II. Definition

  1. Excess umbilical granulation tissue in newborns
  2. Follows Umbilical Cord separation

III. Signs

  1. Soft, granular red or pink tissue at base of Umbilicus
  2. Seropurulent discharge may be present

IV. Differential Diagnosis

  1. Umbilical Polyp
    1. Urachal Anomaly (Bladder communication)
    2. Omphalomesenteric duct anomaly (bowel communication)
  2. Umbilical Mass
    1. Ectopic Pancreas
    2. Umbilical Hernia

V. Management: Topical Treatments

  1. Apply Isopropyl Alcohol or Chlorhexidine to area
  2. Cryotherapy applied to Granuloma
  3. Silver Nitrate 75% solution or stick
    1. Risk of Chemical Burn
    2. Technique
      1. Dry Skin of any umbilical exudate
      2. Protect surrounding skin with petroleum jelly
      3. Apply Silver Nitrate to Granuloma only

VI. Management: Double Ligature Technique

  1. Apply Povidone-Iodine (Betadine) to periumbilical area
  2. Tie stay Suture with 3-0 Silk
    1. Tied around protruding stump of Umbilical Granuloma
  3. Parents or assistant hold up stay Suture
    1. Raises Umbilical Granuloma
    2. Uncovers deeper base of Umbilical Granuloma
  4. Tie second ligature (3-0 silk) at base of exposed stump
  5. Additional Suture may be needed for large Granulomas
  6. Anticipate Granuloma will fall off in 7-14 days
  7. Complications: Bleeding (especially in friable lesions)
  8. Contraindications
    1. Large Granulomas with wide base
    2. Small, deep Umbilical Granulomas
    3. Very friable lesions

VII. Course

  1. Granulomas often persist >2 months without treatment

VIII. References

  1. Behrman (2000) Nelson Pediatrics, Saunders, p. 528
  2. Lotan (2002) Am Fam Physician 65(10):2067-8 [PubMed]

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