2. Introduction / Background
• The umbilical cord is one of the routes of entry of
microorganisms that can cause infection.
• The environmental source includes the hands of the
caregivers.
• Cord infection is most prevalent among newborns born in
developing countries.
• Current routine cord care in India includes keeping the cord
dry.
• Antiseptic solutions such as chlorhexidine can decrease the
risk of infections as well as bacterial colonization in
health-care settings.
• Human breast milk was applied on the cord.
3. Study title
⬜ Effect of Topical Application of Human Breast
Milk Versus 4% Chlorhexidine Versus Dry Cord
Care on Bacterial Colonization and Clinical
Outcomes of Umbilical Cord in Preterm
Newborns.
- by Daiahunlin Lyngdoh, Sukhjit Kaur, Praveen
Kumar1, Vikas Gautam2, Sandhya Ghai
4. Objectives of the study
The objective of the study was
⬜ To compare the effect of topical application of
human breast milk versus 4% chlorhexidine versus
dry cord care on bacterial colonization, and to find
the clinical outcomes of umbilical cord in preterm
newborns.
5. Critical view
⬜ Research problem - concludes with a concise
background and a significant problem statement.
⬜ Purpose – clear, concise statement of the specific
aim or goal of the study. It is measurable and
observable.
⬜ Hypothesis – Not clearly stated.
6. Methodology
⬜ Design - Experimental research design
⬜ Population – Preterm newborn ≤34 weeks of
gestation
⬜ Sample - 105 preterm newborn ≤34 weeks of
gestation born in Nehru Hospital, PGIMER,
Chandigarh
⬜ Sampling technique - Random sampling
technique.
⬜ Tool & Techniques – A structured interview
schedule was used to gather information about the
baseline data of neonates.
7. Critical Evaluation of methodology
1. Design -
⬜ Used experimental design but did not specified that
which type of experimental design used here.
⬜ It is a case – control study.
2. Population / sample –
⬜ Population ( Pre term newborn) definition was not
correct.
⬜ Sample size calculation was not given by authors.
⬜ Sample size was not sufficient.
⬜ They have given inclusion and exclusion criteria.
8. Cont…
⬜ Inclusion criteria –
i) Both healthy and sick preterm neonates were
recruited between 3 to 12 hrs. after birth.
⬜ Exclusion criteria –
i) Newborn with cord abnormalities such as
Omphalocele and
ii) Mothers of newborn who refuse to participate in
the study were excluded.
9. Cont..
3. Treatment allocation -
⬜ They have used random sampling technique.
⬜ To prevent enrollment bias, there must be develop a
randomization schedule before the study begins.
⬜ Control group was also chosen by random sampling.
⬜ Cord swab was taken on the 3 and 5 day after birth.
rd th
⬜ There was no history of drop out.
10. Cont..
4. Out comes –
⬜ There were multiple endpoints. Subgroups were analyze
and reported appropriately.
5. Statistical analysis –
⬜ Authors has given sufficient details of statistical method.
⬜ There was not a statement about the sample size.
⬜ Statistical test were appropriate. Relevant outcomes are
reported.
⬜ Repeated measures were made over time but analyzed
properly.
19. Critical view
⬜ All the results related to the research question
proposed in the study objectives.
⬜ All the actual values are reported.
⬜ All groups were similar on baseline measures.
⬜ Appropriate graphics are used to present results
clearly.
20. Conclusion
It is concluded that 4% chlorhexidine is very
effective in reducing pathogenic bacteria
colonization of the cord. Further, human breast
milk, to some extent, can reduce bacterial
colonization in low resource settings and is a
better alternative to dry cord care.
21. Cont…
1. Interpretation of result –
⬜ The questions which has posed in the study adequately
addressed and justified from data in the Conclusion.
2. Authors has compared the results from the study to those of
similar studies performed.
3. Authors did not discuss about any limitation of the study and
any suggestions given for the future research.
4. Authors didn’t explore any thing beyond the data.
22. Recommendation
⬜ A similar study can be conducted on a large sample
to validate and generalize its findings.
⬜ Can be conducted on term newborn population.
⬜ Replicated on a sample with different demographic
characteristics.
⬜ Can conducted in rural area or any rural hospital.
23. Strength of the study
1. Research problem is concise and specific.
2. They have used probability sampling technique.
3. They have used interview technique for the data
collection.
4. They have explained the descriptive and inferential
statistics properly.
24. Limitation of this study
1. The study findings could not be generalized because
of the following reasons -
⬜ Small sample size
⬜ Use only those subjects as a sample subjects who
have delivered the pre term baby in this hospital
2. The study was conducted only one selected Hospital.
3. The study finding were limited among the pre term
baby of the selected hospital.
