Determining the current factors on omphalitis development in newborns: A prospective case control study

Introduction and Objectives: Although Omphalitis is a preventable infection, it constitutes an important part of neonatal mortality and morbidity in developing countries. We aimed to define current factors that affect omphalitis development in our region and country thereby determining protective or harmful practices and conditions associated with omphalitis development. Material and Method: This study is planned as a prospective case control study and included newborns who are termed and nearly termed newborns diagnosed with omphalitis in Dokuz Eylul University School of Medicine Department of Neonatology or Pediatric Emergency Clinic and normal newborn in the same period and in similar sex and age groups between the date of 1 May 2014- 31 May 2015 in a one year period. Prenatal, perinatal, postnatal and sociocultural characteristics of newborns with omphalitis and the factors which can affect development of omphalitis were compared with the control group. Results: In this study, newborns were included 100 diagnosed with omphalitis (Group 1) and 100 as a control group (Group 2). In omphalitis group, 71 have mild, 29 have moderate omphalitis. Severe omphalitis was not observed. In omphalitis group, compared to the control group, maternal age was younger (p=0.03), maternal education level was lower (p=0.043), primipar pregnancy rate was higher (0.046), gestational age of infants was greater (p=0.001), birth weight was greater (p<0.001), vaginal birth frequency was higher (p=0.048), cord separation time was longer (p=0.016), history of hospitalization rate was less (p=0.009) and cotton clothing type frequency was lower (p = 0.004). The presence of a hospitalization history was detected as a protective factor (OR = 2.6; CI: 1.2 to 5.3), non-cotton clothing was detected a significant risk factor (OR = 13.50; CI: 1.72 to 105.93) for omphalitis development. Mild and moderate omphalitis facts as compared with the control group; significant difference among three groups has been continuing in terms of gestational age (p <0.001), birth weight (p = 0.001), hospitalization history (p = 0.020) and clothing types (p = 0.006); additionally, significant difference was detected between moderate omphalitis group and the control group in terms of hand washing habits (p = 0.022). Omphalitis incidence was significantly higher in the warmer months (April-October) when microorganisms can easily breed and colonized than the colder months (p <0.001). In Izmir, the umbilical cord care is done mainly with 10% povidone-iodine (89%) in delivery room and with dry clean care after birth (62.5%) and there were not widespread traditional methods. Conclusion and recommendations: Many factors have been shown to play a role in the omphalitis development. In Izmir conditions, attaching importance to giving umbilical cord care education, emphasizing cotton clothes usage and giving directions about handwashing practice to the mothers; who are young, primipar, making normal vaginal delivery and not well educated; are determined as methods for decreasing the recent omphalitis frequency. Umbilical cord care regimens at delivery and postnatal period have no impact on omphalitis development. Accordingly, in our city conditions, dry cord care at postnatal period can be continued and high rate using of 10% povidone-iodine practice at delivery can be reviewed. Key words: dry cord care, newborn, omphalitis, risk factors, umbilical cord care