Table 3 Summary of findings of trials to assess the effect of application of CHX to newborn’s umbilical cord

No. of studies

Design

Limitations

Consistency

Generalizability to Population of Interest

Generalizability to intervention of Interest

CHX

Control

Relative risk (95 % CI)

Sepsis Specific mortality: GRADE quality: Low

1

RCT

None

Only one trial reported data

All the participants were neonates

4.0% chlorhexidine solution.

Only RR was reported in the published manuscript.

0.69 (0.40-1.18)

All-Cause neonatal mortality: GRADE quality: Moderate

3

RCT

All three included studies are well conducted community randomized trials. Intervention was not masked in two studies.

Direction of effect in favor of intervention in all three studies. There was moderate statistical heterogeneity (I² =50%).

All the participants were neonates

All the studies used 4.0% chlorhexidine solution. Frequency of application was different in different study groups.

670/29543

655/25072

0.77

(0.63-0.94)

Incidence of omphalitis: Algorithm 1 GRADE quality: Moderate

3

RCT

All three included studies are well conducted community randomized trials. Intervention was not masked in two studies.

Direction of effect in favor of intervention in all three studies. There was moderate statistical heterogeneity (I² =34%).

All the participants were neonates

All the studies used 4.0% chlorhexidine solution. Frequency of application was different in different study groups.

Not applicable as data was pooled by generic inverse variance

Not applicable as data was pooled by generic inverse variance

0.73

(0.64-00.83)

Incidence of omphalitis: Algorithm 2 GRADE quality: High

3

RCT

All three included studies are well conducted community randomized trials. Intervention was not masked in two studies.

Direction of effect in favor of intervention in all three studies. No statistical heterogeneity (I² =0%).

All the participants were neonates

All the studies used 4.0% chlorhexidine solution. Frequency of application was different in different study groups.

Not applicable as data was pooled by generic inverse variance

Not applicable as data was pooled by generic inverse variance

0.69

(0.60-0.79)

Incidence of omphalitis: Algorithm 3 GRADE quality: High

3

RCT

All three included studies are well conducted community randomized trials. Intervention was not masked in two studies.

Direction of effect in favor of intervention in all three studies. Small statistical heterogeneity (I² =19 %).

All the participants were neonates

All the studies used 4.0% chlorhexidine solution. Frequency of application was different in different study groups.

Not applicable as data was pooled by generic inverse variance

Not applicable as data was pooled by generic inverse variance

0.46

(0.32-0.66)