Background Umbilical cord is a potential portal of entry for invasive bacteria causing neonatal sepsis and death from serious infections. Studies have used a single swab covering tip, stump and base region for identifying umbilical cord colonization. Information for bacteriological profile of the cord evaluating variation from tip, stump and base is lacking. As a pilot for a large randomized controlled trial of Chlorhexidine intervention the present study aimed to evaluate the variation in colonization at three sites of cord tip/stump/base.
Methods Newborns enrolled from hospitals in Delhi (n=56) and Pemba (n=68), three swabs were collected one each from tip, stump and base of the cord. Swabs were sent to laboratory within 6 hours of collection for identification of pathogens.
Results Positivity for bacterial colonization at tip was lower than stump and base. Highest positivity for bacterial growth was found at base (Delhi 0hr-16%; 24hrs-23%; Pemba 0hr-20%) followed by stump (Delhi 0hr-7%; 24hrs-27%; Pemba 0hr-11%). Percentage of newborns with positivity at tip was lowest with 5–6%, 3% and 1.97% among Delhi 0hr, 24hrs and Pemba 0hr respectively. At 24hr, the bacterial colonization for stump and base combination increased from 5% (at baseline) to 21.4%.
Conclusion With non-significant variation between the three sites for bacterial isolation, for clinical trials evaluating association of colonization with clinical outcomes taking two swabs (one from tip and other from stump and base of the cord) should be adequate. Association between bacterial isolation at each of two sites with clinical events and mortality needs investigation.