UMBILICAL CORD CARE

INTRODUCTION
The use of alcohol and other anti-microbials has been shown to delay separation of the umbilical cord.
Cord separation is shorter doing nothing more than keeping the cord clean. However the primary objective
of cord care is to prevent infection and the use of antimicrobials has not been completely abandoned.
The greatest period of risk for umbilical stump colonization is the first 3 days of life. Signs of swelling or
redness in the periumbilical region extending from the umbilicus requires assessment for omphalitis.
Skin-to-skin contact with the mother is encouraged to promote colonization of the umbilicus with non-
pathogenic bacteria from the mother’s skin flora.

POLICY
Upon admission, ensure cord clamp has been correctly applied and secure.
A registered nurse removes the cord clamp at about 24 hours and when the exposed end of the cord
stump is dry and crisp.
The umbilical stump is to be kept clean and uncovered to promote healing, drying and cord separation.
Natural healing is encouraged.
Water or a mild cleanser with a neutral pH. (e.g. cetaphil) may be used if umbilicus is soiled. Chlorhexidine
is a favorable choice of antiseptic when developing infection is suspected.
Infant may be tub bathed once cord clamp removed.
No study has investigated umbilical care with an umbilical catheter in place.
Following shedding of the umbilical stump, granulation tissue may persist and lead to bleeding or a
persistent lesion. Silver nitrate, over several occasions, may be applied after consulting physician.
Families will be taught principles of cord care before discharge home, including
1. Cleaning cord with water only
2. Wash hands before and after cord care
3. Seeking medical care with any signs of swelling, redness, or drainage in peri-umbilical area. Fever,
lethargy and change in feeding behaviour may indicate system infection.

PROCEDURE

Gather equipment
1. Cord clamp remover
2. Water/sterile water/ low alkaline soap/Dexidin 2 solution (2% chlorhexidine gluconate with 4%
isopropyl alcohol solution).
3. Sterile q-tips
4. Clean gloves
Procedure Notes
1. Collect equipment.
2. Wash hands.
3. Glove.
4. Clean around base of cord using q-tip and clean Use sterile water for cord care for infants < 32
or sterile water and/or mild cleanser. (i.e. weeks gestation.
Cetaphil) Separation of the umbilical stump occurs by
inflammation of the junction of the cord and the
skin of the abdomen. During the normal process
of separation, small amounts of cloudy mucoid
Policy NN.19.10 Neonatal Program Policy & Procedure Manual Effective Date: 01-MAY-2006
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 UMBILICAL CORD CARE

Procedure
5. Clean with Dexidin 2 solution around base of the
cord if developing infection is suspected.
Note: for infants < 1000 grams, if Dexidin is used to
clean the cord, remove the Dexidin residual on the
cord using sterile water after cleaning is done.
6. Fold diaper below level of umbilicus
7. Cord clamps should be soaked in 70% alcohol.
8. Discard used supplies appropriately. Wash
hands.
Notes
material may collect at the junction and may be
interpreted as pus and the cord may appear
moist, sticky and smelly. After the cord separates,
the umbilicus continues to emit small amount of
mucoid material until complete healing takes
place, usually a few days after separation.
The greatest period of risk for umbilical stump
colonization is the first 3 days of life. Signs of
swelling or redness in the periumbilical region
extending from the umbilicus require assessment
for omphalitis.
Exposure to air enhances drying and separation.
Must be cleaned before immersing in the solution
as organic material can affect the concentration of
the disinfectant.

DOCUMENTATION
Nursing Flowsheet:
 Tick box to indicate cord care given
 Cord condition, drainage etc.

REFERENCES
Aygun C, Subas A, Kucukoduk S. (2005) Timing of Umbilical Cord Separation and Neonatal Intensive Care
Practices. American Journal of Perinatology. 22(5): 249-251.
Dore, S. et al (1998) Alcohol versus natural drying for newborn cord care.
J Obstet Gynecol Neonatal Nurs. 27(6):621-7.
British Columbia Reproductive Care Program: Guidelines for Prenatal Care (2001, March). Newborn
Guidelines 10: Care of the Umbilical Cord. Vancouver: BCRCP.
Evens K., George J. et al. (2004) Does Umbilical Cord Care in the Preterm Infant Influence Cord Bacteria
Colonization or Detachment? J Perinatol. Feb; 24(2):100-4.
Janssen PA., Selwood B.L, Dobson S.R., Peacock D., Thiessen P.N. (2003) To Dye or Not to Dye: A
Randomized, Clinical Trial of a Triple Dye/Alcohol Regime Versus Dry Cord Care. Pediatrics 111(1): 15 –
20.
McConnell T., Lee C. (2004) Trends in Umbilical Cord Care: Scientific Evidence for practice. Newborn and
Infant Nursing Reviews. 4(4): 211-222.
Mullany LC, et al. (2003) Role of Anti-microbial Applications to the Umbilical Cord in Neonates to Prevent
Bacterial Colonization and Infections. A Review of the Evidence. Pediatr Infect Dis Journal. 22: 996 – 1002.
Zupan J. et Garner P. (1999) Topical Umbilical Cord care at Birth. The Cochrane Database of Systematic
Review: The Cochrane Library, Volume (4).

Policy NN.19.10 Neonatal Program Policy & Procedure Manual Effective Date: 01-MAY-2006
Page 2 of 2
Refer to online version – Print copy may not be current – Discard after use