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Am Fam Physician. 2003;67(8):1787

Staphylococcus aureus is a common organism that colonizes the umbilical stump, and omphalitis is a major cause of necrotizing fasciitis. Triple dye has been one of the most effective agents against S. aureus, but it is unsightly, may be carcinogenic, and actually promotes gram-negative bacterial colonization. Some nurseries no longer use triple dye because infant-to-infant transmission has become less likely; more mothers and infants are staying in the same room and breastfeeding, which may have a protective effect. A study by Janssen and associates compares the rates of colonization and infection, as well as the clinical appearance of the umbilical stump in infants given triple dye or dry care.

Study subjects were randomized by means of consecutively numbered opaque envelopes indicating within whether an infant was to receive triple dye or dry care for the umbilical stump. Primary outcomes were omphalitis andS. aureus–induced conjunctivitis or skin infection. Secondary outcomes included cord colonization rates byS. aureus and other pathogens. Observations and cultures were provided by visiting home nurses on the second or third day after hospital discharge.

The study involved 766 infants. One child was diagnosed with omphalitis and was treated in the hospital with antibiotics. At the initial home visit, more infants in the dry-care group had exudates from the umbilical stump (7.4 versus 0.3 percent) and a foul odor (2.9 versus 0.7 percent). There were no differences or only marginal differences between the two groups in terms of redness, conjunctivitis, or contact with physicians. Of the children from whom culture swabs were obtained, colonization rates were significantly higher in the dry-care group. S. aureus colonized in 31.3 percent of infants in the dry-care group as opposed to 2.8 percent of infants in the triple-dye group.

Although this study was insufficient to establish a relationship between infection and colonization, colonization rates were higher in the dry-care group than in the triple-dye group. The authors conclude that cessation of bactericidal care of the umbilical stump must be accompanied by vigilant attention to the signs and symptoms of omphalitis.

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