II. Physiology

  1. Umbilical vessels composed of 2 arteries and 1 vein
  2. Umbilicus separates within 2-3 weeks of delivery
    1. Dries and separates by 8 days in most infants
    2. Usually separation site heals by 15 days

III. Management: Routine care of Umbilicus

  1. Initial care: Clean cord and surrounding skin
    1. Sterile water or
    2. Mild cleanser with neutral pH (5.5 to 7.0)
  2. Ongoing cord care: Keep cord stump clean and dry
    1. Clean cord area with sterile water
      1. Keep cord area clean and dry
      2. Clean cord area when soiled with urine or stool
      3. Cleaning cord area with water alone is preferred
      4. Results in fastest cord separation
        1. No increased risk of Bacterial Infection
    2. Other cleaning or drying agents are not beneficial
      1. Background
        1. These agents do not shorten cord separation time
        2. These agents do not decrease risk of infection
      2. Agents to avoid
        1. Alcohol and other topical drying agents
        2. Topical Antibiotics (may prolong cord separation)
        3. Topical Antiseptics (may prolong cord separation)
  3. References
    1. Gfatter (1997) Int J Clin Lab Res 27(4):238-43 [PubMed]
    2. Dore (1998) J Obstet Gynecol Neonatal Nurs 27:621-7 [PubMed]
    3. Medves (1997) Can J Public Health 88(6):380-2 [PubMed]

IV. Findings: Abnormalities of the Umbilical Cord

  1. Umbilical Granuloma
  2. Urachal Anomaly
  3. Omphalitis (umbilical stump infection)
    1. Infectious emergency
    2. The umbilical vessels in a newborn are central conduits to rapidly spread infection
    3. Presents with Cellulitis in the region of umbilical stump
  4. Umbilical Hernia
    1. Usually closes by age 2 to 3 years
    2. Surgery indications
      1. Defect exceeds 3 cm
      2. Hernia persists beyond age 5 years
  5. Delayed separation of the Umbilical Cord (>3 weeks)
    1. Urachal Anomaly
    2. Leukocyte adhesion defect
  6. Single Umbilical Artery
    1. Incidence: 1% of newborns
    2. Associated with renal anomalies, IUGR and prematurity
    3. In the past, renal Ultrasound was performed at 2 to 4 weeks of life
      1. No longer recommended in isolated Single Umbilical Artery cases (unless other indications)
      2. Deshpande (2009) Arch Dis Child Fetal Neonatal Ed 94(4):F265-7 [PubMed]
  7. Short Umbilical Cord
    1. Requires more vigilant evaluation
      1. Monitor closely in first year of life
      2. Careful exam for comorbid malformations
    2. Associated with increased morbidity and mortality
      1. Chromosomal abnormalities
      2. Gastrointestinal malformations
      3. Cardiopulmonary malformations
      4. Overall Relative Risk of death in first year: 2.4
    3. References
      1. Krakowiak (2004) Obstet Gynecol 103:119-27 [PubMed]

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