***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We conducted a double-blind comparative study on the effectiveness of 80 % ethanol ( EtOH ) , with or without chlorhexidine ( CHD ) , in the prevention of neonatal umbilical colonization by Staphylococcus aureus , the most frequently isolated pathogen on the neonatal umbilicus in the early period . A total of 100 neonates born at the National Tokyo Medical Centre from March to May 2000 and nursed at a maternity ward were enrolled . Forty-eight were r and omly allocated to the group for whom umbilical cord disinfection was performed using 80 % EtOH containing 0.5 % CHD ( CHD group ) and 52 to disinfection with 80 % EtOH alone ( EtOH  group ) . The mothers of the neonates and the nursing staff were unaware as to which disinfectant was being used . Disinfection of the umbilicus and the surrounding area was done immediately after birth and twice daily thereafter , after bathing and in the evening , throughout the hospitalization period . Specimens for bacterial culture were taken from the umbilical cord and surrounding skin on day 4 or 5 after birth . As a disinfectant susceptibility test , we checked the minimum killing concentration ( MKC ) of CHD and EtOH . There was no statistically significant difference between the two groups with respect to sex , gestation period , birthweight , APGAR score or delivery method . In the CHD group , S. aureus was isolated from 25 % of the patients , while it was isolated from 57.7 % in the EtOH group ( P<0.001 ) . In the CHD group , 50 % of the S. aureus strains were MRSA , compared with 73.3 % in the EtOH group ( non-significant ) . All the S. aureus strains were killed by the combination of both CHD and EtOH at the concentrations used . In terms of the MKC90 , there was no significant difference between the CHD group and the EtOH group . For the daily care of the neonatal umbilicus , disinfection using 80 % EtOH containing CHD was found to be more effective than that using 80 % EtOH alone in preventing colonization by S. aureus OBJECTIVES To evaluate the effect of 2 cord-care regimens ( salicylic sugar powder vs chlorhexidine as a 4 % detergent water solution ) on cord separation time and other outcomes in preterm infants . METHODS A prospect i ve , r and omized , controlled trial was conducted on 244 preterm newborns with a gestational age of < 34 weeks and a birth weight of < 2500 g. All preterm newborns were enrolled , regardless of their health condition . We excluded from the study infants whose conditions during the first hours of life required the catheterization of umbilical vessels . We also excluded from the general statistical analysis all newborns who had their programmed cord-care regimen changed because of the presence or the suspicion of omphalitis . On arrival at our neonatal intensive care unit or neonatal special care unit , infants were bathed thoroughly with a soap solution ( Saugella , Guieu , Italy ) , and the umbilical cord ( UC ) was treated with 1 of the 2 antiseptic products chosen for the study . The stump was then folded and covered with common sterile , dry gauze and kept in place by an elastic net . Until cord detachment and at every diaper change , the cord stump was cleaned with sterile water and treated with the same product initially used for first-time cord care . On the third day of life , we obtained an umbilical swab either from the base of the cord or from the umbilicus if the cord was already sloughed . Six weeks after birth , during hospitalization or during a follow-up visit if already discharged , all infants had a medical examination to check the umbilicus area . Cord separation time , changing of the programmed cord-care regimen , death , omphalitis , sepsis , cord bleeding , nurses ' opinion on treatments efficacy , and UC colonization were measured . RESULTS The cord separation time was significantly lower in infants who were treated with salicylic sugar powder ( 6 + /- 2 days ) than in infants who were treated with chlorhexidine ( 9 + /- 2 days ) . The programmed cord-care regimen was changed in a significantly higher number of newborns in the chlorhexidine group ( 17 ) than in the salicylic sugar group ( 3 ) . None of the newborns died , and we found only sporadic cases of sepsis ( 1 patient in each group ) and omphalitis ( 1 patient in the chlorhexidine group ) . A significantly higher percentage of nurses were satisfied with the salicylic sugar powder treatment ( 98 % ) than with the chlorhexidine treatment ( 67 % ) , notwithst and ing a more frequent occurrence of slight cord scar bleeding in the salicylic sugar group ( 7.8 % ) than in the chlorhexidine group ( 4 % ) . The rate of negative umbilical swabs was significantly higher in infants treated with salicylic sugar powder ( 73.1 % ) than with chlorhexidine ( 53 % ) . CONCLUSIONS In neonatal intensive care units and neonatal special care units of developed countries , salicylic sugar powder can be used effectively and safely for UC care of preterm infants Background : R and omized trials from South Asia indicate umbilical cord chlorhexidine cleansing reduces mortality and omphalitis . No community-based data are available on bacteriological profile of the cord , early neonatal colonization dynamics , or impact of cord cleansing on colonizing organisms . Such data could clarify the design of scaled chlorhexidine interventions . Methods : Umbilical swabs were collected at home ( days 1 , 3 , 6 ) after birth from infants participating in a trial of 3 cord-care regimens ( no chlorhexidine , single cleansing , multiple cleansing ) in Sylhet , Bangladesh .  Overall and organism-specific positivity rates were estimated by cord-care regimen and by day of collection . Results : Between September 2008 and October 2009 , 1923 infants contributed 5234 umbilical swabs .  Positivity rate was high ( 4057 of 5234 , 77.5 % ) and varied substantially across groups . Immediate ( day 1 ) reductions in cord colonization were observed in single- ( prevalence rate ratio = 0.75 , 95 % confidence interval : 0.70–0.81 ) and multiple- ( prevalence rate ratio = 0.71 , 95 % confidence interval : 0.66–0.77 ) cleansing groups . Reductions persisted and increased in magnitude through day 6 only if babies received multiple applications . On days 1 , 3 , and 6 , respectively , multiple cleansing consistently reduced invasive organisms such as Escherichia coli ( 49 % , 64 % , and 42 % lower ) , Klebsiella pneumoniae ( 46 % , 53 % , and 33 % lower ) , and Staphylococcus aureus ( 34 % , 84 % , and 85 % lower ) . Conclusions : Cord cleansing with 4.0 % chlorhexidine immediately after birth reduces overall and organism-specific colonization of the stump . Reductions are greater and sustained longer with daily cleansing through the first week of life , suggesting that programs promoting chlorhexidine cleansing should favor multiple over single applications Comparison of two different methods of vaginal disinfection was made with regard to prevention Of neonatal infections . In method I , an antepartum vaginal douche with a chlorhexidine solution was used ; method II involved the use of chlorhexidine gluconate obstetrical gel during vaginal exploration . We studied 2853 normal deliveries from a total number of 3236 deliveries : 1467 deliveries were allocated r and omly to receive a vaginal douche  whereas 1386 underwent vaginal exploration using chlorhexidine gel .  A total of 203 neonates were transferred to the neonatal unit ( 120 males and 83 females ) : 101 belonged to the group where the mothers were subjected to method I , whereas in 102 method II had been used . Within 48 h postpartum 30 neonates from the method I group and 34 neonates from the method II group received systemic antibiotics . There was a tendency towards a higher proportion of full‐term neonates with verified septicaemia in the method II group ( 6 versus 2 ) , whereas the numbers of probable infections were 8 versus 12 . The corresponding total numbers in preterm infants were 3 and 2 , respectively . These differences were not statistically significant . We conclude that the use of chlorhexidine douche compared with vaginal exploration with chlorhexidine gel provides no additional advantages OBJECTIVE : Cord cleansing with chlorhexidine reduces  neonatal mortality . We aim ed to quantify the impact of this intervention on cord separation time and the implication s of such an increase on maternal and other caretaker ’s acceptance of chlorhexidine in future scaled up programs . METHODS : Between June 2007 and September 2009 , 29 760 newborns were r and omly assigned within communities in Bangladesh to receive 1 of 3 cord regimens : dry and clean cord care ( comparison ) , single-cleansing , or multiple-cleansing with 4.0 % chlorhexidine . Workers recorded separation status during home visits . Mothers of 380 infants in r and omly selected clusters reported age at separation and satisfaction with cord regimen . RESULTS : Compared with dry and clean care ( mean 4.78 days ) , separation time was longer in the single ( mean 6.90 days , difference = 2.10 ; 95 % confidence interval : 1.85–2.35 ) and multiple ( mean 7.49 days , difference = 2.69 ; 95 % confidence interval : 2.44–2.95 ) cleansing groups . Increased separation time was not associated with omphalitis . Mothers in these groups more frequently reported “ longer than usual ” separation times and dissatisfaction with the separation time ( 11.1 % and 17.6 % , respectively ) versus the comparison group ( 2.5 % ) . Overall satisfaction with the received cord care regimen was high ( 96.2 % ) . CONCLUSIONS : Topical chlorhexidine  increased cord separation time by ∼50 % . Caretakers are likely to detect this increase and might express dissatisfaction but still accept the intervention overall . When scaling up chlorhexidine cord cleansing , inclusion of appropriate messaging on expectation and nonrisks of increased cord separation time , in addition to the benefits of reduced infection and improved survival , might improve compliance Objective : To assess development of fatigue during chest compressions ( CCs ) in simulated neonatal cardiopulmonary resuscitation ( CPR ) . Study design : Prospect i ve r and omized manikin crossover study . Thirty neonatal healthcare professionals who successfully completed the Neonatal Resuscitation Program performed CPR using ( i ) 3:1 compression : ventilation ( C : V ) ratio , ( ii ) continuous CC with asynchronous ventilation ( CCaV ) at a rate of 90 CC per min and ( iii ) CCaV at 120 CC per min for a duration of 10 min on a neonatal manikin . Changes in peak pressure ( a surrogate of fatigue ) and CC rate were continuously recorded and fatigue among groups was compared . Participants were blinded to pressure tracings and asked to rate their level of comfort and fatigue for each CPR trial . Result : Compared with baseline , a significant decrease in peak pressure was observed after 72 , 96 and 156 s in group CCaV-120 , CCaV-90 and 3:1 C : V , respectively . CC depth decreased by 50 % within the first 3 min during CCaV-120 , 30 % during CCaV-90 and 20 % during 3:1 C : V. Moreover , 3:1 C : V and CCaV were similarly preferred by healthcare professionals . Conclusion : Similarly , 3:1 C : V and CCaV CPR were also fatiguing . We recommend that rescuers should switch after every second cycle of heart rate assessment during neonatal CPR Background : Infection control is an essential part of caring for hospitalized infants . With regard to the change of bacterial resistance over time and places , as well as the need for periodic studies on the effectiveness of antiseptics , this study aims to compare the effects of both solutions of povidone-iodine and chlorhexidine on skin bacterial flora among hospitalized infants . Material s and Methods : This clinical trial recruited 98 hospitalized infants and each of the above-mentioned solutions has been applied to a small area in the left or right side of the infants ’ bodies .  Skin cultures were taken before , immediately after and 2 h after the r and omly chosen infants ’ skin areas that were disinfected by each solution ( 588 skin cultures in total ) . Colony count and determination of microorganism types were done by only one person in a single laboratory . The study has been conducted in two teaching hospitals in Isfahan , Iran . Results : Staphylococcus epidermidis was the most common microorganism prior to skin disinfection by either solution . Two hours after disinfection , “ Staphylococcus epidermidis ” and “ Staphylococcus epidermidis and kelebsila ” had the highest frequencies of 3.1 % and 3.1 % , respectively . Before and 2 h after disinfection , distribution of different types of microorganisms had no significant difference between the two groups ( P = 0.84 and 0.13 , respectively ) ; however , the difference was significant immediately after disinfection , P < 0.01 . Conclusion : The present study demonstrated that 10 % povidone-iodine solution has more significant effect on reduction of skin pathogens promptly after application compared to 2 % chlor 
    Output:
    
AUTHORS ' CONCLUSIONS There is some uncertainty as to the effect of chlorhexidine applied to the umbilical cords of newborns in hospital setting s on neonatal mortality .