文献：El Arifeen S et al.The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial.The Lancet, Early Online Publication, 8 February 2012.

　バングラデシュ農村部で新生児2万9760人を対象に、クロルヘキシジンによる臍帯ケアの死亡率への影響を並行クラスター無作為化試験で検討。新生児死亡率は自然乾燥群（生産児1000人当たり28.3人）に比べ、クロルヘキシジン単回使用群で低下した（同22.5人）。7日連続使用群では統計学的有意な低下はなかった（同26.6人）。

The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial

Original TextShams El Arifeen DrPH a, Luke C Mullany PhD b, Rasheduzzaman Shah MBBS b, Ishtiaq Mannan MBBS b c, Syed M Rahman MBBS a, M Radwanur R Talukder MBBS a, Nazma Begum MA b, Ahmed Al-Kabir PhD d, Gary L Darmstadt MD e, Prof Mathuram Santosham MD b, Prof Robert E Black MD b, Prof Abdullah H Baqui DrPH a b

Summary

Background

Up to half of neonatal deaths in high mortality settings are due to infections, many of which can originate through the freshly cut umbilical cord stump. We aimed to assess the effectiveness of two cord-cleansing regimens with the promotion of dry cord care in the prevention of neonatal mortality.

Design

We did a community-based, parallel cluster-randomised trial in Sylhet, Bangladesh. We divided the study area into 133 clusters, which were randomly assigned to one of the two chlorhexidine cleansing regimens (single cleansing as soon as possible after birth; daily cleansing for 7 days after birth) or promotion of dry cord care. Randomisation was done by use of a computer-generated sequence, stratified by cluster-specific participation in a previous trial. All livebirths were eligible; those visited within 7 days by a local female village health worker trained to deliver the cord care intervention were enrolled. We did not mask study workers and participants to the study interventions. Our primary outcome was neonatal mortality (within 28 days of birth) per 1000 livebirths, which we analysed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT00434408.

Results

Between June, 2007, and September, 2009, we enrolled 29 760 newborn babies (10 329, 9423, and 10 008 in the multiple-cleansing, single-cleansing, and dry cord care groups, respectively). Neonatal mortality was lower in the single-cleansing group (22・5 per 1000 livebirths) than it was in the dry cord care group (28・3 per 1000 livebirths; relative risk [RR] 0・80 [95% CI] 0・65?0・98). Neonatal mortality in the multiple-cleansing group (26・6 per 1000 livebirths) was not statistically significantly lower than it was in the dry cord care group (RR 0・94 [0・78?1・14]). Compared with the dry cord care group, we recorded a statistically significant reduction in the occurrence of severe cord infection (redness with pus) in the multiple-cleansing group (risk per 1000 livebirths=4・2 vs risk per 1000 livebirths=1・2; RR 0・35 [0・15?0・81]) but not in the single-cleansing group (risk per 1000 livebirths=3・3; RR 0・77 [0・40?1・48]).

Interpretation

Chlorhexidine cleansing of a neonate's umbilical cord can save lives, but further studies are needed to establish the best frequency with which to deliver the intervention.

Funding

United States Agency for International Development and Save the Children's Saving Newborn Lives program, through a grant from the Bill & Melinda Gates Foundation.