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Risk of Mortality Subsequent to Umbilical Cord Infection Among Newborns of Southern Nepal: Cord Infection and Mortality

Mullany, Luke C. PhD*; Darmstadt, Gary L. MD*; Katz, Joanne ScD*; Khatry, Subarna K. MBBS†; LeClerq, Steven C. MPH*†; Adhikari, Ramesh K. MBBS‡; Tielsch, James M. PhD*

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e318181fb4c
Original Studies
Abstract

Background: Neonatal sepsis may stem from local umbilical cord infections. Signs of cord infection are common in low-resource settings, yet the risk of mortality subsequent to these signs has not been quantified in either developed or developing countries. We compared the risk of mortality between infants with and without signs of umbilical cord infection during a community-based trial of chlorhexidine interventions in southern Nepal.

Methods: Newborns were evaluated for signs of umbilical cord infection (pus, redness, swelling). A nested case-control approach was used to estimate the odds of mortality between infants with and without umbilical cord infection as defined by various levels of severity. For each death in the parent trial, 10 controls were selected, matched on sex, treatment group, and number of cord assessments. The main outcome measures were all-cause and sepsis-specific mortality.

Results: Among 23,246 assessed infants, there were 392 deaths. Odds of all-cause mortality were 46% (8–98%) higher among infants with redness extending onto the abdominal skin. A nonsignificant increased odds of mortality [odds ratio (OR): 2.31; 95% confidence interval (CI): 0.66–8.10] was observed among infants with severe redness and pus. Infections occurring after the third day of life were associated with subsequent risk of all-cause (OR: 3.11; 95% CI: 1.68–5.74) and sepsis-specific (OR: 4.63; 95% CI: 2.15–9.96) mortality.

Conclusions: This study provides evidence that common local signs of cord infection are associated with increased risk of mortality. Where exposure of the umbilical cord to potentially invasive pathogens is high, interventions to increase hygienic care of the cord should be promoted and including hand washing, avoiding harmful topical applications, and topical cord antisepsis.

Author Information

From the *Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Nepal Nutrition Intervention Project, Sarlahi (NNIPS), Kathmandu, Nepal; and the ‡Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

Accepted for publication June 3, 2008.

Supported by grants from the National Institutes of Health, National Institute of Child Health and Human Development (HD44004, HD38753 and R03 HD049406), The Bill and Melinda Gates Foundation (810-2054), and cooperative agreements between the Johns Hopkins Bloomberg School of Public Health and the Office of Heath and Nutrition, United States Agency for International Development (HRN-A-00-97-00015-00, GHS-A-00-03-000019-00).

The funding sources played no role in the study design, collection, data analysis, writing of the report, or decision to submit the article for publication.

Address for correspondence: Luke C. Mullany, PhD, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite E8646, Baltimore, MD 21211. E-mail: lmullany@jhsph.edu.

© 2009 Lippincott Williams & Wilkins, Inc.