ABSTRACT: Ethanol is widely used in all kinds of products with direct exposure to the human skin (e.g. medicinal products like hand disinfectants in occupational settings, cosmetics like hairsprays or mouthwashes, pharmaceutical preparations, and many household products). Contradictory evidence about the safety of such topical applications of the alcohol can be found in the scientific literature, yet an up-to-date risk assessment of ethanol application on the skin and inside the oral cavity is currently lacking. The first and foremost concerns of topical ethanol applications for public health are its carcinogenic effects, as there is unambiguous evidence for the carcinogenicity of ethanol orally consumed in the form of alcoholic beverages. So far there is a lack of evidence to associate topical ethanol use with an increased risk of skin cancer. Limited and conflicting epidemiological evidence is available on the link between the use of ethanol in the oral cavity in the form of mouthwashes or mouthrinses and oral cancer. Some studies pointed to an increased risk of oral cancer due to locally produced acetaldehyde, operating via a similar mechanism to that found after alcoholic beverage ingestion. In addition, topically applied ethanol acts as a skin penetration enhancer and may facilitate the transdermal absorption of xenobiotics (e.g. carcinogenic contaminants in cosmetic formulations). Ethanol use is associated with skin irritation or contact dermatitis, especially in humans with an aldehyde dehydrogenase (ALDH) deficiency. After regular application of ethanol on the skin (e.g. in the form of hand disinfectants) relatively low but measurable blood concentrations of ethanol and its metabolite acetaldehyde may occur, which are, however, below acute toxic levels. Only in children, especially through lacerated skin, can percutaneous toxicity occur. As there might be industry bias in many studies about the safety of topical ethanol applications, as well as a general lack of scientific research on the long-term effects, there is a requirement for independent studies on this topic. The research focus should be set on the chronic toxic effects of ethanol and acetaldehyde at the point of impact, with special regard to children and individuals with genetic deficiencies in ethanol metabolism.

As has been repeatedly demonstrated, alcohol can exert deleterious morphological and physiological effects during early stages in development. The present review examines nonteratological links existing between alcohol and ontogeny. Human and animal studies are taken into consideration for the analysis of fetal, neonatal, infantile, adolescent, and adult responsiveness to the drug. Sensitivity to alcohol's chemosensory and postabsorptive properties, as well as learning and memory processes mediated by such properties, are examined from this developmental perspective. The studies under discussion indicate that, within each stage in development, we can trace alcohol-related experiences capable of determining or modulating alcohol seeking and intake patterns.(c) 2007 Wiley Periodicals, Inc. Dev Psychobiol 49: 227-242, 2007.

BACKGROUND: Despite good evidence that ethanol abuse in adulthood is more likely the earlier human adolescents begin drinking, it is unclear why the early onset of drinking occurs in the first place. A review of experimental studies with animals complemented by clinical, epidemiologic and experimental studies with humans supports the idea that precipitating conditions for ethanol abuse occur well before adolescence, in terms of very early exposure to ethanol as a fetus or infant. Experimental studies with animals indicate, accordingly, that ethanol intake during adolescence or adulthood is potentiated by much earlier exposure to ethanol as a fetus or infant. METHODS: Two broad theoretical frameworks are suggested to explain the increase in affinity for ethanol that follows very early exposure to ethanol, one based on effects of mere exposure and the other on associative conditioning. Studied for 50 years or more in several areas of psychology,"effects of mere exposure" refers to enhanced preference expressed for flavors, or just about any stimuli, that are relatively familiar. An alternative framework, in terms of associative conditioning, is guided by this working hypothesis: During ethanol exposure the fetus or infant acquires an association between ethanol's orosensory (odor/taste) and pharmacological consequences, causing the animal subsequently to seek out ethanol's odor and taste. RESULTS AND CONCLUSIONS: The implication that ethanol has rewarding consequences for the fetus or young infant is supported by recent evidence with perinatal rats. Paradoxically, several studies have shown that such early exposure to ethanol may in some circumstances make the infant treat ethanol-related events as aversive, and yet enhanced intake of ethanol in adolescence is nevertheless a consequence. Alternative interpretations of this paradox are considered among the varied circumstances of early ethanol exposure that lead subsequently to increased affinity for ethanol.

OBJECTIVE: To explore the types of advice that women in Argentina received from health professionals, family members, and friends about drinking alcoholic beverages and about alcohol usage during pregnancy and lactation. METHODS: In December 2001 and December 2002, structured interviews were conducted with a total of 167 women who were then breast-feeding or who had recently breast-fed their infant. Mothers were asked about the type of advice, if any, that they had received about the use of alcohol from health professionals and from family members and friends. Also included were questions related to the usage of the traditional Argentine beverage "mate"(an infusion widely consumed in South America that is prepared from the leaves of the Ilex paraguayensis plant) and the types of advice the women had received about breast-feeding and neonatal care in general. RESULTS: Of the 167 women studied, 96.4% of them reported that their physician had advised them to breast-feed their infant. In addition, 93.4% of the women said they had treated their infant's umbilical cord stump with alcohol. Fewer than half of the women (46.7%) reported that their physician had advised them about drinking alcoholic beverages during pregnancy, and even fewer (25.7%) received such advice during lactation. Family and friends were about equally likely to give advice about the consumption of alcoholic beverages during pregnancy (42.6%) and during lactation (47.9%). However, the type of advice changed, with the family and friends being significantly more likely to encourage drinking when the women were lactating than when they were pregnant (P < 0.001). Family members and friends also encouraged the drinking of mate to increase milk production. CONCLUSIONS: As in other cultures, in Argentina the belief exists that alcohol enhances lactation. However, the majority of women whom we interviewed had not been counseled by their health professional about the consumption of alcoholic beverages during pregnancy and lactation. There is a need for professional development strategies that will address women's awareness of the risks of alcohol consumption and alcohol usage.

The emergence of West Nile Virus (WNV) in North America has resulted in increased public awareness and utilization of insect repellents containing N,N-diethyl-m-toluamide (DEET) in the prevention of mosquito-borne disease. Regulatory reassessments in North American countries have recently been completed for insect repellents containing DEET as active ingredient, resulting in labeling changes intended to minimize unnecessary exposure to special populations, including children. This article describes those changes, and summarizes more recent data relating to the pharmacokinetics, toxicology, and epidemiology of adverse effects associated with DEET in humans.

Visits to the emergency department (ED) by neonates and their parents can cause anxiety for parents and the ED staff. Many of the presenting complaints are unique to the neonatal population, and an understanding of both common problems and true medical emergencies is paramount. This article discusses the complaints the EDs have seen more frequently as a result of earlier newborn discharges from hospitals.

The clinical application of a new method for the quantitative determination of urinary glycosaminoglycans (GAGs) is presented. 115 normal subjects and 44 patients affected by different types of mucopolysaccharidoses (MPSo-ses) have been studied by this method in comparison with the conventional borate-carbazole method. All patients showed an urinary GAG excretion well above the normal subjects. In particular, patients affected by Morquio syndrome showed values well beyond the normal range; on the contrary, with the borate-carbazole method, 6 out of 7 patients had borderline values of urinary GAGs. The new method is also more rapid and easier to perform than conventional methods.

We describe a simple, rapid, precise, and sensitive spectrophotometric method for measuring urinary glycosaminoglycan (GAG) sulfate excretion. The GAG sulfates are precipitated with cetylpyridinium chloride, resuspended in water, and mixed with the basic dye 1,9-dimethylmethylene blue to produce a complex with the polyanionic molecule of sulfated GAGs. Absorbance is read at 535 nm. The standard curve for reaction was linear up to 12 micrograms of the different GAGs: dermatan sulfate, heparan sulfate, keratan sulfate, chondroitin 4-sulfate, and chondroitin 6-sulfate. Within- and between-run precision (CV), measured at three different GAG concentrations (normal and pathological), varied from 1.6% to 2.5% and from 1.8% to 4.5%, respectively. Analytical recovery ranged from 71% to 107%. Urinary GAG excretion, measured by this procedure, correlates (r = 0.837; p less than 0.001) with the values obtained with the borate-carbazole reaction (Anal Biochem 1962;4:330-4).

A sensitive and accurate assay was developed for the measurement of 8-methoxypsoralen in plasma using electron-impact positive-ion mass fragmentography. 4,5,8-Trimethylpsoralen was used as an internal standard. Sample preparation consisted of a two-step liquid phase extraction using acetonitrile and methylene chloride. The calibration curve showed a linear relationship between the peak areas of 8-methoxypsoralen and 4,5,8-trimethylpsoralen over a wide range of 8-methoxypsoralen concentrations (1-500 ng/ml). With-in- and between-run precisions, measured at five different drug concentrations, varied from 0.82 to 1.41% and from 0.82 to 1.86%, respectively.

We describe a case of hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome documented by longitudinal magnetic resonance imaging (MRI). A two-year and nine-month-old boy had a prolonged hemiconvulsion during fever followed by right hemiparesis. Seven days later the imaging abnormality on T2 and diffusion-weighted images (DWI) was limited to the white matter of the left hemisphere. One month later severe gliosis and unilateral brain atrophy were already evident. MRI is useful in the early stages of prolonged seizures and T2 and DWI abnormalities appear to be well correlated with parenchymal damage that results from sustained ictal activity. The neuroradiological findings in our case and in the few HHE patients reported in the literature seem to be very characteristic and, if confirmed in larger series, could permit an early diagnosis.

Coenzyme Q10 (CoQ10) deficiency has been associated with various clinical phenotypes, including an infantile multisystem disorder. The authors report a 33-month-old boy who presented with corticosteroid-resistant nephrotic syndrome in whom progressive encephalomyopathy later developed. CoQ10 was decreased both in muscle and in fibroblasts. Oral CoQ10 improved the neurologic picture but not the renal dysfunction.

AIM: The aim of this paper was to study the evolution of ventriculomegaly, the treatment and the developmental problems of a group of very low birth weight infants (VLBWI) born between 1985 and 1999 who met Levene's percentiles for post-hemorrhagic ventricular dilatation (PHVD). METHODS: A retrospective hospital-based study of a cohort of 66 VLBWI who fulfilled the diagnostic criteria for PHVD was performed. Measures of neurodevelopmental outcome were evaluated by analyzing neurosensorial patterns as well as mental and behavioral adjustment up to pre-school age in 35 survivors. RESULTS: The PHVDs initially (1985-1989) were due to a grade 4 intraventricular hemorrhage (IVH)(71.4%), and in the latter period (1995-1999) to IVH grade 2 (36.4%), grade 3 (31.8%) and grade 4 (31.8%). Acetazolamide has been used since the 90's in neonates with progressive PHVD. The 90s were characterized by an increasing incidence of tiny babies and rapidly-progressive PHVD. Taps were more frequent in the arrested dilatation group. Similarly, taps and acetazolamide were administered to newborns with persistent, slowly-progressive ventricular dilatation (PHVD > 4 weeks). The highest correlation was found for gestational age with the mental and psychomotor developmental indexes. Delayed performance and/or mental retardation were diagnosed in 71.4% of the survivors. CONCLUSION: Acetazolamide and lumbar puncture, associated with other risk variables (severity of IVH, PHVD evolution and associated parenchymal lesions) are harmful in terms of development, but they have a role in the short-term arrested and slowly progressive PHVD of the surviving babies, and not in the mortality incidence. Our retrospective data demonstrated that lower gestational age at birth increased the risk of lower mental and psychomotor developmental indexes.

Photopheresis (extracorporeal photochemotherapy, ECP) is a new type of photochemotherapy used for the treatment of oncological and autoimmune diseases. Additionally, recent reports indicate that this therapy is promising in both pediatric and adult patients who develop graft versus host disease (GVHD) resistant to conventional protocols after bone marrow transplantation (BMT). In this paper, we review 31 studies where ECP was used in the treatment of acute and chronic GVHD. A total of 76 (32% female) acute GVHD patients have been considered in 11 series. Fifty-nine patients presented with skin involvement; 47 had liver involvement, and 28 had gastrointestinal manifestations. Treatment duration ranged from 1 to 24 months. A regression of skin manifestations was observed in 83% of the patients with a complete response in 67%. A complete regression of liver and gut manifestations was reported in 38% and 54% of the patients, respectively. The overall patient survival was 53%. Of the 43 patients alive, 8 developed chronic GVHD manifestations. The immunosuppressive therapy was discontinued in 28% of cases and reduced in 46%. A total of 204 (45% female) chronic GVHD patients treated with ECP 1 to 110 months from transplantation have been considered in 20 series. One hundred twenty-eight patients presented with skin involvement, 84 with liver, 31 with lung, and 59 with oral manifestations. Treatment duration ranged from 3 to 40 months. A regression of skin manifestations was observed in 76% of patients with a complete response in 38%. An improvement of liver and lung involvement was reported in 48% and 39% of the patients, respectively. Of the 59 patients with oral manifestations, an improvement was obtained in 63% of cases. The overall patient survival was 79%. ECP is a nonaggressive treatment that may benefit patients with both acute and chronic GVHD who do not respond to standard immunosuppressive therapy.

Photopheresis (ECP) is a new immunomodulatory therapy in which recipient lymphocytes are treated extracorporeally with 8-methoxypsoralen and ultraviolet light. The treatment seems to induce an inhibition of both humoral and cellular rejection after transplantation. OBJECTIVE: Since recurrent rejection (RR) continues to be a severe complication after heart transplantation (HTx) and the immunosuppressive regimes used for the treatment are often associated with increased morbidity and mortality, we investigated whether ECP could have a beneficial effect on the number and severity of rejection episodes. METHODS: Eleven HTX recipients (5 M and 6 F, mean age 48.5 yrs) with RR were enrolled in the study. ECP was performed at weekly intervals during the 1st month, at 2 week intervals during the 2nd and 3rd month, and then monthly for another 3 months. RESULTS: The fraction of biopsies (EMB) with a grade 0/1A rejection increased during ECP from 46% to 72% while the EMB showing a 3A/3B rejection decreased from 42% to 18%. It is also noteworthy that out of the 78 EMB performed during ECP only one showed a 3B rejection in comparison with 13 out of 110 EMB in the pre-ECP period. Six rejection relapses were observed in a total follow-up of 60 months, two of them occurring during the tapering of oral steroid. Four relapses were reversed by ECP, one by i.v. steroids and the last by methotrexate after the failure of both i.v. steroids and ECP. The mean doses of immunosuppressive drugs resulted lower after 6 months of ECP: steroids were reduced from 13 to 8.25 mg/day, cyclosporine from 375 to 285 mg/day, azathioprine from 55 to 35 mg/day. CONCLUSIONS: ECP is a well tolerated treatment. Its administration allows better RR control and significant reduction in immunosuppressive therapy.

The purpose of the study was to investigate the management of pyelonephritis in a large Italian pediatric population. A total of 1,333 patients (36% male) were considered. Escherichia coli was the most frequently isolated agent (89.9%), followed by Proteus mirabilis (3.6%) and Klebsiella oxytoca (2.1%). 27% of microorganisms were resistant to amoxicillin, 4% to amoxicillin/clavulanic acid, 11% to trimethoprim-sulfamethoxazole, 2.4% to gentamicin and less than 2% to ceftazidime. Despite this resistance pattern showing that oral antibiotics, such as amoxicillin/clavulanic acid, are effective in vitro as well as parenteral antimicrobials, a parenteral antibiotic was given initially to 756 (57.2%) children. A prophylactic regimen was started in 922 patients with a rate of reinfection during prophylaxis of 9.5%; a higher rate of reinfection was observed in patients with reflux (25%) compared to children without reflux (3%)(p < 0.0001). Vesicoureteral reflux was demonstrated in 30% of patients. The number of renal abnormalities detected by DMSA in patients with and without reflux was significantly different (p < 0.001). CRP was higher in patients with scars (p < 0.02). In conclusion, pyelonephritis represents a common disease with about 2,500 days of hospitalization per year in the Veneto Region where there is a pediatric population of about 800,000 under 15 years of age. The results of antimicrobial in vitro tests indicate that amoxillicin/clavulanic acid could represent the antibiotic of choice. The high frequency of malformations, observed even in children between 6 and 12 years of age, may suggest the need of an imaging study including DMSA scan and VCUG in all age groups.

BACKGROUND: In the last time the alcohol consumption among children and adolescents is a big theme in all kind of media. The ethanol consumption among children and adolescents has risen during the last years, but also new hazardous drinking patterns like "binge-drinking" are increasing. These drinking episodes are responsible for many hospital presentations of children and adolescents with acute ethanol intoxication. PATIENTS AND METHODS: This study is a retrospective analysis of 173 patients admitted to the university children hospital of Leipzig due to acute ethanol intoxication during the period 1998-2004. Investigated parameters were: socio-demographic factors, clinical presentation and management as well as quantity and type of alcohol. RESULTS: During the years 1998-2004 the rate of alcohol intoxicated patients in this study increased, from 1998-2003 at about 171.4%. Totally 173 patients with an average age of 14.5 years were admitted to the university children hospital. There were significantly more boys than girls. The mean blood alcohol concentration of these patients was 1.77%. Some of the patients had severe symptoms. 62 were unconscious, 2 were in coma and at least 3 patients had to be ventilated. A difference between socioeconomic groups could be observed by comparing the different school types. 44.8% of the patients went to the middle school. Furthermore 17 patients of this study had mental disorders or psychosocial problems and were therefore in psychological or psychiatric treatment. CONCLUSIONS: In this study a significant influence of social classes or psychosocial problems on alcohol consumption such as binge-drinking leading to acute ethanol intoxication could not be found. Alarming is the increasing number of ethanol intoxicated patients, the young age, the high measured blood ethanol concentrations and the severe symptoms of these patients. This is the reason why early and intensive prevention strategies are required.

Significant chemical and biochemical signs of acute alcoholic intoxication are considered tanatologically. A complex approach to diagnosis of acute poisoning with ethyl alcohol is proposed.

Reports on the influence of fructose on blood alcohol clearance have not always been consistent. Notwithstanding, information concerning the Nigerian population is yet to be documented. In this present study, ten consenting adults in apparent sound health, and who did not have any traceable history of alcohol or drug abuse were selected. The subjects were non-smoking Nigerians with an average age of 23.3 years and body weight of 55 kg, and were matched in body frame size and weight. The volunteers were given 0.55g (20%) ethanol/kg body weight as single dose about 4 hours after their breakfast meal, and on another occasion, 0.25g fructose/kg body weight was used to sober the intoxicating effect produced by 0.55g (20%) ethanol/kg body weight. In each case, the blood alcohol level (BAL) was determined every 30 minutes using about 0.5 ml whole blood obtained by venipuncture. The mean peak BAL obtained for the male and female subjects (0.093% vs 0.096%) imply that the women were more intoxicated, though for a shorter time (314 minutes vs 280 minutes). This investigation also demonstrates that the group of women cleared blood alcohol faster (0.026%/hr) and oxidized blood alcohol more rapidly (115.8 mg/kg/hr) than the men, who respectively recorded mean values of 0.021%/hr and 102 mg/kg/hr. However, among the male and female volunteers, oral fructose intake significantly (p<0.05) increased the blood ethanol clearance rate by 66.7 and 92.3%, decreased intoxication time by 41.7 and 40%, reduced peak BAL by 18.3 and 0%, but enhanced blood ethanol oxidation rate by 71.2 and 66.7%, respectively. The oxidokinetic data obtained suggest that Nigerian women may be more susceptible to alcohol's effects than Nigerian men, and oral fructose seems promising in the treatment of Nigerian alcoholics.

BACKGROUND: Preweanling rats detect ethanol (175 mg/100 ml) in maternal milk when the dam is moderately intoxicated. Repeated experiences with the intoxicated dam facilitate subsequent recognition of ethanol's chemosensory attributes and promote ethanol-related memories with a negative hedonic content. This memory has been attributed to the infant's acquired association between ethanol's chemosensory attributes and its disruptive effects on maternal care. In this study, infant and adolescent ethanol intake patterns were analyzed as a function of prior interactions, during early infancy, with their intoxicated dams. METHODS: During postpartum days 3, 5, 7, 9, 11, and 13, breast-feeding dams received an intragastric administration of either 2.5 g/kg of ethanol or water. Pups whose dams had been given one of these two maternal treatments were tested on postnatal day 15 for ingestion of 0%(water), 2.5, 5.0, or 10% v/v ethanol solution. During adolescence, remaining animals from these litters were first adapted to ingest water from drinking tubes and then were given simultaneous access to tap water and a given ethanol solution. The first day, a 3% v/v ethanol solution was used. This solution was increased by 1% ethanol each following day until the solution was 6% v/v ethanol. RESULTS: Maternal drug treatment did not affect the body weights of dams, infants, or adolescents. Water intake during infancy and adolescence also was unaffected by prior maternal treatment. However, infants that had previously interacted with ethanol-intoxicated dams exhibited heightened ethanol intake scores (grams per kilogram and percentage body weight gains), especially when tested with 5 or 10% v/v ethanol solutions. Similarly, adolescent males (but not females) that had interacted with an intoxicated dam during infancy also had higher ethanol consumption levels than those that had interacted with a nonintoxicated dam. CONCLUSIONS: Contrary to what might be expected in animals that acquire an aversive memory for ethanol's chemosensory cues as a function of prior interactions with an intoxicated mother, these results indicate that such interactions promote a long-lasting increase in ethanol intake. These results suggest that rats reared by intoxicated dams become sensitive to the negative reinforcing properties of ethanol.

The purpose of this study was to investigate the factors effecting on an observation time needed for outpatient treatment of acute alcohol intoxication. Subjects were 181 patients with acute alcohol intoxication who visited at the Center of Critical Care Medicine of St. Luke's International Hospital from June 1999 to May 2000. One of 181 patients was admitted as an inpatient. The mean observation time of 180 outpatients was about 3 hours. Ninety-nine outpatients (55%) needed observation time less than 3 hours. High level of Blood Alcohol Concentration (BAC), moderate consciousness disorder (Japan Coma Scale; JCS 10-30), and severe consciousness disorder (JCS 100-300) were significant factors to increase observation time more than 3 hours. Gender and age were not significant factors associated with more-than-3-hour observation time. Observation time of mild consciousness disorder (JCS 1-3) was significantly decreased against that of clear consciousness (JCS 0). Effects of acetaldehyde might be related to elongation of the observation time among clear consciousness patients. Medical resources of emergency medicine in Japan are not enough in some cases (such as few beds and small numbers of staffs), and it is occasionally difficult for patients to stay at a emergency unit for a long time. And the number of hospitalization for acute alcohol intoxication is likely to increase in Japan. Consideration on the attributes, such as BAC or patient's consciousness, associated with observation time of outpatient treatment might be useful to reduce the number of hospitalization and the cost of medical care for acute alcohol intoxication in emergency medicine.

OBJECTIVE::The purpose of the present study was to compare alcohol versus natural drying for umbilical cord care in preterm infants and to examine its effects on bacterial colonization and cord detachment. STUDY DESIGN AND METHODS::Eligible infants <34 weeks gestation admitted to the NICU were randomized to receive either umbilical cleansing with 70% isopropyl alcohol at each diaper change or natural drying. Umbilical stump cultures were performed at 12 to 24 hours, 72 hours, 7 days, and 14 days of age. RESULTS::A total of 109 infants were enrolled; 102 completed the study. Analyses revealed that the median cord detachment time was significantly shorter in the natural drying group compared to the alcohol group (13.0 versus 16.0 days; p=0.003). There were no cases of local umbilical infection in either group. CONCLUSION::Based on the present study, it appears that natural drying is a safe and effective means of umbilical cord care in preterm infants.Journal of Perinatology (2004) 24, 100-104. doi:10.1038/sj.jp.7211027 Published online, 22 January 2004

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 prospective, randomized, 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%), notwithstanding 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.