A Simple Solution for Saving Infants

Some of the most gratifying experiences in public health come when years of research yield effective new policies and programs. That moment came last fall for Joanne Katz, ScD ’93, MS, professor in International Health (IH), when representatives from several South and Southeast Asian countries met in Nepal to recommend the application of the antiseptic chlorhexidine to infants’ umbilical cords after delivery in their countries.

The recommendation follows two studies conducted from 2002 to 2005 by Katz and her colleagues in IH, associate professor Luke Mullany, PhD ’05, MHS ’02, and Professor James Tielsch, PhD ’82, MHS ’79. The researchers were working in a field site in Nepal where most babies are born at home. Infant mortality due to sepsis was high, with cord infections posing a particular challenge. The team hoped that chlorhexidine—affordable and widely available as a liquid or ointment—would act on a series of pathogens entering the infants’ bloodstream through the open portal.

“Our primary interest was to see whether we could reduce infectious mortality in infants,” Katz says.

The researchers conducted a randomized trial of 15,804 newborns who received varied care from community-based research workers: either a 4 percent chlorhexidine solution, soap and water, or dry cord care. Mortality in the group receiving chlorhexidine was 24 percent lower than those receiving dry cord care, and if the antiseptic was applied within the first 24 hours of birth, the mortality reduction was 34 percent. Severe cord infection was reduced 75 percent.

The striking results have sparked several replication studies using slightly different designs. Studies have been completed in Pakistan by Aga Khan University and in Bangladesh by IH Professor Abdullah Baqui, MBBS, DrPH ’90, MPH ’85, and Luke Mullany. Those studies had “comparable effects,” according to Katz. Other studies are under way in Africa.