Care of the Cord – Newborn Care Series

By Global Health Media Project. Download link: http://globalhealthmedia.org/videos/
Revised with updated chlorhexidine guidelines.

The umbilical cord is an entry point for dangerous infection, including tetanus. Infection can easily pass through the cord into the baby’s body leading to sepsis and death. The fresh cord stump can also bleed if not tightly tied or clamped. This video will show how to care for the cord of the newborn.

The intended audience is frontline health workers in the developing world.

Script follows:

Care of the Cord
The umbilical cord is an entry point for dangerous infection, including tetanus.
Infection can easily pass through the cord into the baby’s body leading to sepsis and death.
The fresh cord stump can also bleed if not tightly tied or clamped.
This video will show how to care for the cord of the newborn.
Start by preventing tetanus in the baby by vaccinating women for tetanus during their pregnancy.
At every birth have a clean delivery kit available.
The kit should include, at least: a clean surface for the birth, gloves, soap, a new blade, and 2 sterile cord ties or clamps.
Cord ties can be made of string or narrow tape at least 15 centimeters in length; the widest distance between your thumb and first finger.
This length will let you tie 3 knots easily.
Wash your hands with soap and water before the birth and wear gloves.
After the baby is safely born, delay cutting the cord until it has stopped pulsating — a few minutes after birth.
This will allow the baby to get his full iron stores to prevent anemia in the first 6 months of life.
To prevent the cord stump from bleeding, tie or clamp the cord.
To tie the cord: tie the first string 2 finger widths away from the baby’s belly.
Tie 3 tight knots.
Pinch the cord with your fingers and push the blood away from the baby.
Two finger widths away from the first string, tie the second string with 3 knots.
Cut the cord with sterile scissors or a new blade.
Be sure you cut away from the baby.
To clamp the cord: measure 2 finger widths away from the baby’s belly.
Place the clamp securely.
Pinch the cord with your 2 fingers and push the blood away from the baby.
2 finger widths away from the first clamp, place the second clamp.
Cut the cord with sterile scissors or a new blade.
Do not put anything on the cord stump unless advised by your countries practice.
Let it dry open to air.
Along with other newborn assessments, check the cord for bleeding every 30 minutes to one hour for at least 6 hours.
Bleeding from the cord stump can be rapidly fatal.
Here the tie is placed too close to the baby’s belly.
There are only 2 knots and the second knot is loose.
Because the cord is cut too close to the baby’s belly and the knot is loose, the cord stump starts to bleed.
Retie or clamp the cord if you see any bleeding.
This baby’s cord has been slowly losing blood.
There is shock due to severe blood loss.
He has rapid breathing, pale lips, and pale inner eyelids.
Prevent these emergencies by securing the cord well.
Over the next few days, the cord stump dries out, changing from light to dark yellow to brown to black, and then falls off.
The wound heals in 1-2 weeks.
Advise the mother and her family to wash their hands before and after caring for the cord.
Immersing the baby during a bath is safe for the cord.
If the cord does get soiled, wash it with clean water and soap.
Dry it thoroughly.
Keep cloth folded below the stump.
In many cultures it is common to cover the cord, binding the baby’s abdomen with a cloth.
This practice should be avoided.
It can delay drying of the cord and increase the chance of infection.
Instead advise the family to keep it open to air or loosely covered with the baby’s clothes.
Some babies are born with an umbilical hernia.
Binding is not helpful.
The hernia will usually go away by itself as the baby grows.
In many cultures there are deeply rooted beliefs to apply some kind of substance to the cord stump despite the recommendation to apply nothing.
This is dangerous as the substances can be contaminated with germs that may lead to infection.
Dung is a particularly dangerous source for tetanus.
In areas of the world where newborns are at greatest risk for cord infection, chlorhexidine gel or solution applied to the cord stump is recommended for babies born at home.
Apply it as a single application or every day for 7 days, according to your national guidelines.
Caution mothers to use chlorhexidine only on the cord, never in the eyes.
It can cause blindness.
Soon after the cord is cut, apply the gel.
… full script is available at http://globalhealthmedia.org/videos/

Care of the Cord – Newborn Care Series

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