Dry cord care leads to earlier separation of the cord after birth. It also leads to reports of wetter, odoriferous cords (described by some parents as nasty, smelly, or yucky) and higher colonization rates with S aureus and other bacteria (sometimes dramatically so). Whether this increased colonization rate is, or will be, associated with higher rates of omphalitis or other neonatal infection is controversial. Some studies have suggested that higher colonization rates are associated with increased infection, whereas others have not.
Dry cord care may not be appropriate in certain populations. Because there is increased risk of omphalitis and other serious neonatal infections when delivery occurs in a nonhygienic environment, application of a topic antiseptic agent to the cord may be indicated. The WHO recommends topical application of chlorhexidine to the umbilical cord stump during the first week of life for neonates born at home in high neonatal mortality settings (ie, those with at least 30 neonatal deaths per 1000 live births).[6] Meta-analysis of topical application of chlorhexidine to the umbilical cord of children born in underdeveloped countries under nonhygenic conditions revealed that this intervention significantly reduced the incidence of omphalitis, as well as overall neonatal mortality. Optimal dosing strategies for chlorhexidine application are unknown.[8]