What are the benefits and risks of using antiseptics on the umbilical cord stump of newborns for preventing sepsis (serious reaction to an infection) and death among newborns?

Key messages

• Applying the antiseptic chlorhexidine to the umbilical cord stump of a newborn likely reduces the risk of infection and may reduce the risk of death in low- and middle-income countries. Chlorhexidine likely also delays the time it takes for the cord stump to fall off by one to two days.

• Evidence on other antiseptics (like alcohol, silver sulfadiazine, and povidone) is limited and unclear in low- and middle-income countries.

• In high-income countries, there is no clear benefit to using antiseptics compared to keeping the cord clean and dry. Antiseptics likely delay cord separation.

Why is umbilical cord-care important?

After a baby is born, the umbilical cord is cut, leaving a small stump that usually dries and falls off on its own within five to 15 days. During this time, the area can easily become colonized by bacteria from the baby’s skin or the environment. Because the stump contains dead tissue, bacteria can grow there and cause infection of the surrounding skin (called omphalitis). In some cases, these bacteria can enter the baby’s bloodstream and lead to a serious body-wide infection (sepsis), which can be life-threatening — especially in places where hygiene and access to healthcare are limited.

What did we want to find out?

We wanted to know if applying antiseptics (substances that prevent bacterial growth) to the cord stump could reduce the risk of:

• Death

• Cord infection

• Changes in how long it takes for the umbilical cord to fall off (cord separation time), which may affect caregiver concern and care practices but is usually not harmful

We also wanted to know whether these effects differed between low- and middle-income countries, and high-income countries.

What did we do?

We reviewed evidence from randomized controlled trials that compared different antiseptics — such as chlorhexidine, 70% alcohol, silver sulfadiazine, and povidone-iodine — with dry cord-care (keeping the stump clean and dry) or no application of the same antiseptic.

We evaluated how these treatments affected:

• Newborn deaths (within first 28 days of life)

• Infection of the cord stump (omphalitis)

• Time for the cord stump to fall off

We assessed the quality of the studies and combined results from similar studies in a meta-analysis. We also analyzed studies from low- and middle-income countries separately from those in high-income countries, because the risk of infection is not the same across these settings.

What did we find?

We included 18 studies in this review, adding nine more than in our previous 2013 version. The studies were conducted in both low- and high-income settings and included 143,150 newborns.

In low- and middle-income countries, applying chlorhexidine:

• May reduce the risk of newborn deaths (from 18 to 15 per 1000 live births), but we are uncertain about this effect;

• Likely reduces cord infections (from 87 to 62 per 1000 live births);

• Likely increases the average time for the cord stump to fall off by about 1.85 days.

In high-income countries, chlorhexidine:

• Was not studied for prevention of newborn deaths;

• We do not know whether it prevents cord infection or affects cord separation time, because the evidence is very uncertain.

In low- and middle-income countries, using 70% alcohol:

• Was not studied for prevention of newborn deaths;

• We do not know whether alcohol prevents cord infection, because the evidence is very uncertain;

• We do not know whether alcohol affects how long it takes for the cord to fall off, because the evidence is very uncertain.

In high-income countries, using 70% alcohol:

• Was not studied for prevention of newborn deaths or cord infection;

• Likely increases the average time for the cord stump to fall off by about 1.6 days.

What are the limitations of the evidence?

• Our confidence in the evidence for using chlorhexidine to prevent cord infection in low- and middle-income countries is moderate, because people in the studies knew which treatment they received, and the studies were done in different settings. Our confidence that chlorhexidine reduces newborn deaths is low, because results varied between studies and the effect could range from a small benefit to no clear difference. We are moderately confident that chlorhexidine makes the umbilical cord fall off slightly later.

• Our confidence in the evidence for chlorhexidine use in high-income countries is very low, because only one small study was available.

• For alcohol use in low- and middle-income countries, our confidence in the evidence is very low. Few babies were studied and results were very uncertain, so we do not know whether alcohol affects cord infection or cord separation time.

• In high-income countries, we are moderately confident that alcohol makes the cord fall off a little later. However, we do not know whether alcohol prevents cord infection or affects newborn deaths, because these outcomes were not studied.

How up-to-date is this evidence?

This summary is based on evidence available up to December 2025, and it updates our previous review from 2013.