The EINC practice that fits
The Department of Health (DOH) Essential Intrapartum and Newborn Care (EINC) protocol recommends dry cord care. The umbilical cord stump is kept clean and dry, with nothing applied to it: no alcohol, no povidone-iodine, and no other substance, and the stump is not trimmed. Leaving the cord stump clean and dry with nothing applied is the practice that best follows EINC.
Why dry cord care is recommended
In settings with clean births and good hygiene, applying antiseptics to the cord does not reduce infection and may delay separation of the stump. Keeping the stump exposed to air and dry helps it separate naturally. The mother is taught to fold the diaper below the stump, to wash it with clean water and dry it if it becomes soiled, and to watch for redness, swelling, foul smell, or discharge, which need prompt care.
Why the other practices do not follow EINC
| Practice | EINC position |
|---|
| Wiping off all the vernix | Harmful; the vernix is left on because it protects the skin |
| Cutting next to the 5-cm clamp | Wrong; clamps go at 2 cm and 5 cm from the base, and the cord is cut close to the 2-cm clamp |
| Suctioning every baby with meconium-stained fluid | Not routine; suction only if secretions block the airway |
| Dry cord care | Recommended |
Details that are often tested
Thorough drying removes wetness, blood, and meconium, but the vernix caseosa is left in place because it protects the skin and helps keep the newborn warm. Wiping it off is listed among harmful practices. When the cord is clamped, the first clamp is placed 2 cm from the umbilical base and the second 5 cm from the base, and the cord is cut close to the 2-cm clamp. Cutting next to the 5-cm clamp would leave a long stump. Watch out! For a baby who cries and breathes well, the color of the amniotic fluid does not change the rule: routine suction is not done even with meconium-stained fluid, because suction can cause injury and bradycardia and delays skin-to-skin contact.
Exam takeaway
In EINC, the cord stump is kept clean and dry with nothing applied, the vernix is left on, and suction is used only for a blocked airway. Key point! Many EINC items test practices that were once routine but are now considered unnecessary or harmful, so recognize which traditional practices have been dropped.