Breastmilk for the Umbilical Cord
by Anne Eglash MD, IBCLC, FABM
In 2016 the American Academy of Pediatrics (AAP) published recommendations on umbilical cord care. The umbilical cord stump can become infected itself (omphalitis) or can be the portal of entry for aggressive disease-producing bacteria. Risk factors for omphalitis include a septic delivery, a precipitous home delivery, low birth weight, prolonged rupture of membranes, umbilical catheterization, and chorioamnionitis. The recommendations for care of the umbilical cord stump vary depending on the level of health care resources in a country. In the United states and other high-resource countries, the rate of omphalitis is 1 per 1000 infants who are managed with ‘dry cord care’, meaning that no antiseptic is applied to the cord. Using chlorhexidine on the cord does not appear to provide an advantage, given that the rate of infection is so low. It can cause skin irritation, and possibly select out for more aggressive bacterial strains.
In low-resource countries, the risk of omphalitis is up to 8% of infants born in hospitals and as high as 22% of infants born at home, so the World Health Organization recommends using an anti-bacterial agent such as chlorhexidine daily for the first 7 days to the umbilical cord to prevent infection.
Rooming-in and skin-to-skin may help to decrease the risk of omphalitis because they enable colonization of the infant with mother’s healthy bacteria.
So why are we talking about breastmilk on the cord? The umbilical cord stump falls off because the cord is invaded by the infant’s immunologic cells and bacteria around the region. Using an antibacterial agent on the cord can prolong the time that the cord is attached, and therefore might increase the risk of infection over time, as the cord remains attached after the antibacterial treatments are done. The application of breastmilk to the cord has been studied as a strategy to prevent cord infection and to speed up the time of cord separation. Breastmilk has bacteria but also bioactive proteins that help fight infection, reduce inflammation, and promote healing.
The authors of this study performed a systematic review of 7 randomized controlled trials that evaluated the application of breastmilk to the umbilical cord stump. In general, 4-6 drops of freshly expressed mother’s own breastmilk were applied to the cord every 8-24 hours and allowed to air dry.
- The average time for cord separation among most studies was 5-7 days with breastmilk treatment, and 6-8 days for dry cord care treatment.
- The risk of cord infection was greater for breastmilk treatment than for chlorhexidine treatment.
- The risk of cord infection was approximately the same for breastmilk treatment vs dry cord care.
- Colostrum is more effective than more mature breastmilk in preventing umbilical cord infections.
See the Answer
To evaluate the efficacy of topical application of human breast milk to reduce umbilical cord separation time.
We used a three-step search strategy. First, we searched six electronic databases from inception through July 16, 2018: PubMed, Cochrane, CINAHL, Embase, Scopus, and ProQuest Dissertations and Theses Global. We used the following search terms: infant, newborn, baby, babies, colostrum, breast milk expression, breast milk, breastmilk, mother milk, human milk, umbilical cord, and umbilicus. We included published trials in English without any time limit to optimize the search. Second, we searched for ongoing clinical trials and grey literature. Last, we conducted a manual review of the reference lists of the identified articles.
From 1,303 articles initially screened, eight articles reporting seven randomized controlled trials (RCTs) were included in the systematic review and meta-analysis.
Two independent reviewers used a standardized extraction form to extract data from eligible articles. We evaluated the quality of individual and overall evidence according to risk of bias and the Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) system.
Allocation concealment was not clearly identified in any of the studies. In only two trials were participants and personnel blinded to the intervention group, and in none was the assessment of outcomes blinded. The overall quality of evidence was very low for RCTs according to the GRADE criteria. We found a significant reduction in time to cord separation with the topical application of human breast milk (z = 6.22, p < .001), with a mean difference of –1.01 day (95% confidence interval [–1.3,–0.690]) compared with dry cord care. Incidence of omphalitis was not significantly different (risk ratio = 0.82, 95% confidence interval [0.57, 1.18], z = 1.06, p = .29) between human breast milk and dry cord care groups.
Topical application of human breast milk is an effective and safe way to reduce cord separation time. Given that the overall quality of the included RCTs was very low, further well-designed trials are needed.
Studies included in this systematic review compared the safety and effectiveness of umbilical cord care using breastmilk, chlorhexidine, alcohol, silver sulfadiazine, and dry cord care. None of the studies showed statistically significant higher rates of infection from breastmilk application versus any other strategies, and all showed a trend towards earlier separation of the cord.
I find that in my clinical practice in the USA where we recommend dry cord care, many families complain that the cord is stinky at the end of the first week. Perhaps applying mother’s own fresh breastmilk would be a safe and reasonable strategy to cut down on the smell and speed separation of the cord.