DOI: https://doi.org/10.53350/pjmhs2115103509 ORIGINAL ARTICLE P J M H S Vol. 15, No.10, OCT 2021 3509 Cord Care Methods in Neonates ANDLEEB KANWAL 1 , ZAHID ANWAR 2 , MATEEN AKRAM 3 , SHAHID ANWAR 4 , SAIMA PIRZADA 5 1 Senior Registrar Gynae & Obs, Fatima Memorial Hospital, Lahore 2 Assistant Professor Paeds department, Fatima Memorial Hospital, Lahore 3 Assistant Professor Nephrology, Shaikh Zayed Hospital, Lahore 4 Associate Professor Nephrology, Fatima Jinnah Medical University, Lahore 5 Senior Registrar Paeds department, Fatima Memorial Hospital, Lahore Corresponding author: Andleeb Kanwal, Email: sana755@hotmail.com, Cell: +92 333 6118211 ABSTRACT Background: Proper cord care methods in neonates have been known to reduce infections, sepsis, and death. This study intends to document the frequency of cord care methods. Methods: A questionnaire-based study was done in 6 months in a tertiary care hospital with a level 3 nursery and NICU (Fatima Memorial Hospital, Lahore). We interviewed mothers and female companions of neonates in wards and outpatient clinics. Answers were added to SPSS in socio-demographic categories and cord care methods. Result: A total of 778 females were interviewed. The mean age is 28 + 8.1 years, mostly educated (90%) and resided in urban areas (83%). 39.4% of the participants had personal experience of newborn care. Most were housewives (74.4%). 36.8% would not apply anything to the cord, but the other majority would apply some agent to the newborn cord, methylated spirit being the favourite (48.5%), remaining being mostly antibiotics and antimicrobial agents. Chlorhexidine was used only by one participant. Doctors and nurses had counselled 70% of the participants, but 10% listened to the advice of relatives and grandmothers. 18.5% declined any knowledge of safe practices. Conclusions: Our study emphasizes the need to educate our hospital staff (doctors, nurses and midwives) as well as family members of neonates with standardised cord care methods. Keywords: Neonates, Cord care, Umbilical cord,Methylated spirit. INTRODUCTION Sustainable Development Goals aim to reduce neonatal mortality to 12 per 1,000 live births and under-5 mortality to 25 per 1,000 live births(1). Pakistan still ranks second-highest in the world with a Neonatal mortality rate of (41.2 per 1000 live births), in 2019(2)(3). Clean Birthing Process is a concept comprising of 6 hygienic practices, which are clean hands of the birth attendant, clean delivery surface, clean perineum, clean instrument to cut the cord, clean cord tie, and clean cord care (4). It has proven to reduce perinatal and neonatal infections(5). Another way to emphasize it is the incidence of cord infections (0.7%) in developed and 8-22 % in developing countries, ultimately leading to sepsis and mortality (6)(7). World Health Organization (WHO) recommends “Daily chlorhexidine (7.1% chlorhexidine digluconate aqueous solution or gel, delivering 4% chlorhexidine) application to the umbilical stump during the first week of life, for home deliveries especially in regions with high neonatal mortality (30 or more neonatal deaths per 1,000 live births). Clean and dry cord care is recommended for newborns born in health facilities or born at home in areas with low neonatal mortality. In low-risk areas, chlorhexidine is recommended only if there is tradition or risk of harmful methods such as application of cow dung (8). Objective: This study aims to document the frequency of different methods in our hospital and their relation to different social (demographic)factors. MATETRIAL AND METHODS Fatima Memorial Hospital, Lahore is a teaching and tertiary care hospital, with well-established and busy obstetric and neonatal units. The study was conducted over 1 year fromJuly-2020 to December 2020. The approximate sample size was 700 interviews, keeping the confidence interval at 99% (z value=2.57), error of margin at 3%, and assumed prevalent poor cord care practices at 80%, according to a previous study from Lahore. Sampling was done by non-probability convenient technique. Participating doctors were trained about the questionnaire. They interviewed mothers and their female attendants, during ward rounds in obstetrics and neonatology as well as in neonatal outpatient rooms.Unmarried women were excluded from the study because of the traditional reluctance to answer the questions. Verbal consent was taken. The anonymity of data was ensured.SPSS version 20 was used, descriptive parameters were expressed as frequency and percentages. A Chi-square test was used to identify any significant association between methods of cord care with age, parity, education, occupation and area of residence. RESULTS A total of 778 females were interviewed in 6 months.The mean age was 28+ 8.1 years. The socio-demographic characteristics of participants are shown in table 1. Table 1: Socio-Demographic Characteristics of Participants Variable Frequency (n) Percentage (%) Age 20 or less 11 1.41 21-30 years 422 54.24 31-40 years 234 30.08 41-50 years 102 13.11 >50 years 9 1.16 Educational Status 10 or more years 432 55.53 Less than 10 years 267 34.32 Nil 79 10.15 Marital Status Married but No Kid 357 11.5 Married and First baby 637 20.4 Married and 2nd baby 788 25.3 Married and > 2 kids 438 14.1 Residence Lahore 442 56.81 Villages 132 16.97 Other Cities 180 23.14 Outside Pakistan 24 3.08 Occupation Housewives 579 74.42 Jobs/careers 199 25.58 Most of our participants belonged to urban areas (83%), were educated (illiterate only 10%) and were housewives (74.4%). 31.9% of females (married but no child + new mothers) previously had no personal experience of neonatal care. They were likely telling the practice that they had observed in the family. The preferred methods of cord care are shown in Table 2.