Abstract

Introduction: There are perplexing findings from large randomized controlled trials regarding the effectiveness of topical application of 4% chlorhexidine on reducing neonatal mortality. Meta-analysis and systematic review of South Asia and Europe support chlorhexidine application to reduce neonatal mortality whereas trials of Sub-Saharan Africa have not. The aim of this review was to determine the pooled effect of the application of chlorhexidine on cord stump on neonatal mortality in addition to omphalitis and cord separation time.

Methods: MEDLINE through PubMed, EMBASE, CINAHL, SCOPUS, Google Scholar, Web of Science, Cochrane Central Register of Controlled Trials and LILACS database and other study sources were searched to identify RCTs published between January 2000 and September 04, 2018 that meet the inclusion criteria. We included studies that used 7.1% chlorhexidine digluconate (4% chlorhexidine) as the intervention compared with dry care in control arms.  Seven RCTs were conducted in Zambia, Tanzania, Bangladesh, Nepal, India and Pakistan with a total of 123,196 participants were identified from low and lower-middle income countries. Pooled relative risks (RR) with 95% confidence intervals (CI) using fixed-effect model was calculated.

Results: The result of the Analysis revealed that there is a 20% reduction in the pooled incidence of neonatal mortality among the chlorhexidine group as compared to the dry cord care group (pooled RR = 0.80; 95% CI: 0.73-0.0.87; P = 0.00001). Furthermore, incidence in omphalitis was decreased by 28% in the chlorhexidine group as compared to the dry cord care group (pooled RR = 0.72; 95% CI: 0.70-0.74; P = 0.00001). On the other hand, chlorhexidine topical application delayed cord separation time by 2.69 days than dry care.

Conclusion: Topical application of chlorhexidine significantly reduce the incidence of omphalitis and neonatal mortality even if it resulted in a delay of cord separation time. We recommend a guideline on the use and incorporation of chlorhexidine in the routine cord care.

Systematic Review Registration: CRD42018109280