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Background: Ongoing high neonatal mortality rates (NMRs) represent a global challenge. In 2021, of the 5 million deaths reported worldwide for children under five years of age, 47% were newborns. Pakistan has one of the five highest national NMRs in the world, with an estimated 39 neonatal deaths per 1,000 live births. Reducing newborn deaths requires sustainable, evidence-based, and cost-effective interventions that can be integrated within existing community healthcare infrastructure across regions with high NMR. Methods: This pragmatic, community-based, parallel-arm, open-label, cluster randomized controlled trial aims to estimate the effect of Lady Health Workers (LHWs) providing an integrated newborn care kit (iNCK) with educational instructions to pregnant women in their third trimester, compared to the local standard of care in Gilgit-Baltistan, Pakistan, on neonatal mortality and other newborn and maternal health outcomes. The iNCK contains a clean birth kit, 4% chlorhexidine topical gel, sunflower oil emollient, a ThermoSpot™ temperature monitoring sticker, a fleece blanket, a click-to-heat reusable warmer, three 200 μg misoprostol tablets, and a pictorial instruction guide and diary. LHWs are also provided with a handheld scale to weigh the newborn. The primary study outcome is neonatal mortality, defined as a newborn death in the first 28 days of life. Discussion: This study will generate policy-relevant knowledge on the effectiveness of integrating evidence-based maternal and newborn interventions and delivering them directly to pregnant women via existing community health infrastructure, for reducing neonatal mortality and morbidity, in a remote, mountainous area with a high NMR. Trial registration: NCT04798833, March 15, 2021. [ABSTRACT FROM AUTHOR]

Objectives: To study the impact of applying topical Chlorhexidine compared with Methylated spirit on umbilical cord sloughing time in neonates. Study Design: Quasi-experimental study. Place and Duration of Study: Paediatric Department, KRL Hospital, Islamabad Pakistan from Oct 2018 to Mar 2019. Methodology: A total of 100 neonates were enrolled in each Group, i.e., Chlorhexidine and Methylated spirit. After taking informed consent from the parents, the treatment was applied twice daily for five days. Parents had telephonic interviews about the signs of umbilical cord infection on day two following enrollment in the study, and then babies were examined for signs of omphalitis during each hospital visit on days-7, 14 and 21. Umbilical cord sloughing time was noted. Results: Both Groups were independent (statistically insignificant) with respect to neonatal birth weight, gestational age, neonatal sex, mode of delivery and type of feed with p-values of 0.258 and 0.17, 0.066, 0.304 and 0.143, respectively. The result showed that the mean rank of cord sloughing time with the Methylated spirit was significantly less than Chlorhexidine, with the p-value of 0.001. Conclusion: Based on our results, we concluded that the application of Methylated spirit on the umbilical cord shortens the sloughing time compared to Chlorhexidine, but both treatments have comparable efficacy in preventing omphalitis. [ABSTRACT FROM AUTHOR]

The article offers information on community-based, cluster-randomised study trial regarding the effect of application of chlorhexidine (CHX) in the umbilical cord of newborn babies in preventing omphalitis and neonatal mortality. It states that study, which was conducted in Dadu, Pakistan, shows increase reduction of mortality and omphalitis on neonates that undergone CHX application. It adds that there was no strong evidence to shows the effect of handwashing.

Introduction: Although omphalitis (umbilical infections) among newborns is common and a major cause of neonatal deaths in developing countries, information on its burden and etiology from community settings is lacking. This study aimed to determine the incidence and etiology of omphalitis in newborns in high neonatal mortality settings in Karachi, Pakistan. Methodology: Trained community health workers surveyed all new births in three low-income areas from September 2004 to August 2007. Pus samples from the umbilical stumps were obtained from babies with pre-defined signs of illness and subjected to culture and antimicrobial susceptibility testing. Results: Among 6904 births, 1501 (21.7%) newborns were diagnosed with omphalitis. Of these, 325 (21.6%) were classified as mild, 1042 (69.4%) as moderate, and 134 (8.9%) as severe; 141 (9.3%) were associated with clinical signs of sepsis. The incidence of omphalitis was 217.4/1000 live births; moderate-severe omphalitis 170.3 per 1000 live births; and associated with sepsis 20.4 per 1000 live births. Of 853 infants with purulent umbilical discharge, 64% yielded 583 isolates. The most common pathogens were Staphylococcus aureus, of which 291 (95.7%) were methicillin-susceptible Staphylococcus aureus (MSSA) and 13 (4.2%) methicillin-resistant S. aureus (MRSA); Streptococcus pyogenes 105 (18%); Group B beta-hemolytic streptococci 59 (10 %); Pseudomonas spp., 52 (8.9 %); Aeromonas spp. 19 (3.2%); and Klebsiella spp. 12 (2%). Conclusions: A high burden of omphalitis can be associated with sepsis among newborns in low-income communities in Pakistan. S. aureus is the most common pathogen isolated from umbilical pus. Appropriate low-cost prevention strategies need to be implemented. [ABSTRACT FROM AUTHOR]