Systematic Review of the Effect of Topical Application of Human Breast Milk on Early Umbilical Cord Separation.

Objective: To evaluate the efficacy of topical application of human breast milk to reduce umbilical cord separation time.

Data Sources: We used a three-step search strategy. First, we searched six electronic databases from inception through July 16, 2018: PubMed, Cochrane, CINAHL, Embase, Scopus, and ProQuest Dissertations and Theses Global. We used the following search terms: infant, newborn, baby, babies, colostrum, breast milk expression, breast milk, breastmilk, mother milk, human milk, umbilical cord, and umbilicus. We included published trials in English without any time limit to optimize the search. Second, we searched for ongoing clinical trials and grey literature. Last, we conducted a manual review of the reference lists of the identified articles.

Study Selection: From 1,303 articles initially screened, eight articles reporting seven randomized controlled trials (RCTs) were included in the systematic review and meta-analysis.

Data Extraction: Two independent reviewers used a standardized extraction form to extract data from eligible articles. We evaluated the quality of individual and overall evidence according to risk of bias and the Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) system.

Data Synthesis: Allocation concealment was not clearly identified in any of the studies. In only two trials were participants and personnel blinded to the intervention group, and in none was the assessment of outcomes blinded. The overall quality of evidence was very low for RCTs according to the GRADE criteria. We found a significant reduction in time to cord separation with the topical application of human breast milk (z = 6.22, p < .001), with a mean difference of -1.01 day (95% confidence interval [-1.3,-0.690]) compared with dry cord care. Incidence of omphalitis was not significantly different (risk ratio = 0.82, 95% confidence interval [0.57, 1.18], z = 1.06, p = .29) between human breast milk and dry cord care groups.

Conclusion: Topical application of human breast milk is an effective and safe way to reduce cord separation time. Given that the overall quality of the included RCTs was very low, further well-designed trials are needed.