See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/284194711

The Effect of Topical Application of Mother Milk on Separation of Umbilical

Cord for Newborn Babies

Article  in  American Journal of Nursing Science · January 2015

DOI: 10.11648/j.ajns.20150405.16

CITATIONS READS

14 647

1 author:

Nehal Allam
Princess Nora bint Abdul Rahman University
5 PUBLICATIONS   19 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

this project View project

All content following this page was uploaded by Nehal Allam on 09 January 2016.

The user has requested enhancement of the downloaded file.

American Journal of Nursing Science
2015; 4(5): 288-296
Published online October 13, 2015 (http://www.sciencepublishinggroup.com/j/ajns)
doi: 10.11648/j.ajns.20150405.16
ISSN: 2328-5745 (Print); ISSN: 2328-5753 (Online)

The Effect of Topical Application of Mother Milk on

Separation of Umbilical Cord for Newborn Babies
Nehal A. Allam1, Wafa A. AL Megrin2, Amal M.Talat3
1
Pediatric Nursing, Faculty of Nursing at Ain Shams University, Cairo ,Egypt
2
Biology, Faculty of Science at Princess Nourah Bint Abdulrahman University, AL Riyadh, Kingdom of Saudia Arabia
3
Obstetric and Gynecological Nursing, Faculty of Nursing at Ain Shams University, Cairo ,Egypt

Email address:
[email protected] (N. A. Allam)

To cite this article:

Nehal A. Allam, Wafa A. AL Megrin, Amal M.Talat. The Effect of Topical Application of Mother Milk on Separation of Umbilical Cord for
Newborn Babies. American Journal of Nursing Science. Vol. 4, No. 5, 2015, pp. 288-296. doi: 10.11648/j.ajns.20150405.16

Abstract: Global policy regarding optimal umbilical cord care to prevent neonatal illness is an active discussion among
researchers and policy makers. The objective of the study is to identify the best available evidence regarding newborn
umbilical cord care through, assessing the knowledge of mothers regarding best practice of umbilical cord care and monitoring
the effect of both methods of topical mother milk application versus dry method on quickly separation time of umbilical cord
stump of newborn babies. The study method is an experimental design. The study result showed that topical application of
mother milk on the remaining part of the cord reduces the cord separation time and it can be used as an easy, cheap and
noninvasive way for cord care.
Keywords: Dry Cord Care, Umbilical Cord, Mother Milk, Separation Time

1. Introduction
Umbilical infections are an important cause of neonatal the establishment of the pathogen at the appropriate portal of
morbidity and mortality in developing countries with entry. Pathogens usually colonize host tissues that are in
incidence rates as high as 55-197 per 1000 live births in contact with the external environment. The umbilicus is
community-based studies (Ganatra and Zaidi, colonized by bacteria from environmental sources such as the
2010).Annually about 3.3 million neonatal deaths occur mother’s vagina, her skin flora, and the hands of caregivers
around the world , Oestergaard et al (2011) reported that , so; colonization rates with pathogenic organisms and
more than 30% are caused by infections. Some of these infections are significantly lower in rooming-in babies than
infections start as umbilical cord infection. The umbilical in babies kept in nurseries (Mullany et al 2003) and
cord area supports growth of some harmless or beneficial ( Nourain, et al 2009).
microorganisms (commensals) whereas others are harmful As cord infections should be preventable in most
(e.g., Clostridium tetani). Cord infection may be localized to cases( Capurro, 2004). It is important to identify best cord
the umbilical cord (omphalitis) or, after entry into the blood care practices to reduce neonatal mortality and morbidity and
stream, become systemic (e.g., neonatal sepsis) Lawn et al offer an alternative to widespread potentially harmful
(2005) and Mullany et al (2009). Data on the incidence of traditional practices. Examples of such practices include use
omphalitis in low-income countries is generally scarce, the of traditional herbs mixed with cooking oil or water that has
available data estimate the risk to range between 2 and 77 per been used to wash an adult woman’s genitals (num-bati) or
1000 live births in hospital settings, with fatality rates of application of ash, breast milk, fluid from pumpkin flowers,
between 1% and 15% depending on the definition of powder ground from local trees, cow dung, ghee and saliva
omphalitis used. (Mir, et al . 2011). that may be applied to the cord area and which may be
Moreover the newborn has no protective flora at birth, and harmful. (Mullany et al. 2007)and (Mrisho et al. 2008).
normal skin flora begin to be acquired within 24hours. The Factors that delay the process of cord stump separation are
first stage of microbial infection is colonization which means the application of antiseptics to the stump, infection and
 American Journal of Nursing Science 2015; 4(5): 288-296 289

caesarean section. Delayed cord separation with antiseptics after birth. Following delivery, the umbilical cord stump is
may be due to destruction of the normal flora around the colonized, usually with bacteria that are non-pathogenic.
umbilicus (navel) and a subsequent decrease in the number of Until the cord stump detaches and the umbilical area heals, it
leucocytes attracted to the cord (Whaly , et al 2003). In the is recommended to keep the area clean and dry to prevent an
same stream, Zupan et al. (2004) performed a meta-analysis infection. In summary, evidence clearly supports the use of
of twenty-one (21) studies involving 8959 participants to dry cord care or natural drying in newborns. The
assess the effects of topical cord care in preventing cord recommended practice leads to shorter cord separation times
infection, illness and death. The researchers found that there without an increase in the current infection rate (Broom and
were no advantages in terms of the use of antibiotics or Smith, 2012).
antiseptics over simply keeping umbilical cords clean and dry. As cord infections should be preventable in most
The researchers stated that antiseptic use actually prolonged cases( Capurro, 2004). It is important to identify best cord
the time for cord separation. care practices to reduce neonatal mortality and morbidity and
Human milk contains large amounts of IgA antibodies, and offer an alternative to widespread potentially harmful
these appear to have a preventive effect on skin infections traditional practices. Examples of such practices include use
(Kramer et al., 2001). Human milk also appears to have more of traditional herbs mixed with cooking oil or water that has
general antibacterial and antiviral effects. Besides providing been used to wash an adult woman’s genitals (num-bati) or
excellent immune support, human milk promotes application of ash, breast milk, fluid from pumpkin flowers,
musculoskeletal repair and growth. Human milk is a source powder ground from local trees, cow dung, ghee and saliva
of two classes of major growth factors, namely the that may be applied to the cord area and which may be
transforming growth factors alpha and beta (TGF-A and harmful. Mullany et al. 2007)and (Mrisho et al. 2008).
TGF-B) and the insulin-like growth factors 1 and 2 (IGF-1 WHO (2006) testified that , in developed countries,
and IGF-2) ( Ginjala & Pakkanen, 1998 ). These growth individual cases of umbilical cord infections continue to
factors promote muscle and cartilage repair and wound occur in aseptic nurseries . According to McConnell et al.,
healing (Wilson, 1998). TGF-A and TGF-B are involved in (2004) regardless of the cord care practice utilized,
normal cell activities such as embryonic development, cell educating the healthcare providers and care givers is
proliferation, and tissue repair. IGF-1 has pronounced essential. Teaching should include the normal appearance of
anabolic and wound-healing characteristics. It slows the umbilical cord stump, especially if a “drying” agent is
catabolism, and it is the only growth factor that can stimulate not used. Moreover it is important to ensure that parents
muscle growth and repair by itself. receive useful consistent skincare information . For
As recommended by Mousa, et al (2006), who described example, a parent information leaflet is being compiled
that one of the agents that be used for umbilical cord care is which will provide evidence based information to allow
topical application of breast milk and distilled water. parents to make an informed choice about how they care for
Applying human milk to the cord stump is one of the cultural their baby’s skin.
cord care practices used in Turkey. According to the WHO,
this could be beneficial in view of the antibacterial factors 2. Significance of the Problem
present in breast milk also; it has a lot of immunologic and
anti-infective agents. Colostrum contains significantly The best way to treat the umbilical cord after birth is a
quantities of complement components that act as natural controversial issue, especially in developing countries which
antimicrobial agents and is also equipped with protective challenged by many local practices and beliefs. Efforts to
factors that provide specific and nonspecific passive identify and implement affordable and effective community-
immunity. On the other hand in (2006) Vural and Kisa based interventions for umbilical cord care may reduce the
reported that, Breast milk may accelerate the complicated large burden of infection related neonatal mortality in
process of umbilical cord separation through developing countries. This is highlighted by requests from
plymorphonoklear leukocytes present at umbilical cord, pediatric nurses to improve umbilical cord care according to
photolytic enzymes and other present immunologic evidence-based best practice. As a result the new change in
compounds Previous studies have reported that cord practice based on the literature by approaching topical
separation time in topical application of human milk and cord application of the mother milk ,since it is free and readily
dry care groups was shorter compared to topical application available and it will shorten the cord separation time and
of povidone iodine. improved cord care practices. A better accepting of such
Dore et al., (1998) reported that “Evidence supports the practices is vital issue for researchers to proposal a new
use of dry umbilical cord care in the newborn”. Vural and effective behavioral change strategies to reduce cord
Kisa (2006) performed a pilot study that compared the use of infections in the millions of babies born each year.
povidone iodine (Betadine), human milk, and dry care. They Aim of the Study.
concluded that dry cord care and topical human milk were The study aimed to identify the best available evidence
associated with shorter cord separation times when compared regarding newborn umbilical cord care through: assessing the
with povidone iodine use. The cord stump normally dries, mothers knowledge regarding best practice of umbilical cord
epithelializes and detaches from the neonate within 15 days care, comparing the effect of both methods on occurrence of
290 Nehal A. Allam et al.: The Effect of Topical Application of Mother Milk on
Separation of Umbilical Cord for Newborn Babies

bacterial colonization among neonates and monitoring the them. This tool included two parts: the first was checklist to
effect of both methods of topical mother milk application follow up the compliance of mothers to type of cord care and
versus dry method on quickly separation time of umbilical the second one, to check the presence or not the signs of cord
cord stump among newborn babies. infection as (redness, swelling, secretion of blood or pus,
odor or tenderness) until cord detachment occur.
3. Subjects and Methods Tools Validity
Tools submitted to a panel of five experts in the field of
Design and Setting neonatology, maternity nursing and obstetric medicine to test
An experimental design was used to conduct the study. the content validity. Modification was carried out according
The study conducted at both settings first one was , Obstetric to the panel judgment on clarity of sentences and
and Gynecological Hospital , postpartum unit, affiliated to appropriateness of the content.
Ain Shams University, Cairo, Egypt and second one was A pilot Study:
Tertiary Hospital in postpartum unit affiliated to Ministry of It was conducted on 10 % of the total sample to measure
Health, Al Riyadh, Kingdom of Saudia Arabia. clarity of items practicability of the study tools ,and
Sample determine the feasibility of the study. Tools was empirically
Purposive sample size included 400 neonates were validated by 5 experts for content and construct. They agreed
recruited from the postpartum units in the both mentioned that tools has the ability to measure its objectives. According
settings based on simple random sampling technique to the pilot study results, the necessary modifications carried
Researchers selected the even numbers of beds who met out .All mothers and their neonates participated in the pilot
the following inclusion criteria : study were excluded from the research sample.
Healthy full term neonates from (38-42 weeks gestation); Procedure Technique Plan:
delivered by caesarean section, normal birth weight This study was conducted in a period of 19 months from
from(2.500 to 4000) grams ,free from congenital anomalies; June 2013 up to December 2014 . Agreement to conduct the
roomed-in with their mothers and breast fed. Apgar score at study was obtained from the Head of the postpartum Units in
first and fifth minute equal 7 and more, and free from any both settings, also nurses and mothers agreement to
health problems. participate in the study was obtained.
Exclusion criteria: The plan of study was carried out through the following
Neonates with health problems or congenital anomalies phases:
who requiring immediate transfer to neonatal intensive care 1- Assessment phase:
unit. This phase included activities related to reviewing of
Tools of data collection related literature review . Evidence based practice and
Three tools was used and filled by the researchers to current national/international guidelines related to umbilical
collect data: cord practices reviewed using the CINHL database along
Content of tools was decided through an extensive review with the Cochrane Database of Systematic Reviews. Meeting
of literatures and researches about cord care. with nurses that currently working in labor and delivery,
1- Structured interview Questionnaire for mothers was postnatal units at both settings, obstetrician, pediatrician , and
conducted to collect data related to the mothers and their to debate current umbilical cord care practice.
neonates. This tool included three parts: the first part The Ethical review of the study design was obtained. The
includes data related to the mother as code of file, mother's researchers allocated one month to collect data about the
age and educational level; the second part includes data study literature reviewing and one month to obtain agreement
related to the neonate as gestational age, gender and birth and interview panel in both settings to discuss the study
weight. Third part includes mother culture, beliefs and objectives and way of intervention to all nurses staff and to
habits about cord care. Researchers asked questions in a be sure not to apply anything otherwise the study protocol for
simple Arabic language and recorded the answers in the the selected cases.
structure interview tool. Interview consumed about 10 2- Implementation and data collection phase:
minutes for each mother . At the beginning of the study, the researchers presented the
2- Cord swab bacteriological examination tool. best evidence practice about the way of cord care via a 30
For group A: who underwent topical application of mother minutes lecture, using power point presentation to the nurses
milk. First swab taken (immediately after delivery) of the in three hospitals shifts at the both settings to gain their
babies and second swab taken (after 3 days) from delivery, understanding and cooperation.
then the specimen was labeled with baby of mother name, Each mother was interviewed for 10 minutes to determine
room number bed number and delivery date . The specimen her perception about cord care best practice . Explanation for
sent to the bacteriology laboratory. Also the same way was the mothers in both groups was done either group( A) about
followed for the group B who practiced dry cord care. new method of topical application of their mother milk on
3- Follow up Timetable checklist for monitoring signs of umbilical cord of their babies or for the mothers in group B
cord healing and separation . about keeping cord clean and dry .This to get their agreement
This checklist developed by the researchers and filled by to participate in the study .
 American Journal of Nursing Science 2015; 4(5): 288-296 291

After getting mother consent , the researchers labeled the cord stump exposed to air and umbilical cord stump will
coat of baby by blue card to ensure from safety of the study change from yellowish green to brown to black as it dries out
sample . Data was collected through the designed tools and and eventually falls off within 10days or less. The mother
instruments and investigated the sample under microscopic in informed to keep the umbilical cord stump and surrounding
the lab. as the following: skin clean and dry, way of sponge bath . Warning signs to call
Two groups were constituted 400 neonates, each chosen the researchers to make referral to the hospital if her baby
according to the random assignment into group(A) who develops any potential risk factors. Mothers informed that it
received cord care with topical application of mothers breast is normal to notice some oozing of fluid for two days after
milk, and group (B) who received with dry cord care. The the stump fell off. These instruction consumed about 10
researchers determined certain days of the week to collect minutes for each mother.
data from both groups. Researchers collected data four days For both group (A&B): As soon after delivery the
per week ( Friday & Saturday & to collect data from group A, researchers took the first swab from base of umbilical cord
(8 am – 10 pm), Sunday & Monday to collect data from , (3 stump immediately after admission to postpartum unit to be a
pm – 10 pm),and same manner for group B. base line data, and the second swab was taken on the third
Group A: After mothers had been fully informed about the day of delivery, to detect early the occurrence of colonization.
research and consented for participation in the research .The If the situation go smooth , the researcher asked the
researchers ensure safety and prevention of the potential risk mother to follow same manner after discharge for 7 days
by enforced good hand washing by mothers prior to more and instructed her to come to hospital soon ,if any
implementation of both methods of cord care. Researchers infections signs appear(redness, hotness, swelling ,pus, bad
gave each mother instructions about way of cleaning the odor…etc.) . Home visit was carried out in case of inability
umbilical cord stump and the surrounding skin area 3 times of the mothers not able to attend the baby in the promised
per day and as needed during diaper care. time at the hospital.
Mothers instructed after washing their hands with water The cord generally falls off in 7 to 10 days.
and soap to squeeze foremilk drops (before lactation) on the Bacteriological examination
remaining part of the cord about 4-6 drops and its cut edge The swab was taken from the baby by a trained
and let the milk get completely dry .The application of the technologist immediately after delivery and direct it to the
care beginning 4 hours after birth to ensure the mother laboratory for investigation. The technologist monitored the
became alert after cesarean section operation. The swabs for bacterial growth as the following schedule: first 24
researchers’ asked the mother to apply milk drops 3times per hours after collecting the swabs if any infection detected ,the
day until cord separation and 2 days after . Nothing was baby excluded from the study , if there was no bacterial
applied to the umbilical cord stump, including topical agent growth, the study carried on and the technologist followed
with breast milk and the mothers were delivered cesarean the sample to confirm the result and talked another sample on
section to ensure follow up of the baby condition for 4 days the 3rd day after delivery to be sure from integrity of the
at the hospital. Emphasize the mothers to keep diaper folded research process.
under the umbilical stump area to enhance dryness, healing Follow up time table for signs of cord infection: The
and prevent contamination for both groups. researchers follow up the compliance of mothers in both
Group B : After mothers had been fully informed about the groups regarding instructions of cord care using checklist, to
research and consented for participation in the research. The register symptoms signs of cord infection, cord
researchers were taught the mothers to leaving the cord clean bleeding ,secretion from the cord and the day of cord
and dry alone after cutting the umbilical cord and clean it detachment for 4 day before the mother discharge . Mothers
with sterile water ,then allowing the cord to complete dryness completed these forms at home for 2 days after umbilical
and separate when it is ready. cord separation. Then Researcher called mothers daily to get
Mothers in both groups were recommended not to use informed on date and hour of cord separation as well as
any other compound on umbilical cord. If the cord does eventual complications after cord separation containing
become soiled with urine or stool, asked the mother to gently bleeding, mucoid secretions and colonization of granuloma
wipe it along the entire cord from the umbilical base upward tissue. This to ensure from integrity of the process of cord
by one cotton ,then used another one cotton to clean fall off and to measure and record the duration of cord
thoroughly and around the sides of the stump by wet cotton separation from the date of birth. The researchers encouraged
ball and dry the cord with gauze. The Mothers were the mothers to feel free to request help if they had any
instructed to follow similar home cord care handling. Cotton problems or questions. Two days after cord separation, the
and gauze sponges was given to the mothers at the time of researchers checked umbilical cord cords of the newborns .
discharge. 4- Data analysis phase
The researcher developed educational booklet and gave it This phase related to analyses the collected data using
to the mothers in both groups ,it involved information about computer, SPSS version 20 and finding obtained.
the method of cord care, and how the mother preserve the 5- Final Report dissemination phase. Conclusions and
baby's diaper folded below the umbilical cord stump to recommendations obtained from the data and the final report
prevent contamination by baby urine and stools and to keep be written at the end of this phase.
292 Nehal A. Allam et al.: The Effect of Topical Application of Mother Milk on
Separation of Umbilical Cord for Newborn Babies

4. Ethical Consideration 5. Results

An official permission was granted from the directors of ble(2) Variale Table (1) illustrate that, the mean age of the
the hospitals. The researchers introduced themselves to mothers in group (A) were 25.9±5.2, half (50%) of the
mothers who had neonates and met the inclusion criteria and mothers were educated to the university level , (40%) of
informed them about the purpose of this research in order to them educated to diploma level and only (5%) got master
obtain their acceptance to participate in this study. The degree. Regarding group (B), the mean age of the mothers
researchers assured them, that the research posed no risk or were 21.4±5.4,it is clear that majority of the mothers got
hazards on their neonates. All mothers and nurses were diploma and none of them got master degree. Concerning
knowledgeable that, participation in the study is voluntary parity , the majority (78%) of the mothers in group (A) had
and they can withdraw from this study at any time. A written from 2 to 3 children, nevertheless the mothers in group (B) ,
informed consent was obtained from mothers who were keen more than two thirds(65%) had from 4to 5 children. Adding
to participate in the study. that boys constituted more than half (51%) in group
(A ),where girls constituted (53%)in group (B).
Table 1: Socio-demographic Characteristics of mothers and their neonates among two groups of the study.

Group A Topical application of mother milk Group B l Dry cord care

Variables
N=200 N=200 pplication
Mother’s Age/years Mean± SD 25.9±5.2 21.4±5.4
Education Level NO % NO %
Illiterate 00 00 8 4
Read & write 10 5 10 5
Diploma 80 40 150 75
University 100 50 32 16
Highly educated M S 10 5 - -
Parity
Primi Para 30 15 12 6.0
2-3 156 78 22 11
3-4 10 5 24 12
4-5 2 1 130 65
>5 2 1 12 6
Gender
Boys 102 51 94 47
Girls 98 49 106 53
Birth weight in kilogram Mean ± SD 3.250± 450.14 3.010 ±100. 12

Table 2: Methods of Cord Care as described by Mothers Before The Study Implementation.

Group A Topical application of mother milk Group B l Dry cord care

Method of umbilical N=200 N=200 pplication
cord care Frequency of usage Frequency of usage
Always No (%) Sometimes + No (%) Never No (%) Always No (%) Sometimes + No (%) Never No (%)
Warm cloth water 70 35 100 50 30 15 30 15 72 36 98 49
Soap and water 88 44 112 56 00 00 32 16 62 31 106 00
Butter 33 16.5 24 22 143 71.5 12 6 8 4 180 90
Cooking oil 20 10 63 31.5 117 58.5 6 3 12 6 188 94
Olive oil 80 40 120 60 00 00 180 90 20 10 00 00
Alcohol 177 86 23 11.5 00 00 50 25 10 5 140 70
Dusting powder 155 77.5 45 22.5 00 00 36 18 34 17 130 65
Breast milk 12 6 20 10 168 84 4 2 00 00 196 98
Camphor oil 52 26 89 44.5 59 29.5 150 75 50 25 00 00
Cord Bandaging on
10 5 12 6 1 78 89 20 10 12 6 168 84
abdomen
Gentian violet 20 10 10 5 170 85 38 19 26 13 136 68
Beta dine 12 6 17 8.5 171 00 28 14 33 16.5 139 69.5
Ordinary water only 5 2.5 9 4.5 186 93 44 22 72 36 84 42

Number are not exclusive About (44.5%) informed that they sometimes using camphor
It clear from table (2) that in group (A) , most of the oil and only (6%) identified that breast milk could use as
mothers reported that they always using alcohol (86%)and topical application of umbilical cord .On the other hand in
(77.5%) using dusting powder in caring of umbilical cord. group (B), most of the mothers described that they always
 American Journal of Nursing Science 2015; 4(5): 288-296 293

using olive oil (90%) and (75) using camphor oil in caring of developed normal Staphylococcus epidermis. Low
umbilical cord. More than one third (36%) well-versed that percentage 5% to 6% of neonates in the breast milk and dry
they sometimes using Warm cloth water and ordinary water cord groups had hotness and mild redness. Pathogenic
only and (2%) identified that breast milk could use as topical organism, only2% in the breast milk group developed
application of umbilical cord. Escherichia coli and Staphylococcus aureus as compared to2%
and 4% in dry cord group.
Table 3: Comparison the cord separation time per days among the 2 groups
of the study. Table 4: Number and Percentage Distribution of Neonates according to
Incidence of Bacterial Colonization.
Application of Breast Dry cord care Group
Cord separation
Milk Group N=200 N=200 Breast Milk Group Dry Milk Group
time per days Variable
No % N0 % N=200 N=200
Between 4-5 Days 160 80 6 3 Colonization normally NO % NO %
From 5 to 6 40 20 44 22 Elevated baby body
7and more 00 00 150 75 0 00 0 00
temperature
Hotness and mild redness 10 5 12 6
From table (3) it is clear that umbilical cord separation was Moderate or severe redness 0 00 0 00
earlier among mother breast milk group than dry milk group. Severe redness with pus 0 00 0 00
By the way the majority 80% of breast milk group babies had Foul odor of cord 0 00 0 00
Exudates from the cord 0 00 0 00
their cord fallen off at the 4th to 5th day of age and only (20%) Abnormal skin color 0 00 0 00
of them had their cord fallen off at the 5th to 6th day of age. Staphylococcus
190 95 188 94
On the other hand, only 11 (3%) of the babies in the dry cord Epidermises- normal
care group had their cord fallen off at the4th to 5 th day of age Pathogenic Organism
while the majority75% of them had their cord fallen off at the founded
Escherichia coli 4 2 4 2
7th day and more Staphylococcus aureus 4 2 8 4
It is evident from table(4) that the majority of neonates in Acimtobacter (gram
2 1 0 00
the breast milk and dry cord groups had normal bacterial negative)
colonization where 95% and 94% of them respectively
Table 5: Comparison the cord separation median time among the 2 groups of the study.

Application of Breast Milk Group Dry cord care Group

Variable P value
(Mean ±SD) N=200 (Mean ±SD)
Cord separation time (days) 4.2 20.45 7.12 10.39 <0.001
Bleeding continuation after separation (day) 1.2 8 2.49 3. 38 3.89 <0.001
Moucouid secretion after separation (day) 1.88 0.64 2.18 0.79 NS

Table (5) displays that there were statistically significant morbidity ,they could be benefited from comparing the
differences. The data confirm that the mean cord separation mother breast milk application with no application (Dry
time in the breast milk group was significantly method). Mothers in the maternity wards were found
shorter(p<0.001) than in the dry cord care group . The mean apprehensive to institute the mode of pharmacological
cord separation time was4.2±20.45 among mother breast treatment to the newborn.
milk group and 7.12±10.39 in dry cord care group The findings of present study have been discussed as per
respectively. On other hand, the bleeding continuation after the objectives of the study.
separation (day) was significantly shorter(p<0.001) among A finding of the study displays that the intervention of
breast milk group than the dry cord care group. There was no mother breast milk application was significantly effective
significant difference concerning moucouid secretion after for early separation of the cord as shown in table (3) where
separation in both groups. There were no stated problems at the majority( 80%) of breast milk group babies had their
the cord site among both groups. cord fallen off at the 4th to 5 th day of age as compared by
the majority75% of dry cord had their cord fallen off at the
5. Discussion 7th day and more. Moreover when compared together it was
statistically found that there is highly significant difference
There is a growing importance on good care of the among the mother breast milk application group and in dry
umbilical cord after birth. However, studies of cord care have method group in relation to, time of cord stump separation
focused more often on interventions such as cord clamping and occurrence of bacterial colonization. These in
time and the use of topical antimicrobials on the stump, and congruent with, Yonis, (2010) who reported that, umbilical
much less attention has been given to practices that are cord stump separation time in human milk group was
“ natural” or cultural. shorter than in the alcohol group (4+1 & 8+2 days
The researchers found very few literature with the current respectively) (P< 0.001) .
topic of research. Both Egypt and Kingdom of Saudia Arabia In this view, the study presented that, the duration of the
quiet sorrow from high rate of neonate mortality and umbilical cord stump separation time in breast milk group is
294 Nehal A. Allam et al.: The Effect of Topical Application of Mother Milk on
Separation of Umbilical Cord for Newborn Babies

shorter than in the dry cord group by about two days. In spit colonization where 95% and 94% of them respectively
the umbilical cords were detached in both groups within the developed normal Staphylococcus epidermis. Concerning
normal period between (5-15 days following the birth) as Pathogenic organism, the most common cultured organisms
documented in literatures. illustrated that only 2% in the breast milk group developed
As clarified in (table 5), there were statistically significant Escherichia coli and Staphylococcus aureus in the umbilical
differences. The researchers found that the mean cord stump as compared to2% and 4% in dry cord group. In the
separation time among the mother breast milk group was same field Amirfarhani et al (2008) who compared bacterial
significantly shorter(p<0.001) than in the dry cord care colonization in umbilical cord in topical application of breast
group . The mean cord separation time and standard milk and dry cord care. They found that the most common
deviation was4.2±20.45 in breast milk group as compared to organisms were Staphylococcus aureus, E. coli and
7.12±10.39 in dry cord care group. On other hand, the Klebsiella and there were statically significant differences
bleeding continuation after separation (day) was significantly between the two groups in colonization rate. They showed
shorter(p<0.001) among mother breast milk group than the that in topical application breast milk group, Staphylococcus
dry cord care group. There was no significant difference epidermidis was more than in dry cord care group and in this,
concerning moucouid secretion after separation in both S. aureus, E. coli and Klebsiella pneumoniae was more than
groups. There were no stated problems at the cord site among in topical application breast milk group (P<0.05) but this in
the both groups. This result is matched with Golshan and disagreement with Farahani et al (2008) who reported that
Hossein (2013), they specified that the mean of umbilical there was statistically significance difference between breast
separation time had significant differences among the three milk group and dry cord care group on occurrence of
groups (p <0.0001). The lowest and the highest separation bacterial colonization. High percentage of pathogenic
times belonged to human milk and ethanol groups organisms was found in the dry cord care group, statistically
respectively. Among the neonates, the lowest and the highest significance difference between groups. In the present study,
umbilicus separation times were 3 and 15 days. In post hoc it could be due to the difference in the weather and racial
analysis, umbilical separation time in human milk group had between the samples.
significant differences with ethanol (p <0.0001) and drying Currently and throughout history, many different
groups (p <0.003). On the same line with Dhanawade (2014) substances have been used on the umbilical cord stump to
who recommended that the totals mean score of breast milk accelerate the drying process and reduce the chance of
application group after intervention was 5.22 and in control infection .In the present study, various other modalities
group. (mean 9.36. The research hypotheses (H1) were mentioned by the mothers in the both groups (table2).
accepted as breast milk application is highly effective in the Where ,most of the mothers in group (A) reported that they
early separation of cord stump. Moreover Vural and Kisa always using alcohol (86%)and (77.5%) using dusting
(2006) concluded that dry cord care and topical human milk powder in caring of umbilical cord.About (44.5%) informed
were associated with shorter cord separation times when that they sometimes using camphor oil and only (6%)
compared with povidone iodine use. recognized that breast milk could use as topical application
Furthermore , the present study showed that there was of umbilical cord .On the other hand in group (B), most of
statistically significant difference between mother breast milk the mothers described that they always using olive oil (90%)
topical group and dry cord care where , the bleeding and (75) using camphor oil in caring of umbilical cord. More
continuation after cord separation (day) was significantly than one third (36%) well-versed that they sometimes using
shorter(p<0.001) among breast milk group than the dry cord Warm cloth water and ordinary water only and (2%)
care group. There was no significant difference concerning identified that breast milk could use as topical application of
moucouid secretion after separation in both groups. There umbilical cord. These results was matched with some
were no stated problems at the cord site among the both researches of (Evens et al., 2004; London et al., 2007;
groups. The findings of the present study is supported by one McKinney et al., 2009; Suliman, 2007; Vural & Kisa, 2006;
of the study which was done by A whonn (2007)who sounds Zupan et al., 2004). They reported that Some of the methods
that the normal healing process producing a “mucky that have been used on umbilical cord stumps include; plant
appearance. This isolated presentation running head, extracts, coins, olive oil, coconut oil, colostrum, triple dye,
umbilical cord care of a “mucky” cord has not been povidone- iodine (Betadine), various antibiotics, sterile water,
associated with infection. Health care providers and parents alcohol (70% isopropyl alcohol), and no treatment at all
need to understand the difference between the normal healing (Awhonn, 2007).
process and actual signs of infection. The researchers Concerning maternal satisfaction with the new protocol.
observed that during the normal separation of umbilical cord All of mothers in the group(A) were surprising from the
process of neonates , small amounts of cloudy mucoid results of the early level of separation of umbilical cord after
material may collect at that junction, it seem misinterpreted topical application of breast milk. The majority of them
as pus. Moreover, as the cord is drying and separating from reported they were happy by the results and it is the first time
the stump, the cord may appear moist, sticky or smelly. to follow this way of care. On the other hand all of mothers
As displayed in table (4) the majority of neonates in the in the group(B) were surprising from the results of separation
breast milk and dry cord groups had normal bacterial of umbilical cord after application dry cord care. The
 American Journal of Nursing Science 2015; 4(5): 288-296 295

majority reported they are amazing by the results and the and Neonatal Nurses. Evidence– based clinical practice
cord dry off without application of traditional substance. guideline: Cord care. Neonatal Skin Care: Evidence – Based
Clinical Practice Guideline (2 nd ed). Washington D. C.
In the present study ,none of the factors, such as age ,level
of education or maternal literacy and parity that were [3] Broom, MA., and Smith, SL. (2012) Late Presentation of
associated statistically with differences in cord-separation Neonatal Omphalitis Following Dry Cord, Care. Clinical
time or represents an increase of any practical significance. Pediatrics, 52(7), 675-677.
Umbilical cord care practices for newborns vary between [4] Capurro H. (2004).Topical umbilical cord care at birth: RHL
health care settings which can lead to misunderstanding for commentary. The WHO Reproductive Health Library.
both parents and nurses. It seems that the current standard of
[5] Dhanawade RA .(2014). Innovations in Pharmaceuticals and
umbilical cord care may be based on historic practices and Pharmacotherapy. IPP, Vol 2(3), 386-
traditions rather than on scientific investigation and 394 .www.innpharmacotherapy.com .eISSN: 2321.
justification. Methods currently used nationwide include;
various other modalities as daily cleaning of the umbilical [6] Dore, S, Buchan, D, Coulas, S, Hamber, L, Stewart, M et al.
(1998) .Alcohol versus natural drying for newborn cord care. J
cord with alcohol (70% isopropyl alcohol), triple dye, sterile Obstet Gynecol Neonatal Nurs 27 (6), 621-627.
water and, dry cord care. Dry cord care will lead to shorter
cord separation times and be more cost effective for the [7] Ganatra HA, Zaidi AKM . (2010).Neonatal infections in the
hospital. The findings of this study regarding breast milk developing world. Semin Perinatol; 34: 416-25.
application to the umbilical cord stump can make the health [8] Ginjala V& Pakkanen R. ( 1998 ). Determination of
care workers, specially nurses and doctors aware of it. So that transforming growth factor- beta1 and2 insulin-like growth
it may be used by all settings for the profit of neonates. factor in bovine colostrum samples.J immunoassay,19:195-
Hoping the findings of the present study leads to avoid the 207.
gap between research studies and clinical practice and to [9] Golshan, Hossein N. (2013)Impact of ethanol, dry care and
deliver practical evidence to inform policy on the human milk on the time for umbilical cord separation .JPMA
implementation of sustainable interventions in neonatal units 63: 1117; . Vol. 63, No. 9.
to decrease neonatal mortality. [10] Evens, K., George, J., Angst, D., & Schweig, L. (2004). Does
umbilical cord care in preterm infants influence cord bacterial
6. Conclusion and Recommendation colonization or detachment? Journal of Perinatology(24), 100-
104.
It is important to determine the best practice for umbilical [11] Farahani, L.,Mohammadzadeh,A., Tafazzoli,M.,Esmaeli,H.,&
cord care in order to minimize cord infections in the millions Ghazvini,K. (2008). Effect of topical application of breast
of babies born each year. Mothers should be fully up-to-date milk and dry cord care on bacterial colonization and umbilical
and understand the aims of umbilical cord care. This should cord separation time in neonates. Journal of Chinese Clinical
be supported by provision of evidence-based information Medicine, 3(6): 327-332.
offered to them. Therefore, it is recommended that topical [12] Kramer M S, Chalmers B, Hodnett ED, Sevkovskaya
application of mother milk on the remaining part of the cord Z,Dzikovich I,Shapiro S,etal. (2001 ). Promotion of breast
reduces the cord separation time as compared with dry cord feeding intervention trail(PROBIT).A randomized trial in
care and it can be used as an easy, cheap and noninvasive Republic of Belarus .JAMA.285:413-20.
way for cord care. Further research is proposed to confirm [13] Lawn JE, Cousens S, Zupan J.(2005).Lancet Neonatal
the results and to evaluate the effect of the implementation of Survival Steering Team. 4 million neonatal deaths: when?
Where? Why? Lancet.;365:891–900.
these methods on improvement of the umbilical cord care.
[14] London, M.L., Ladewig, P.W., Ball, J.W., & Bindler, R.C.
(2007). Maternal & Child Nursing Care(2 nd ed). Pearson:
Acknowledgment Upper Saddle River.
The researchers is gratefully acknowledged for all mothers [15] McConnell, T.P., Lee, C.W., Couillard, M., & Sherrill, W.W.
contributions towards the completion of the study. Further, (2004). Trends in umbilical cord care: Scientific evidence for
practice. Newborn and Infant Nursing Reviews(4), 211-222.
acknowledgement is accorded to Doctors Ahmed Atef and
Norah Al Sadhan for their kind help and cooperation [16] McKinney, E.S., James, S.R., Murray, S.S., & Ashwill, J.W.
throughout the study. (2009). Maternal– Child Nursing (3 rd ed). Elsevier: St. Louis.
RUNNING HEAD: Umbilical Cord Care 20.
[17] Mir F, Tikmani SS, Shakoor S, et al. (2011).Incidence and
etiology of omphalitis in Pakistan: a community-based cohort
References study. J Infect Dev Ctries.;5: 828–833.
[1] Amirfarhani L, Tafazol M, Mohammadzade A. (2008).Assess [18] Mousa, A., Yadollah,Z., karimollah,H, Ghasem, J., Hamid, T.
of topical application of human milk in cord separation time in (2006). The effect of topical application of human milk,
healthy neonate.J Sabzevar Med Sci Uni;14(3):165-71[I n ethylalcohol 96%, and silver sulfadiazine on umbilical cord
Persian]. separation time in newborn infant. Archives of Iranian
Medicine, Volume 9, Number 1, 33 – 39.
[2] Awhonn. (2007). Association of Women’s Health, Obstetric
296 Nehal A. Allam et al.: The Effect of Topical Application of Mother Milk on
Separation of Umbilical Cord for Newborn Babies

[19] Mrisho M, Schellenberg JA, Mushi AK, et [26] Vural G,Kiza S.Umbilical cord care.(2006).a pilot study
al.( 2008).Understanding home-based neonatal care practice in comparing topical human milk,povidone-iodine,and dry
rural southern Tanzania. Trans R Soc Trop Med Hyg.;102:669– care.Journal of Obstetrics,Gynecologic,and Neonatal
678. Nursing, ,35(1):123-128.

[20] Mullany LC, Darmstadt GL, Tielsch JM. (2003).Role of [27] Whaly, L.F., and Wong, D. (2003). Nursing care of infants and
antimicrobial applications to the umbilical cord in neonates to children. 7th.ed. Mosby- Year Book, New York.
prevent bacterial colonization and infection: a review of the
evidence. Pediatr Infect Dis];22(l):996-1002. [28] World Health Organization (WHO) (2006) Postpartum care of
mother and newborn, Care of the umblical cord., Family and
[21] Mullany, L.C., Daymstadt, G.L., Katz, J., Khatry, S.K., Reproductive Health, Division, of Child Health and
Lecclerq, S.C., and Adhikari, R.K.( 2007). Risk factors of Development. Evidence for the ten steps to successful
umbilical cord infection among newborn of southern Nepal. breastfeeding. 1998 [cited May 22, 2006]; Available at:
Epidimology Amirican Journal;165:203-11. www.who.int/child-adolescent-
health/New_Publications/NUTRITION/WHO_CHD_98.9.pdf.
[22] Mullany LC, Darmstadt GL, Katz J, et al. (2009).Risk of
mortality subsequent to umbilical cord infection among [29] World Health Organization. WHO Recommendations on
newborns of southern Nepal: cord infection and mortality. Postnatal Care of the Mother and Newborn. 2013.
Pediatr Infect Dis J.;28:17–20. http://apps.who.int/iris/bitstream/10665/97603/1/9789241506
649_eng.pdf.
[23] Nourain, M., Allaii, F., and Heidari, A. (2009). Comparison of
the effect of alcohol 70% versus dry cord care on cord [30] Yonis, E.S. (2010). The effect of topical application of human
bacterial colonization and cord separation time among milk comparable with 70% ethyl Alcohol on umbilical cord
newborns. Pak Medical Science Journal; 25(1):103-107. separation time in newborn infant at Minia University
Hospital. Unpublished thesis.
[24] Oestergaard MZ, Inoue M, Yoshida S, et al.( 2011).United
Nations Inter-Agency Group for Child Mortality Estimation [31] Zupan J, Garner P. Topical umbilical cord care at
and the Child Health Epidemiology Reference Group. birth(Cochrane Review). In: The Cochrane Library, Issue
Neonatal mortality levels for 193 countries in 2009 with 3.Chichester, UK: John Wiley and Sons: Update Software,
trends since 1990: a systematic analysis of progress, 2004.
projections, and priorities. PLoS Med.;8:e1001080.
[32] Zupan, J., Garner, P., & Omari, A. (2009). Topical umbilical
[25] Suliman, A. (2007). Triple dye plus alcohol versus triple dye cord care at birth. The Cochrane Collaboration, .Cochrane
alone for newborn umbilical cord care. Pennsylvania State Database Systemic Review, (3): CD 001057.
Milton S. Hershey Medical Center.ClinicalTrials. gov
identifier: NCT00127699.

View publication stats