Cochrane Review Confirms Chlorhexidine Reduces Newborn Umbilical Infections by 29% in Low-Income Settings

A new Cochrane review of 143,000+ newborns confirms that 4% chlorhexidine reduces umbilical infections and deaths in low-income settings, supporting WHO guidance.

By: AXL Media

Published: Mar 26, 2026, 9:15 AM EDT

Source: Information for this report was sourced from Cochrane

The Critical Role of Umbilical Hygiene in Neonatal Survival

Umbilical cord care is a fundamental component of newborn hygiene, serving as a primary defense against systemic infection during the first days of life. According to the World Health Organization, approximately 2.3 million newborns died in 2023, with a disproportionate number of these deaths occurring in LMICs due to infection. When the umbilical cord is cut, the remaining stump provides a direct gateway for bacteria to enter the infant’s bloodstream. The latest Cochrane review highlights that in environments where sanitary conditions may be suboptimal, the application of antiseptics like chlorhexidine can be a life-saving intervention.

Quantifying the Benefits of Chlorhexidine Application

The systematic review analyzed data from 143,150 newborns to determine the efficacy of various antiseptics, including 70% alcohol and povidone iodine. The results for 4% chlorhexidine were the most robust: its use likely reduces the incidence of umbilical infections from 87 to 62 per 1,000 newborns in LMICs—a 29% decrease. Furthermore, the data suggests a potential reduction in overall neonatal mortality, falling from 18 to 15 per 1,000 births. While chlorhexidine was found to delay the natural separation of the cord stump by one to two days, this was considered a minor trade-off for the substantial protection against sepsis.

Contextualizing Care: Dry vs. Antiseptic Approaches

A key takeaway from the report is that umbilical care is not a "one size fits all" solution. In high-income countries with low neonatal mortality and sterile obstetric environments, "dry cord care"—keeping the stump clean and dry without chemicals—remains the gold standard. However, in regions where babies are born into less hygienic conditions, the daily application of chlorhexidine for one week is recommended. Dr. Aamer Imdad, lead author from the University of Iowa, emphasizes that these simple, accessible interventions are critical precisely because such a large share of neonatal deaths in these settings is linked to preventable infections.