syst. Rev., 5(CD008635): 1-110.
Janssen, P. A., Selwood, B. L., Dobson, S. R., Peacock, D., Thiessen, P. N. (2003). To dye or not to dye: randomized clinical trial of triple dye/ alcohol regime versus dry cord care. Pediatrics, 111(1):15--20.
Karabulut, A. A. (2011). Yenidoğanda deri fizyolojisi ve topikal ilaç kullanımı. Türkderm, 45(2): 60-67.
Karumbi, J., Mulaku, M., Aluvaala, J. (2013). Topical umblical cord care prevention of infection and neonatal mortality. Pediatr Infect Dis J, 32: 78-83.
Kapellen, T. M. ve ark. (2009). Higher rate of cord-related adverse events in neonates with dry umbilical cord care compared to chlorhexidine powder. Neonatology, 96(l): 13-18.
Kul, M. ve ark. (2005). Sağlıklı tenn yenidoğanlarda farklı göbek bakımı uygulamalarının göbek düşme zamanı ve diğer klinik sonuçlar üzerine etkilerinin değerlendirilmesi. iirk Pediatri Arşivi, 40: 227 231.
Kiechl-Kohlendorfer, U., Berger, C., Inzinger, R. (2008). The effect of daily treatment with an olive oil/ lanolin emollient on skin integrity in preterm infants: randomized controlled trial. Pediatric Dermatology, 25(2): 174-178.
Kültürsay, N. (2003). Yenidoğan Sağlığı El Kitabı. Mete Basım Matbaacılık, İzmir.
Lawn, J. E, Cousens, S., Zupan, J. (2005). million neonatal deaths: When? where? why? Lancet, 365(9462): 891-900.
Lahmiti, S., El Fakiri, K., Aboussad, A. (2010). Antiseptics in neonatology: The inheritance of the past in the daylight. Arch Pediatr, 17: 91-96.
Lannelli, V. (2014). Umbilical cord care, http://pediatrics.about. com/od/weeklyquestion/a/0707_umbil_cord.htm (8.1 1.2014).
Liu, M. F., Lee, T. Y., Kuo, Y. L., Lien, M. C. (2012). Comparative effects of using alcohol, natural drying and salicyclic sugar powder on umblical stump detachment of neonates. Perinat Neonatal Nurs,26: 269-274.
Mahrous, S. E., Darwish, M. M., Dabash, A. S., Marie, I., Abdelwahab, F. S. (2012). Topical application of human milk reduces umbilical cord separation time and bacterial colonization compared to ethanol in newborns. Translational Biomediczne, 3: 1-8.
Medina, E., De Castro, A., Romero, C., Brenes, M. (2006). Comparison of the concentrations of phenolic compounds in olive oils and other plant oils: Correlation with antimicrobial activity. Journal of Agricultural and Food Chemistry, 54: 4954-4961.
Mcconnell, P. T., Lee, W. C., Coillard, M., Sherril, W. W. (2004). Trends in umbilical cord care: Scientific evidence for practice. Newborn and Infant Nursing Reviews, 4: 211-222.
Mullany, L. C., Darmstadt, G. L., Tielsch, J. M. (2003). Role of antimicrobial applications to the umbilical cord in neonates to prevent bacterial colonization and infection: review of the evidence. Pediatric Infectious Disease Journal, 22(1 1): 996-1002.
Mullany, C. L. ve ark. (2006a). Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in Southern Nepal: community-based, clusterrandomised trial. Lancet, 367 (95 14): 910-918.
Mullany, C. L. ve ark. (2006b). Impact of umblical cord cleansing with 4.0% clorhexidine on time to cord separation among newborns in Southern Nepal: cluster-randomized, community-based trial. Obstet Gynecol Neonatal Nurs, 35: 123-138.
Mullany, L. C. ve ark. (2007). Risk factors for umblical cord infection among newborns of Southern Nepal. Am Epidemiol, 165(2): 203-211.
Mullany, L. C. ve ark. (2012). Impact of 4.0% clorhexidine cord cleansing on the bacteriologic profile of the newborn umblical stump in rural Sylhet District, Bangladesh: community based, cluster-randomized trial. Pediatr Infect Dis J, 31: 444-450.
Mullany, L. C. ve ark. (2013). Chlorhexidine cleansing of the umblical cord and seperation time: cluster-randomized trial. Pediatrics, 131: 708-715.
Nourian, M., Allaii, F., Heidari, A. (2009). Comparison of the effect of alcohol 70% versus dry cord care on cord bacterial colonization cord separation time among newborns. Pak Med Sci, 25(1): 103--107.
Perk, Y. (2008). Yenidogan yogun bakım enfeksiyonları; korunma ve kontrol. İ.Ü. Cerrahpaşa Tıp Fakültesi Sempozyum Dizisi, İstanbul, 60: 137-141.
Pezzati, M. ve ark. (2002). Umbilical cord care: The effect of eight different cord-care regimens on cord separation time and other outcomes. Biol Neonate, 81: 38- 44.
Pezzati, M. ve ark. (2003). Umblical cord care in prematüre infants: The effect of two different cord-care regimens (Salicylic Sugar Powder vs Chlorhexidine) on cord seperation time and other outcomes. Pediatrics, 12: 275-279.
Sharma, D., Gathwala, G. (2013). Impact of clorhexidine clean-- sing of the umblical cord on cord seperation time and neonatal mortality in comparison to dry cord care-a nursery-based randomised conttrolled trial. Journal of Maternal-Fetal and Neonatal Medicirte, 27(12): 1262-1265.
Shoaeib, F. M., All, S. A., El-Barrawy, M. A. (2005). Alcohol or traditional methods versus natural drying for newborn's cord care. JEgypt Public Health Assoc., 80: 169-201.
Soofi, S. ve ark. (2012). Topical application of chlorhexidine to umblical cords prevention of omphalitis and neonatal mortality in rural district of Pakistan: community-based, cluster randomised trial. Lancet, 379: 1029-1036.
Suliman, A. K. ve ark. (2010). Triple dye plus rubbing alcohol versus tirple dye alone for umblical cord care. Clin Pediatr (Phila), 49: 45-48.
Şilfeler, 1. ve ark. (2011). Göbek bakımı amacıyla kullanılan %70'lik alkole bağlı cilt yanığı gelişen iki term yenidoğan olgusu. JKartal TR., 22(2): 75-78.
Tripoli, E. ve ark. (2005). The phenolic compounds of olive oil: Structure, biological activity and beneficial effects on human health. Nutrition Research Reviews, 18: 98-112.
Usluer, G. ve ark. (2006). İzolasyon önlemleri kılavuzu. Hastane İnfeksiyonları Dergisi, 10: 18-21.
World Health Organization (WHO) (1999). Care of the umbilical cord: review the evidence, http://www.whoint/reproductivehealth/publications (02.01.2014).
World Health Organization (WHO) (2013). WHO recommendations on "Postnatal care of the mother and newborn", http://apps. who.int/iris/bitstream/l0665/97603/1/9789241506649_eng.pdf (5.11.2014).
Vural, G., Kısa, S. (2006). Umbilical cord care: pilot study comparing topical human milk, povidone-iodine, and dry care. JOGNN, 35: 123-128.
Zupan, ., Gamer, P., Omari, A. A. (2004). Topical umblical card care at birth. Cochrane Database Syst Rev., 4: 1-4