From the Stump: Umbilical Cord Care

Once my daughter was out of the NICU, one of my biggest preoccupations was with her umbilical cord stump. The NICU nurses told me to keep it dry and leave it alone - it would fall off in due time. My mother told me they gave her Gentian Violet for the care of my and my sister's stumps. My sister in law was told to put alcohol on it. I had heard through the grapevine that breastmilk was the best for cord care.

So many opinions on what to do! In the end, I followed the NICU nurses' advice and left it alone. It fell off in about 2 weeks and now my little girl has a perfect baby "innie". I was still left wondering, however, what is the best way to care for a cord stump?

An article published last year in the Iranian Journal of Pediatrics touts breastmilk as "an easy, cheap and non invasive way for cord care" (1). They found that stumps fell off faster if treated with breastmilk as compared to no treatment (just left dry). An additional study found no correlation between the prevention of stump infection and treatment with breastmilk as opposed to iodine or dry treatment, but did note that stumps treated with breastmilk or left alone fell off sooner than stumps treated with iodine (2). Both of these studies indicate a 'less is more' approach.

In developing areas, it seems to be a different story. A study conducted on a population in Bangladesh found that repeated treatment of umbilical cord stumps with chlorhexidine, an antiseptic effective against many types of bacteria, decreased the amount of time a stump stayed attached and increased infant survival rate by lowering infection rates (3).

The official stance of the American Academy of Pediatrics is to keep the stump dry and let it fall off on its own. How did you care for your infants stump?

1.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 infants. Iranian Journal of Pediatrics, 22(2),2.Vural, G. and Kisa, S. (2006), Umbilical Cord Care: A Pilot Study Comparing Topical Human Milk, Povidone-Iodine, and Dry Care. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35: 123–128. doi: 10.1111/j.1552-6909.2006.00012.x3. Mullany et al., (2013),Chlorhexidine cleansing of the umbilical cord and separation time: a cluster-randomized trial., Pediatrics, 131(4).

Routine Infant Circumcision - What's the real deal here?

In many western cultures, routine infant circumcision (RIC) in boys is commonplace. Some cite aesthetic, religious, or hygiene as the reason for its widespread practice. In modern discourse, the lines have been drawn in the sand. Those who are staunchly against RIC liken it to female genital mutilation, a practice in some African cultures where a young girl's clitoris is cut or removed. Others against it feel that it is taking the choice away from the boy with an unnecessary and risky procedure. Those for RIC are typically in the hygiene camp - the CDC recommends RIC to help prevent urinary tract infections, and the spread of some sexually transmitted infections, including HIV.

Scientific literature is also somewhat divided. In an article published in the Cochrane Database of Systematic Reviews in 2012, the authors found no information that would lead a doctor to believe that RIC help prevent UTI's in boys, and according to the most recent recommendations from the American Academy of Pediatrics, there is not enough data to advise parents to have their sons routinely circumcised. 

On the flip side, information published in the Journal of Urologic Nursing in 2012 cited an increased risk of penile cancer in uncircumcised males, as well as a decreased risk in contracting HIV from a heterosexual partner. There is also recent evidence to suggest that circumcision offers protection against HIV transmission in homosexual relations as well. This is important because, according to the CDC, homosexual males are in a high risk category for HIV transmission.

So it appears that the jury is still out on this debate, and there are good points on either side of the argument. I'd love to hear your thoughts - on which side of the argument do you find yourself, and why?

(Urol Nurs. 2012 Jan-Feb;32(1):10-8; quiz 19. To circ or not: a reappraisal. Ahmed A, Ellsworth P. Source Providence VA Medical Center, Providence, RI, USA.

and

Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S. Routine neonatal circumcision for the prevention of urinary tract infections in infancy. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD009129. DOI: 10.1002/14651858.CD009129.pub2.)