Effect of chlorhexidine cord application on prevention of neonatal sepsis in developing countries: Systematic review and meta-analysis

Objective: The aim of this review was to identify the pooled effect of chlorhexidine cord application on prevention of neonatal sepsis in developing countries. Methods: We have conducted systemic review and meta-analysis. Articles were searched from electronic databases such as PubMed, EMBASE, CINHAL, Cochrane central register of controlled trials (CENTRAL), and other sources such as direct Google search, Google Scholar, and POPline. Only randomized controlled trial studies were considered for this review. The effect of chlorhexidine cord application on prevention of neonatal sepsis and mortality was assessed as compared to dry cord care. Results: Five studies from developing countries were included in the review with a total of 129,293 participants. Pooled result of meta-analysis showed that chlorhexidine cord application reduces neonatal sepsis by 32% as compared to dry cord care (relative risk [RR] 0.68, 95% confidence interval [CI] 0.57-0.81, random effect model, I-2 = 93%). It also indicated that chlorhexidine cord application reduces severe sepsis by 77% (RR 0.23, 95% CI 0.11-0.48, random effect model, I-2 = 63%) and neonatal mortality reduction by 13 % as compared to dry cord care (RR 0.87, 95% CI 0.79-0.97, random effect model, I-2 = 0%). Conclusions: Chlorhexidine cord application significantly reduces neonatal sepsis and mortality in developing countries. Therefore, we stress the importance of including chlorhexidine cord application into the essential newborn care in the setting with high burden of neonatal mortality.