Yenidoğanlarda göbek bakımının betadine, batikon gibi yüksek iyot içeren solüsyonlarla yapılması bebekler için büyüme ve zeka gelişiminde çok önemli olan tiroit hormon sentezinin bozulmasına neden oluyor.
Bebeklerde alkol, betadine, batikon gibi antiseptik ilaçlarla göbek bakımının gereksiz olduğu yapılan bilimsel çalışmalarla gösterilmiştir. Özellikle göbek bakımının betadine, batikon gibi yüksek iyot içeren solüsyonlarla yapılması yüzey alanı küçük olan bebeklerde iyotun hızla emilmesine ve bebekler için büyüme ve zeka gelişiminde çok önemli olan tiroit hormon sentezinin bozulmasına neden olmaktadır. Bu durum aynı zamanda ülkemizde başlanan hipotiroidi taraması sonuçlarını da olumsuz etkilemekte, geçici hipotiroidi olgularının sayısını artırmakta ve ekstra maliyet getirmektedir.
Keza alkol vb solüsyonların da göbek düşmesini geciktirdiği ve göbek dokusunun enfekte olmasına ise etki yapmadığı yine bilimsel çalışmalarla gösterilmiştir.
Göbek bakımı için bu nedenlerle herhangi bir antiseptik solüsyon kullanılmasına gerek yoktur. Bebeğin göbeğinin düşene kadar temiz tutulması ve aralıklarla değiştirilen kuru steril bezlerle kapatılması yeterlidir.
Göbek bakımı konusundaki yapılan yanlış uygulamalar konusunda sağlık personelinin uyarılması büyük önem taşımaktadır.
Doç. Dr. Bumin Dündar
Konu ile İlgili Literatürler
AAP Textbook of Pediatric Care
Chapter 93: Healthy Newborn Discharge
Umbilical Cord Care
Last updated: August 26, 2008
Christina Kan Sonia Dela Sullivan, MD;Cruz-Rivera, MD
Umbilical Cord Care
Evidence-based care of the umbilical cord in the postnatal period includes effective hand hygiene and keeping the cord dry and exposed to air or loosely covered with clean clothes, with the diaper folded below the umbilicus. If the umbilical cord stump becomes soiled with urine or feces, then cleansing the area with water is adequate. Studies conducted in developed countries have shown that topical antisepsis of the cord stump reduces cord colonization. However, a systematic review of randomized trials that assessed the efficacy of applying topical antimicrobial agents in the prevention of infection has not shown this practice to be superior to simply keeping the cord clean. Chlorhexidine (Hibiclens) or hexachlorophene (pHisoHex), tincture of iodine or povidone-iodine (Betadine), silver sulfadiazine, and triple dye have the most efficacy in reducing umbilical cord colonization. If topical antimicrobial agents are used, then care must be exercised because toxicity has been reported with excess or inappropriate use.
Although some hospitals and practitioners continue to recommend use of application of alcohol to the umbilical cord, alcohol use has been shown to delay umbilical cord drying, is less effective in reducing bacterial colonization, and delays cord separation. Therefore alcohol application is not recommended for routine umbilical cord care.
The umbilical cord stump usually separates between 9 and 15 days of age (up to 3 weeks may be normal). Minimal discharge is to be expected thereafter. However, if significant amounts of discharge persist, it should be brought to the physician's attention. Until the cord falls off, the area should be kept dry as much as is possible to promote separation and healing. For this reason, giving infants only sponge baths is best until the cord is well healed.
19. World Health Organization. Care of the umbilical cord: a review of the evidence, 1998; Zupan J, Garner P, Omari AAA. Topical umbilical cord care at birth. Cochrane Database Syst Rev. 2004;3:CD001057. [PMID:15266437]
20. Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). Neonatal skin care: evidence based clinical practice guideline. Washington, DC:AWHONN; 2001.
21. Anderson JM, Philip AGS. Management of the umbilical cord: care regimen, colonization, infection, and separation. NeoReviews. 2004;5:e155-e162.
The Cochrane Collaboration
Topical umbilical cord care at birth
Zupan J, Garner P, Omari AAA
No evidence that applying sprays, creams or powders are any better than keeping the baby's cord clean and dry at birth
The umbilical cord connects the baby to its food and oxygen supply in the womb, and is clamped and cut at birth. The cord stump dries, shrivels and becomes black before falling off the baby's belly button, five to 15 days after birth. Without proper care, the baby may become infected through the stump. Usually the cord is kept clean and dry by loosely covering it with clean clothes. Hand washing is critical. The review found that not enough trials had been done to show if antiseptics or antibiotics were any better at keeping infection away. More research is needed.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Zupan J, Garner P, Omari AAA. Topical umbilical cord care at birth. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001057. DOI: 10.1002/14651858.CD001057.pub2.
This version first published online: April 27. 1998
Date of last substantive update: May 06. 2004
Umbilical cord infection caused many neonatal deaths before aseptic techniques were used.
To assess the effects of topical cord care in preventing cord infection, illness and death.
We searched the Cochrane Pregnancy and Childbirth Group trials register (September 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2003). We also contacted experts in the field.
Randomized and quasi-randomized trials of topical cord care compared with no topical care, and comparisons between different forms of care.
Data collection and analysis
Two reviewers assessed trial quality and extracted data.
Twenty-one studies (8959 participants) were included, the majority of which were from high-income countries. No systemic infections or deaths were observed in any of the studies reviewed. No difference was demonstrated between cords treated with antiseptics compared with dry cord care or placebo. There was a trend to reduced colonization with antibiotics compared to topical antiseptics and no treatment. Antiseptics prolonged the time to cord separation. Use of antiseptics was associated with a reduction in maternal concern about the cord.
Good trials in low-income settings are warranted. In high-income settings, there is limited research which has not shown an advantage of antibiotics or antiseptics over simply keeping the cord clean. Quality of evidence is low.