臍帶自然乾燥對新生兒臍帶脫離時間成效－－系統性文獻回顧暨統合分析

The Effect of Dry Care on the Time of Umbilical Cord Separation in Newborns: A Systematic Review and Meta-Analysis

背景臨床實務存有多種不同的臍帶護理方式，而世界衛生組織（World Health Organization）所建議的自然乾燥法，具簡便操作、低成本之優勢，而其對臍帶脫離時間或合併症之影響值得進一步探討。
目的整合隨機對照試驗以確認執行臍帶自然乾燥對新生兒臍帶脫離時間之成效，並探討臍帶相關不良事件發生情形。
方法於Cochrane、PubMed、Medline、CINAHL、Embase、華藝線上圖書館及臺灣博碩士論文網搜尋2021年12月前發表的中英文文獻。以Modified Jadad Scale作為篩選研究品質工具，並使用Review Manager 5.3版進行統合分析。
結果最終納入7篇皆為隨機對照試驗，共27,037位新生兒。臍帶護理措施包含自然乾燥、酒精或chlorhexidine（CHX）消毒、塗抹母乳或水楊酸糖粉（salicylic sugar powder, SSP）。統合分析結果顯示，採自然乾燥較酒精消毒有效縮短臍帶脫落時間（MD: -1.78 days, 95% CI [-2.4, -1.16], 3篇, n = 2,102），但與CHX消毒比較，無顯著差異（MD: -0.15 days, 95% CI [-1.99, 1.69], 2篇, n = 10,519）；而塗抹母乳（MD: 1.19 days, 95% CI [0.82, 1.56], 3篇, n = 730）、SSP（MD: 4.9 days, 95% CI [3.71, 6.09], 1篇, n = 92）使臍帶較早脫落之成效優於自然乾燥。另與自然乾燥比較，CHX消毒顯著較少發生臍帶不良事件，而與酒精消毒、塗抹母乳或SSP無顯著差異。
結論／實務應用採自然乾燥縮短臍帶脫落時間成效顯著優於酒精消毒，且未增加臍帶炎發生，可優先做為臍帶護理之第一選擇，而塗抹母乳、塗抹SSP亦能加速臍帶分離且無不良影響，可作為臍帶護理之替代方案。

Background: There are many different approaches to umbilical cord care in clinical practice. Dry care is recommended by the WHO based on its ease of implementation and relatively low cost. However, the effect of dry care on the time of umbilical cord separation and related complications require further study.
Purpose: The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of dry care on the time of umbilical cord separation and related adverse events in newborns.
Methods: A literature search was conducted of articles published before December 2021 in the Cochrane Library, PubMed, Medline, CINAHL, Embase, Airiti Library, and National Digital Library of Theses in Taiwan databases. The research quality of the identified articles was assessed using the Modified Jadad Scale. Statistical analyses were performed using Review Manager, version 5.3, with statistics reported as mean differences with 95% confidence intervals.
Results: Seven randomized controlled trials covering a total of 27,037 newborns were identified for analysis. Umbilical cord care in these studies included the following approaches: dry care, alcohol, chlorhexidine (CHX), mother’s milk, and salicylic sugar powder (SSP). The results of the meta-analysis showed that umbilical cord separation time was significantly lower for the dry care approach compared to the alcohol approach (MD: -1.78 days, 95% CI: -2.4 to -1.16, three studies, n = 2,102) but not significantly different than the CHX approach (MD: -0.15 days, 95% CI [-1.99, 1.69], two studies, n = 10,519). Notably, the umbilical cord separation time for both mother’s milk (MD: 1.19 days, 95% CI [0.82, 1.56], three studies, n = 730) and SSP (MD: 4.9 days, 95% CI [3.71, 6.09], one study, n = 92) approaches were reported as significantly less than the dry care approach. In addition, the CHX approach was associated with significantly fewer cord-related adverse events, while the alcohol, mother’s milk, and SSP approaches were associated with rates of cord-related adverse advents similar to dry care.
Conclusion / Implications for Practice: Because using dry care for umbilical cord care shortens the cord separation time compared to the alcohol approach and does not increase the incidence of omphalitis, this approach should be the first choice for cord care. Both mother’s milk and SSP approaches are also associated with shorter umbilical cord separation times without adverse effects, and may be used as alternatives to dry care in umbilical cord care.