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ir
Original Article (Pages: 6009-
6015)

Comparison of the Umbilical Cord Bacterial Colonization in

Newborn Infants Rooming in with Mothers and Neonates
Admitted to Neonatal Intensive Care Unit
Mohammad Forozeshfard1, Raheb Ghorbani 2, Mohammadreza Razavi3, Navid Danaei4,
*
Shamsoallah Nooripour41
1
Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran.
2
Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.
3
Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran.
4
Department of Pediatric, Amir al-Momenin Hospital, Semnan University of Medical Sciences, Semnan, Iran.

Abstract
Background
Bacterial colonization during and shortly after birth are common in newborn infants. The aim of this
study was to determine the umbilical cord bacterial colonization in newborn infants rooming in with
mothers and neonates admitted to neonatal intensive care unit (NICU).
Materials and Methods
In a cross-sectional study, 180 newborn infants were studied in three groups including: newborn
infants born via normal delivery and stayed with their mothers (n=60), newborn infants born by
cesarean section and stayed with their mothers (n=60), and newborn infants admitted in NICU (n=60).
Umbilical cord care was done as natural drying without use of any disinfectant or local antibiotic for
all newborn infants. Bacterial culture was performed on the second day in three groups and in days of
5-7 only among the infants admitted in NICU.
Results
Among the subjects, 50% (n=90) were boy and 50% (n=90) were the first-time mothers. Normal
gestational age (38 to 42 weeks) was seen in 67.2% (n=121) of subjects. Three groups had no
significant differences in terms of gender (p=0.247), and first-time mothers (p=0.344), but had a
significant difference in terms of gestational age (p=0.001). Staphylococcus aureus was the most
common bacteria responsible for the colonization in the first culture (n=31, 17.22%), and second
culture (n=17, 13.5%). Bacterial colonization was more common in newborn infants who were born
by cesarean section and stayed with their mothers compared to the other groups (p<0.001).
Conclusion
According to the study, bacterial colonization was common in newborn infants who were born by
cesarean section and stayed with their mothers and Staphylococcus aureus had an important role in
this colonization. Future study is recommended to confirm our results.
Key Words: Cesarean section, Colonization, Delivery, Infants, Umbilical cord.

*Please cite this article as: Forozeshfard M, Ghorbani R, Razavi M, Danaei N, Nooripour Sh.
Comparison of the Umbilical Cord Bacterial Colonization in Newborn Infants Rooming in
with Mothers and Neonates Admitted to Neonatal Intensive Care Unit. Int J Pediatr 2017;
5(11): 6009-6015. DOI: 10.22038/ijp.2017.25938.2208

*Corresponding Author:
Shamsoallah Nouripour, Mostafa Khomeini Street, Semnan, Iran. Fax: +98 23 33654177
Email: are20935@gmail.com
Received date: Aug.10, 2017; Accepted date: Aug. 22, 2017
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Comparison of the Umbilical Cord Bacteria Colonization in Neonates
1- INTRODUCTION
Annually, one million newborn infant’s
death occur in the world due to infection
caused by bacteria that are entered the
body through umbilical cord (1). Necrotic
tissues of umbilical cord are the best
places for bacterial colonization which are
established shortly after birth (2, 3).
Staphylococcus aureus, Group
streptococcus (GBS) and Escherichia coli
(E. coli) have been the predominant
isolates from the colonized umbilicus in
newborns (4-6). To the umbilical cord
bacterial colonization a sequences of steps
including the process of bacterial
transmission, an invasion to primary host
defense mechanisms such as skin, mucosal
adhesion, and colonization with bacterial
growth is required (7, 8). Umbilical cord
colonization occurs with the growth of
bacterial organisms including both normal
skin flora and pathogenic bacterial, and
can result in life-threating conditions (9).
Today, advances in umbilical cord care
have reduced exposure of umbilical cord to
infection in developed and developing
countries (10-12). Strategies including use
of disinfection solutions and hygiene
protocols, postnatal care, and reduction the
number of caregivers to a person have
been associated with reduced incidence of
umbilical cord colonization, so that in
studies, application of chlorhexidine and
hygienic caring reduced the incidence of
umbilical cord infection (10-13).
Potential risk factors for umbilical cord
infection are low birth weight, childbirth
prolongs, premature rupture of
membranes, non-sterile delivery, umbilical
cord catheterization, method of umbilical
cord care, and home delivery (14, 15). The
most common complication of umbilical
cord infection is sepsis (6, 16). The
incidence of newborn infant sepsis due to
umbilical cord colonization has been
estimated to occur in 1-4 cases per 1,000
live births in developing countries,
depended on geographic location (12, 17).
Other complications of umbilical cord
infection are inflammation of the umbilical
artery, portal vein thrombosis, hepatic
abscess, peritonitis, intestinal gangrene,
necrosis and finally death (18, 19).
Given that dangerous complication of
umbilical cord infection may be lead to
death, the aim of this study was to
B determine and comparison of the umbilical
cord bacterial colonization in newborn
infants rooming in with mothers and
neonates admitted to neonatal intensive
care unit (NICU).
2- MATERIALS AND METHODS
2-1. Study design and population
In a cross-sectional study, 180 newborn
infants born in female hospital of Amir- al-
Mu'minin hospital in Semnan, Iran, during
the October 2014 to March 2015 were
recruited. Sample size was calculated using
pilot data (10 newborn infants admitted to
NICU, 10 newborn infants who stayed
with mother in normal delivery and 10
newborn infants who stayed with their
mothers in cesarean section). After
counseling with a statistician and that it
would not be possible to evaluate data for
2% of subjects, a total of 60 newborn
infants per group were considered to detect
difference in laboratory finding with 80%
power and 95% confidence interval (CI).
Therefore, 180 patients as convenience
sampling were included to the study.
2-2. Methods
Newborn infants were investigated in three
groups: newborn infants born by caesarean
section, and vaginally who stayed with
mothers at the birth time, and neonates
who were admitted to NICU. In this study,
umbilical cord care method was as
umbilical cord natural drying without use
of any disinfectant or local antibiotic for all
newborn infants.
2-3. Measuring tools
Int J Pediatr, Vol.5, N.11, Serial No.47, Nov. 2017
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Forozeshfard et al.
A questionnaire was used for collecting
data including type of delivery, first time
mothers, gender, birth weight and
gestational age.
2-4. Laboratory measurements
Culture samples were collected by a
laboratory technician who was unaware of
the aim of the study from the newborn
infants cord stump using a sterile swab. All
samples were placed in a sterile tube and
were immediately transferred to
laboratory. In laboratory, samples were
taken by swab and were immediately
transferred to blood agar. After 24 hours,
the grown colonies were separated, and
identified by standard methods. Also, for
newborn infants admitted to NICU, the
second culture samples were collected
from umbilical cord stump on days 5-7
after birth. Bacteriological examinations
were performed on the all colonization.
2-5. Inclusion and exclusion criteria
All newborn infants in NICU were treated
by empirical antibiotic therapy with the
same protocol, based on the treatment of
premature neonatal sepsis bacteria (first
week: Ampicillin and Cefotaxime,
Amikacin). If newborn infants in NICU
received other antibiotics due to sepsis that
resistance to empirical antibiotic treatment
or any other reason were excluded from
the study.
2-6. Ethical consideration
After the full explanation about the
purpose of the study to one of the parents
by the researchers, an informed consent
was obtained before delivery. For selecting
infants admitted to NICU, an informed
consent from parents was obtained
immediately after admission.
2-7. Data Analyses
Data were analyzed by SPSS (version
20.0) and descriptive statistics were used
to determine the frequency and distribution
of data. Kolmogorov-Smirnov test was
used to determine the normality. Also; Chi-
square test, t student test, one-way
ANOVA in normal and Mann-Whitney
and Kruskal Wallis test in non-normal data
were used for data analysis. The level of
statistical significance was set at P <0.05.
3- RESULTS
All 180 infants were investigated and
none of them were excluded from the
study. Among them, 50% (n=90) were boy
and 50% (n=90) were the first-time
mothers. Normal gestational age (38 to 42
weeks) was seen in 67.2% (n=121) of
subjects. The mean birth weight was 3,750
± 250 grams and 3,680 ± 330 grams in
newborns rooming in with their mothers at
the birth time in normal vaginal delivery
and in caesarean section, respectively. The
mean birth weight was 2,310 ± 145 grams
in infants who were admitted to NICU that
majority (85%, n= 51) of them were in
abnormal range. Data analysis showed that
three groups had no significant differences
in terms of gender and first-time mothers,
but had a significant difference in terms of
gestational age and birth weight. Table.1
shows the distribution of these variables.
In investigating of bacterial colonization
on the second day of birth, umbilical cord
bacterial colonization was significantly
higher in the neonates born by cesarean
section and rooming in with mothers
compared to the other groups (P<0.001).
Staphylococcus aureus was the most
frequently isolated from the newborns
umbilical cord. In 13 cases (42%) they
were mixed with other bacteria, and in 18
cases (58%) they were the only isolates.
After Staphylococcus aureus, Escherichia
coli in the NICU neonates, and Klebsiella
pneumoniae in the neonates rooming in
with mothers were the most cause of
umbilical cord colonization (Table.2).
There was no significant difference
between the groups in term of frequency of
isolated bacteria from the newborns
umbilical cord (P>0.05) (Table.2).
Int J Pediatr, Vol.5, N.11, Serial No.47, Nov. 2017
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Comparison of the Umbilical Cord Bacteria Colonization in Neonates

Assessment the distribution of umbilical Staphylococcus saprophyticus (n=2,

cord culture results on the day of 5-7 in 3.5%), were the most frequently isolated
newborns admitted to NICU showed that from the umbilical cord, respectively.
18.3% (n=11) of them were without
Also, umbilical cord culture results in the
growth, and Staphylococcus aureus (n=17,
second day and day of 5-7 had not
13.5%), Escherichia coli (n=8, 13.5%),
significantly relationship with gender, first
Klebsiella pneumonia (n=11, 18.2%),
time mothers, gestational age and birth
Staphylococcus epidermidis (n=6, 10%),
weight and these factors had not effect on
Enterococci (n=3, 5%), Staphylococcus
the colonization rate (P>0.05).
haemolyticus (n=2, 3.5%), and

Table-1: Distribution of gender, first-time mothers, gestational age and birth weight in three groups
Studied groups
Admitted to Stayed with mother Stayed with mother P-
Variables NICU and and value
cesarean section normal vaginal
Number (%) delivery delivery
Number (%) Number (%)
Gender 31 (51.7) 25 (41.7) 34 (56.7)
Boy 35 (58.3) 26 (43.3) 0.247
girl 29 (48.3)
First-time mothers 34 (56.7) 26 (43.3)
Yes 26 (43.3) 34 (56.7) 30 (50) 0.344
No 30 (50)
Gestational age (38-
42 6 (10) 57 (95) 58 (96.7) 0.001
weeks)
Birth weight (2500
– 9 (15) 54 (90) 53 (88.3) 0.001
4000grams)

Table-2: Distribution of umbilical cord culture results on second day of birth in three groups
Studied
groups
Stayed with mother Stayed with mother
Admitted to and and P-
Culture Result cesarean section normal vaginal value*
NICU delivery delivery
Number (%) Number (%)
Number (%)
Without growth 42 (70) 21 (35) 34 (56.7) 0.001
Staphylococcus
aureus 7 (11.8) 16 (26.8) 8 (13.5) 0.051
Escherichia coli 4 (6.7) 6 (10) 5 (8.5) 0.424
Klebsiella
pneumoniae 3 (5) 9 (15) 7 (11.8) 0.134
Staphylococcus 2 (3.5) 4 (6.7) 3 (5) 0.587
epidermidis
Enterococci 1(1.5) 2 (3.5) 1 (1.5) 0.89
Staphylococcus 1(1.5) 1 (1.5) 1 (1.5) -
haemolyticus
Staphylococcus - (0) 1 (1.5) 1 (1.5) 0.811
saprophyticus
*Chi-square test.

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Forozeshfard et al.

4- DISCUSSION were the main cause of microbial

colonization and septicemia in the
This study was conducted aimed to
neonates (23). In our study, Klebsiella
determine of the umbilical cord bacterial
pneumonia and Escherichia coli were the
colonization in newborn infants rooming
leading cause of colonization, too. Ying, et
in with mothers and neonates admitted to
al., conducted a study aimed to determine
neonatal intensive care unit. Our results
the distribution of bacteria isolated in
indicated that newborns born by cesarean
omphalitis. In their study, total of 69
section are more susceptible to develop
strains of pathogens were isolated from
umbilical cord bacterial colonization
samples, which Staphylococcus aureus
compared to newborns born by vaginal
(33.33%), Escherichia coli (64%), and
delivery and neonates admitted to NICU.
Klebsiella pneumonia (59%), were the
Staphylococcus aureus was the most
predominant isolates recovered from the
common bacteria responsible for the
inflamed umbilicus in newborns (24). The
colonization. Statistically, frequency of
results of this study are in line with our
bacteria was similar between the groups.
study. The most common isolated
Chamnanvanakij et al. investigated the organisms in Taffazoli et al. study in
umbilical cord bacterial colonization Mashhad, Iran, were Staphylococcus
among 180 infants stayed at home. In their epidermidis, Staphylococcus aureus,
study, umbilical swab cultures was Escherichia coli and Klebsiella
performed within 7 days post discharge, Pneumoniae in the umbilical stump (25).
which all taken culture specimens were
positive and Klebsiella, Escherichia coli, In Oishi at el. study, also, despite the use
Enterobacter and Staphylococcus were the of disinfectant in order to in the prevention
of neonatal umbilical colonization, a
most frequent organisms, respectively.
significant number of participants
Klebsiella and Escherichia coli were
colonized by Staphylococcus aureus (26).
isolated from the umbilical cord in 60%
and 37.2% of the neonates (20). Staphylococcus epidermidis is a skin and
mucosal flora, which similar to
In our study, majority of the neonates had
Staphylococcus aureus are the most
not any umbilical cord bacterial
frequent causes of nosocomial infections
colonization, which this difference may be
on indwelling devices (27). Therefore,
due to umbilical cord care method. Natural
healthcare personnel have an important
drying of umbilical cord was the only used
role in prevention of Staphylococcus
methods in our study, while in
colonization and standard precautions
Chamnanvanakij at el., triple dye and
should be performed to avoid transfer and
alcohol were the other methods. Despite
spread of bacteria. Association of bacterial
the many studies, there is still controversy
colonization with low birth weight or early
over which umbilical cord care practice is
gestational age has been reported in
the best (21). Several trials have shown
several studies (28, 29).
that dry cord care increased colonization
rates of bacteria, especially We did not observe this relationship that
Staphylococcus aureus (21, 22). further carefully designed studies are
needed to demonstrate them. The most
In another study by Besharati et al.,
important limitation of this study was low
prevalence of bacterial colonization was
sample size and lack of control on the hand
investigated among 100 neonate in-
hygiene of personals due to higher
patients NICU ward. Results of this study
incidence of infection following contacts
showed that Staphylococcus epidermidis,
caregivers with mothers. Also, studies
Klebsiella pneumonia and Escherichia coli
aimed to introduce the best strategies to
Int J Pediatr, Vol.5, N.11, Serial No.47, Nov. 2017
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Comparison of the Umbilical Cord Bacteria Colonization in Neonates
decrees the prevalence of Staphylococcus
aureus were recommended.
4-1. Limitations of the study
The most important limitation of our study
was the lack of uniformity of samples in
terms of gestational age and birth weight.
Other limitation was the second culture
which was done only in infant admitted in
ICU. Also, other factors such as parent
education and socio-economic status, and
history of vaginal infection may be
effective in umbilical cord colonization.
So, we recommend another study with
considering these factors.
5- CONCLUSION
This study showed that umbilical cord
bacterial colonization was more in infants
who were born by cesarean section and
stayed with their mothers. So, due to need
of mothers for special care, number of
caregivers and close contacts caregivers
with mother especially in those with
caesarian section, cares to prevent
transmission of bacteria should be
considered.
6- CONFLICT OF INTEREST
There is no conflict of interest.
7- ACKNOWLEDGMENT
The authors would like to express their
gratitude to the staff of the NICU ward in
Amir al-Mu'mininhospital for their
cooperation. This study was supported in
part by grant from the Semnan University
of Medical Sciences.
8- REFERENCES
1. Karumbi J, Mulaku M, Aluvaala J,
English M, Opiyo N. Topical umbilical cord
care for prevention of infection and neonatal
mortality. The Pediatric infectious disease
journal 2013;32:78.
2. Kai‐Larsen Y, Gudmundsson GH, Agerberth B. A review of
the innate immune defence of the human foetus and newborn,
Int J Pediatr, Vol.5,
4
with the emphasis on antimicrobial peptides.
Acta Paediatrica 2014;103:1000-8.
3. Sangkomkamhang US, Lumbiganon P,
Prasertcharoensook W, Laopaiboon M.
Antenatal lower genital tract infection
screening and treatment programs for
preventing preterm delivery. Cochrane
database of systematic reviews issue, 2015.
4. Chan GJ, Lee AC, Baqui AH, Tan J,
Black RE. Prevalence of early-onset neonatal
infection among newborns of mothers with
bacterial infection or colonization: A
systematic review and meta-analysis. BMC
infectious diseases 2015;15:118.
5. Vergnano S, Heath PT. Fetal and
neonatal infections. Medicine 2013;41:723-9.
6. Camacho-Gonzalez A, Spearman PW,
Stoll BJ. Neonatal infectious diseases:
Evaluation of neonatal sepsis. Pediatric clinics
of North America 2013;60:367-89.
7. Duan Q, Zhou M, Zhu L, Zhu G.
Flagella and bacterial pathogenicity. Journal of
basic microbiology 2013;53:1-8.
8. Fletcher, Madilyn, and Dwayne C.
Savage, eds. Bacterial adhesion: mechanisms
and physiological significance. Springer
Science and Business Media, 2013.
9. Julian S, Burnham C-AD, Sellenriek P,
Shannon WD, Hamvas A, Tarr PI, et al. Impact
of neonatal intensive care bed configuration on
rates of late-onset bacterial sepsis and
methicillin-resistant staphylococcus aureus
colonization. Infection Control and Hospital
Epidemiology 2015;36:1173-82.
10. Imdad A, Mullany LC, Baqui AH, El
Arifeen S, Tielsch JM, Khatry SK, et al. The
effect of umbilical cord cleansing with
chlorhexidine on omphalitis and neonatal
mortality in community settings in developing
countries: A meta-analysis. BMC Public
Health 2013;13(3): 1.
11. Saleh J-EA, Nemecek J, Jones C.
Impact of hygienic caring of the umbilical
cord in the prevention of neonatal tetanus.
2015.
12. Bhutta ZA, Darmstadt GL, Hasan BS,
Haws RA. Community-based interventions for
improving perinatal and neonatal health
N.11, Serial No.47, Nov. 2017
601
Forozeshfard et al.
outcomes in developing countries: A review of
the evidence. Pediatrics 2005;115:519-617.
13. Mullany LC, Darmstadt GL, Tielsch
JM. Role of antimicrobial applications to the
umbilical cord in neonates to prevent bacterial
colonization and infection: A review of the
evidence. The Pediatric infectious disease
journal 2003;22:996.
14. SAWARDEKAR KP. Changing
spectrum of neonatal omphalitis. The Pediatric
infectious disease journal 2004;23:22-6.
15. Davies E, Isaacs D, Levinsky R.
Defective immune interferon production and
natural killer activity associated with poor
neutrophil mobility and delayed umbilical cord
separation. Clinical and experimental
immunology 1982;50:454.
16. Imdad A, Bautista RMM, Senen KAA,
Uy MEV, Mantaring III JB, Bhutta ZA.
Umbilical cord antiseptics for preventing
sepsis and death among newborns. The
Cochrane Library 2013.
17. Puopolo KM, Escobar GJ. Early-onset
sepsis: A predictive model based on maternal
risk factors. Current opinion in pediatrics
2013;25:161-6.
18. Ameh EA, Nmadu PT. Major
complications of omphalitis in neonates and
infants. Pediatric surgery international
2002;18:413-6.
19. Veloso FT, Cardoso V, Fraga J,
Carvalho J, Dias LM. Spontaneous umbilical
fistula in crohn's disease. Journal of clinical
gastroenterology 1989;11:197-200.
20. Chamnanvanakij S, Decharachakul K,
Rasamimaree P, Vanprapar N. A randomized
study of 3 umbilical cord care regimens at
home in thai neonates: Comparison of time to
umbilical cord separation, parental satisfaction
and bacterial colonization. J Med Assoc Thai
2005;88:967-71.
21. Broom MA, Smith SL. Late presentation of
neonatal omphalitis following
dry cord care. Clinical pediatrics.
2013;52(7):675-7.
22. Evens K, George J, Angst D, Schweig
L. Does umbilical cord care in preterm infants
influence cord bacterial colonization or
detachment? Journal of perinatology
2004;24:100-4.
23. Besharati R, SADEGHIAN A,
MAMORI GA, Lashkardoust H, GHOLAMI
S. Sources of bacteria causing nosocomial
infections at NICU of Ghaem hospital in
Mashhad, Iran. Journal of North Khorasan
University of Medical Sciences. 2013; 5 (1):
25-30.
24. Ying C. Study on 69 Pathogens and Drug-
resistance of Neonatal Omphalitis. Journal of
Mathematical Medicine. 2013; 2:015.
25. Taffazoli M, Farahani L, Mohammadzadeh
A, Esmaeeli H, Ghazvini K. Dose topical
application of breast milk affect on bacterial
colonization in umbilical cord? Koomesh
2008;10:Pe29-Pe35, En5.
26. Oishi T, Iwata S, Nonoyama M, Tsuji
A, Sunakawa K. Double-blind comparative
study on the care of the neonatal umbilical
cord using 80% ethanol with or without
chlorhexidine. Journal of Hospital Infection
2004;58:34-7.
27. Otto M. Staphylococcus epidermidis—
the'accidental'pathogen. Nature Reviews
Microbiology. 2009;7(8):555-67.
28. Mullany LC, Darmstadt GL, Katz J,
Khatry SK, LeClerq SC, Adhikari RK, Tielsch
JM. Risk factors for umbilical cord infection
among newborns of southern Nepal. American
Journal of Epidemiology. 2007;165(2):203-11.
29. Güvenç H, Aygün D, Yaşar F, Şoylu F,
Güvenç M, Kocabay K. Omphalitis in term
and preterm appropriate for gestational age and
small for gestational age infants. Journal of
tropical pediatrics. 1997;43(6):36
 Perbandingan Kolonisasi Bakteri Tali pusat Bayi Baru Lahir
yang tinggal dengan Ibu Mereka dan Neonatus yang dirawat di
Unit Perawatan Intensif Neonatal

Abstrak
Latar Belakang
Kolonisasi bakteri selama dan sesaat setelah kelahiran sering terjadi pada bayi
baru lahir. Tujuan penelitian ini adalah untuk menentukan kolonisasi bakteri tali
pusat pada bayi baru lahir dengan ibu dan neonatus yang dirawat di unit
perawatan intensif neonatal (NICU, neonatal intensive care unit).
Bahan dan metode
Dalam penelitian cross-sectional, 180 bayi baru lahir diteliti dalam tiga kelompok,
termasuk: bayi baru lahir yang lahir melalui persalinan normal dan tinggal dengan
ibu mereka (n = 60), bayi baru lahir yang lahir melalui operasi caesar dan tinggal
dengan ibu mereka (n = 60) , dan bayi baru lahir di NICU (n = 60). Perawatan tali
pusat dilakukan dengan pengeringan alami tanpa menggunakan antibiotik
desinfektan atau lokal untuk semua bayi baru lahir. Kultur bakteri dilakukan pada
hari kedua dalam tiga kelompok dan pada hari ke 5-7 hanya di kalangan bayi yang
dirawat di NICU.
Hasil
Di antara subjek, 50% (n = 90) adalah anak laki-laki dan 50% (n = 90) adalah ibu
pertama kali. Usia kehamilan normal (38 sampai 42 minggu) terlihat pada 67,2%
(n = 121) subjek. Tiga kelompok tidak memiliki perbedaan signifikan dalam hal
jenis kelamin (p = 0,247), dan ibu yang baru pertama kali (p = 0,344), namun
memiliki perbedaan signifikan dalam hal usia kehamilan (p = 0,001).
Staphylococcus aureus adalah bakteri paling umum yang bertanggung jawab atas
kolonisasi dalam kultur pertama (n = 31, 17,22%), dan kultur kedua (n = 17,
13,5%). Kolonisasi bakteri lebih sering terjadi pada bayi baru lahir yang lahir
dengan operasi caesar dan tinggal dengan ibu mereka dibandingkan dengan
kelompok lainnya (p <0,001).
Kesimpulan
Menurut penelitian, kolonisasi bakteri adalah umum pada bayi baru lahir yang
lahir dengan operasi caesar dan tinggal dengan ibu mereka dan Staphylococcus
aureus memiliki peran penting dalam kolonisasi ini. Penelitian selanjutnya
disarankan untuk mengkonfirmasi hasil penelitian kami.
Kata Kunci: Bedah caesar, Kolonisasi, Kelahiran, Bayi, Tali pusat.

1. PENDAHULUAN
Setiap tahun, satu juta kematian bayi baru lahir terjadi di dunia karena
infeksi yang disebabkan oleh bakteri yang masuk ke tubuh melalui tali pusat.
Jaringan nekrotik tali pusat adalah tempat terbaik kolonisasi bakteri yang
terbentuk segera setelah lahir. Staphylococcus aureus, Kelompok streptococcus B
(GBS) dan Escherichia coli (E. coli) menjadi isolat utama umbilikus kolonisasi
pada bayi baru lahir. Untuk kolonisasi bakteri tali pusat, serangkaian langkah
termasuk proses bakteri transmisi, invasi ke mekanisme pertahanan host utama
seperti kulit, adhesi mukosa, dan kolonisasi dengan pertumbuhan bakteri
diperlukan. Kolonisasi tali pusat terjadi dengan pertumbuhan organisme bakteri
termasuk flora kulit normal dan bakteri patogen, dan dapat menyebabkan kondisi
yang mengancam kehidupan.
Saat ini, kemajuan perawatan tali pusat mengurangi paparan tali pusat
terhadap infeksi di negara maju dan berkembang. Strategi termasuk penggunaan
solusi desinfeksi dan protokol kebersihan, perawatan postnatal, dan pengurangan
jumlah pengasuh untuk seseorang telah dikaitkan dengan penurunan kejadian
kolonisasi tali pusat, sehingga dalam studi, penerapan chlorhexidine dan peduli
higienis mengurangi kejadian infeksi tali pusat.
Faktor risiko potensial infeksi tali pusat adalah berat lahir rendah,
persalinan persalinan berkepanjangan, pecahnya membran prematur, persalinan
non steril, kateterisasi tali pusat, metode perawatan tali pusat, dan kelahiran di
rumah. Komplikasi paling umum infeksi tali pusat adalah sepsis. Kejadian sepsis
bayi baru lahir akibat kolonisasi tali pusat diperkirakan terjadi pada 1-4 kasus per
1.000 kelahiran hidup di negara berkembang, bergantung pada lokasi geografis.
Komplikasi lain infeksi tali pusat adalah pembengkakan arteri umbilikalis,
trombosis vena portal, abses hepatik, peritonitis, gangren usus, nekrosis dan
akhirnya kematian.
Mengingat komplikasi berbahaya infeksi tali pusat dapat menyebabkan
kematian, tujuan penelitian ini adalah mengetahui dan membandingkan kolonisasi
bakteri tali pusat pada bayi baru lahir yang tinggal dengan ibu dan neonatus yang
dirawat di unit perawatan intensif neonatal (NICU, neonatal intensive care unit).
2. MATERI DAN METODE
2.1 Desain Penelitian dan Populasi
Dalam sebuah studi cross-sectional, 180 bayi baru lahir yang lahir di
rumah sakit perempuan Amir- al-Mu'minin di Semnan, Iran, selama Oktober 2014
hingga Maret 2015 direkrut. Ukuran sampel dihitung dengan menggunakan data
percobaan (10 bayi baru lahir masuk ke NICU, 10 bayi baru lahir yang tinggal
dengan ibu dalam persalinan normal dan 10 bayi baru lahir yang tinggal dengan
ibu mereka dalam operasi caesar). Setelah berkonsultasi dengan ahli statistik dan
tidak mungkin untuk mengevaluasi data untuk 2% subjek, total 60 bayi baru lahir
per kelompok dipertimbangkan untuk mendeteksi perbedaan temuan laboratorium
dengan kekuatan 80% dan interval kepercayaan 95% (CI). Oleh karena itu, 180
pasien sebagai convenience sampling dimasukkan ke dalam penelitian.
2.2 Metode
Bayi baru lahir diselidiki dalam tiga kelompok: bayi baru lahir yang lahir
dengan operasi caesar, dan vaginal yang tinggal dengan ibu pada waktu kelahiran,
dan neonatus yang dirawat di NICU. Dalam penelitian ini, metode perawatan tali
pusat adalah pengeringan alami tali pusat tanpa penggunaan desinfektan atau
antibiotik lokal untuk semua bayi baru lahir.
2.3 Alat Ukur
Kuesioner digunakan untuk mengumpulkan data termasuk jenis
persalinan, kelahiran pertama bagi ibu, jenis kelamin, berat lahir dan usia
kehamilan.
2.4 Pengukuran Laboratorium
Sampel kultur dikumpulkan oleh teknisi laboratorium yang tidak
mengetahui tujuan penelitian dari bayi baru lahir dengan menggunakan sapuan
steril. Semua sampel ditempatkan dalam tabung steril dan segera dipindahkan ke
laboratorium. Di laboratorium, sampel diambil dengan swab dan segera
dipindahkan ke agar darah. Setelah 24 jam, koloni yang tumbuh dipisahkan, dan
diidentifikasi dengan metode standar. Juga untuk bayi baru lahir yang dirawat di
NICU, sampel kultur kedua dikumpulkan dari tali pusat pada hari ke 5-7 setelah
kelahiran. Pemeriksaan bakteriologis dilakukan pada semua kolonisasi.
2.5 Kriteria Inklusi dan Eksklusi
Semua bayi baru lahir di NICU diobati dengan terapi antibiotik empiris
dengan protokol sama, berdasarkan pengobatan bakteri sepsis neonatal prematur
(minggu pertama: Ampisilin dan cefotaxime, Amikasin). Jika bayi baru lahir di
NICU menerima antibiotik lain karena sepsis yang menolak pengobatan antibiotik
empiris atau alasan lain dikeluarkan dari penelitian ini.
2.6 Pertimbangan Etis
Setelah penjelasan lengkap tentang tujuan penelitian pada salah satu orang
tua oleh para peneliti, sebuah informed consent diperoleh sebelum melahirkan.
Untuk memilih bayi yang dirawat di NICU, informed consent orang tua diperoleh
segera setelah masuk.
2.7 Analisis Data
Data dianalisis dengan SPSS (versi 20.0) dan statistik deskriptif digunakan
untuk mengetahui frekuensi dan distribusi data. Uji Kolmogorov-Smirnov
digunakan untuk menentukan normalitas. Juga; Chi-square, uji student t, ANOVA
satu arah dalam data normal dan uji Mann-Whitney dan uji Kruskal Wallis dalam
data non-normal digunakan untuk analisis data. Tingkat signifikansi statistik
ditetapkan pada P <0,05.
3. HASIL
Sebanyak 180 bayi diselidiki dan tidak satupun mereka dikeluarkan dari
penelitian ini. Di antara mereka, 50% (n = 90) adalah anak laki-laki dan 50% (n =
90) adalah ibu pertama kali. Usia kehamilan normal (38 sampai 42 minggu)
terlihat pada 67,2% (n = 121) subjek. Berat rata-rata lahir adalah 3.750 ± 250
gram dan 3680 ± 330 gram pada bayi baru lahir dan tinggal dengan ibu mereka
pada saat lahir dalam kelahiran vagina normal dan di operasi caesar, masing-
masing. Berat rata-rata lahir adalah 2.310 ± 145 gram pada bayi yang dirawat di
NICU dan mayoritas (85%, n = 51) dari mereka berada di kisaran normal. Analisis
data menunjukkan bahwa tiga kelompok tidak memiliki perbedaan signifikan
dalam hal jenis kelamin dan ibu pertama kali, namun memiliki perbedaan
signifikan dalam hal usia kehamilan dan berat lahir. Tabel 1 menunjukkan
distribusi variabel-variabel ini.
Dalam menyelidiki kolonisasi bakteri pada hari kedua kelahiran,
kolonisasi bakteri tali pusat secara signifikan lebih tinggi pada neonatus yang lahir
dengan operasi caesar dan melakukan pembedahan dengan ibu dibandingkan
dengan kelompok lainnya (P <0,001). Staphylococcus aureus paling sering
diisolasi dari tali pusat bayi baru lahir. Dalam 13 kasus (42%) ini dicampur
dengan bakteri lain, dan dalam 18 kasus (58%) ini adalah satu-satunya isolat.
Setelah Staphylococcus aureus, Escherichia coli dalam neonatus NICU, dan
Klebsiella pneumoniae dalam neonatus yang tinggal dengan ibu adalah penyebab
sebagian besar kolonisasi tali pusat (Tabel 2). Tidak ada perbedaan signifikan
antara kelompok dalam hal frekuensi bakteri terisolasi dari tali pusat bayi baru
lahir (P> 0,05) (Tabel 2).
Penilaian distribusi hasil kultur tali pusat pada hari 5-7 pada bayi baru
lahir di NICU menunjukkan bahwa 18,3% (n = 11) dari mereka tanpa
pertumbuhan, dan Staphylococcus aureus (n = 17, 13,5%), Escherichia coli ( n =
8, 13,5%), Klebsiella pneumonia (n = 11, 18,2%), Staphylococcus epidermidis (n
= 6, 10%), Enterococci (n = 3, 5%), Staphylococcus haemolyticus (n = 2, 3,5%),
dan Staphylococcus saprophyticus (n = 2, 3,5%), paling sering diisolasi dari tali
pusat.
Juga, hasil kultur tali pusat pada hari kedua dan hari ke 5-7 tidak memiliki
hubungan signifikan dengan jenis kelamin, ibu, ibu hamil, usia kehamilan dan
berat lahir pertama dan faktor-faktor ini tidak berpengaruh pada tingkat kolonisasi
(P> 0,05).
4. DISKUSI
Penelitian ini dilakukan untuk mengetahui kolonasi bakteri tali pusat pada
bayi baru lahir dengan ibu dan neonatus yang dirawat di unit perawatan intensif
neonatal. Hasil kami menunjukkan bahwa bayi baru lahir yang lahir melalui
operasi caesar lebih rentan terkena kolonisasi bakteri tali pusat dibandingkan bayi
baru lahir yang lahir melalui persalinan per vaginam dan neonatus yang dirawat di
NICU. Staphylococcus aureus adalah bakteri paling umum yang bertanggung
jawab untuk kolonisasi. Secara statistik, frekuensi bakteri sama di antara
kelompok.
Chamnanvanakij et al. menyelidiki kolonasi bakteri tali pusat di antara 180
bayi yang tinggal di rumah. Dalam studi mereka, kultur swab pusar dilakukan
dalam waktu 7 hari pasca debit, semua spesimen kultur diambil positif dan
Klebsiella, Escherichia coli, Enterobacter dan Staphylococcus adalah organisme
yang paling sering. Klebsiella dan Escherichia coli diisolasi dari tali pusat pada
60% dan 37,2% neonatus.
Dalam penelitian kami, sebagian besar neonatus tidak memiliki kolonisasi
bakteri tali pusat, perbedaan ini disebabkan oleh metode perawatan tali pusat.
Pengeringan alami tali pusat adalah satu-satunya metode yang digunakan dalam
studi kami, sementara dalam Chamnanvanakij et. al., Triple dye dan alkohol
adalah metode lain. Meski banyak penelitian, masih ada kontroversi mengenai
praktik perawatan tali pusat mana yang terbaik. Beberapa percobaan menunjukkan
bahwa perawatan tali pusat kering meningkatkan tingkat kolonisasi bakteri,
terutama Staphylococcus aureus.
Dalam studi lain oleh Besharati et al., prevalensi kolonisasi bakteri
diselidiki antara 100 neonatus pada pasien bangsal NICU. Hasil penelitian
menunjukkan bahwa Staphylococcus epidermidis, Klebsiella pneumonia dan
Escherichia coli adalah penyebab utama kolonisasi mikroba dan septikemia pada
neonatus. Dalam penelitian kami, Klebsiella pneumonia dan Escherichia coli juga
adalah penyebab utama kolonisasi,. Ying, et al., melakukan studi bertujuan untuk
mengetahui distribusi bakteri yang diisolasi dalam omphalitis. Dalam studi
mereka, total 69 strain patogen diisolasi dari sampel, Staphylococcus aureus
(33,33%), Escherichia coli (64%), dan Klebsiella pneumonia (59%), dominan
dalam isolat pulih dari umbilikus meradang pada bayi baru lahir). Hasil penelitian
ini sejalan dengan penelitian kami. Organisme terisolasi paling umum dalam studi
Taffazoli et al. di Mashhad, Iran, adalah Staphylococcus epidermidis,
Staphylococcus aureus, Escherichia coli dan Klebsiella Pneumoniae dalam ujung
umbilikalis.
Dalam studi Oishi et. al., terlepas dari penggunaan desinfektan dalam
rangka pencegahan kolonisasi tulang belakang neonatal, signifikansi jumlah
peserta dikolonisasi oleh Staphylococcus aureus.
Staphylococcus epidermidis adalah kulit dan mukosa flora, yang sama
untuk Staphylococcus aureus adalah penyebab paling sering infeksi nosokomial
pada perangkat indwelling. Oleh karena itu, petugas kesehatan memiliki peran
penting dalam pencegahan kolonisasi Staphylococcus dan tindakan pencegahan
standar yang harus dilakukan untuk menghindari transfer dan penyebaran bakteri.
Hubungan kolonisasi bakteri dengan berat lahir rendah atau usia gestasi dini telah
dilaporkan dalam beberapa penelitian.
Kami tidak melihat hubungan ini bahwa studi dirancang lebih lanjut
dengan hati-hati untuk menunjukkan mereka. Keterbatasan paling penting dalam
penelitian ini adalah rendahnya ukuran sampel dan kurangnya kontrol terhadap
kebersihan tangan personal karena tingginya insiden infeksi mengikuti kontak
pengasuh dengan ibu. Juga penelitian ditujukan untuk memperkenalkan stratagi
terbaik untuk memutuskan prevalensi Staphylococcus aureus yang
direkomendasikan.
4.1. Keterbatasan Penelitian
Batasan paling penting penelitian kami adalah kurangnya keseragaman
sampel dalam hal usia kehamilan dan berat lahir. Keterbatasan lainnya adalah
kultur kedua yang dilakukan hanya pada bayi yang dirawat di ICU. Selain itu,
faktor lain seperti status pendidikan orang tua dan status sosial ekonomi, dan
riwayat infeksi vagina mungkin efektif dalam kolonisasi tali pusat. Jadi, kami
merekomendasikan penelitian lain dengan mempertimbangkan faktor-faktor ini.
5. KESIMPULAN
Studinya menunjukkan bahwa kolonisasi bakteri tali pusat lebih pada bayi
yang lahir dengan operasi caesar dan tinggal dengan ibu mereka. Jadi, karena
kebutuhan ibu untuk perawatan khusus, jumlah pengasuh dan kontak mendekati
pengasuh dengan ibu terutama pada mereka dengan bedah caesar, peduli untuk
mencegah penularan bakteri harus dipertimbangkan.