Umbilical Cord Granuloma (Newborn)

The umbilical cord connects the unborn baby to the mother in the uterus. After birth, the cord is no longer needed. It is clamped, and then cut. This leaves a small stump.

In most cases, the umbilical cord stump dries up and falls off the newborn in the first few weeks of life. But sometimes after the stump falls off a granuloma forms. This is a small mass or stalk of pinkish-red tissue. The granuloma may be moist and drain fluid. The area around it may be slightly inflamed or infected.

Granulomas may be treated with silver nitrate. This chemical dries the granuloma. It is not painful to the newborn. In rare cases, the granuloma may need to be removed with a procedure. For instance, liquid nitrogen may be applied to the granuloma to freeze the tissue. Or the granuloma may be tied off with thread used for stitches (sutures). Your provider will give you more information if these procedures are needed.

Home care

Medicines

A granuloma itself does not require any prescribed medicines. The healthcare provider may prescribe medicine if the granuloma looks infected. If so, follow the provider’s instructions for giving this medicine to your child.

General care

• Wash your hands well before and after you clean the area around the granuloma. This will help prevent infection.

• Care for the area around the granuloma as directed. Use a clean, moist cloth or cotton swab. Be sure to remove all drainage and clean an inch around the base. Pat the area with a clean cloth and allow it to air-dry. 

• Roll your child’s diapers down below the belly button (navel) until the granuloma has healed. This helps prevent contamination from urine and stool. If needed, cut a notch in the front of the diapers to make a space for the belly button.

• Don’t put your baby in bathwater until the granuloma has healed. Instead, bathe your baby with a sponge or damp washcloth.

• Watch for signs of infection (see “When to seek medical advice” below).

Follow-up care

Follow up with your child’s healthcare provider as advised. Let the provider know if you have other questions or concerns.

When to seek medical advice

Call your child’s healthcare provider right away if any of these occur:

• Your child has a fever (see “Fever and children” below)

• Your child’s granuloma does not heal in the timeframe given by the provider.

• Your child has signs of infection around the granuloma, such as increased redness, swelling, or cloudy or bad-smelling drainage.  

• There is bleeding from the granuloma.

• Your child cries or seems to be pain when you touch the area around the cord and belly button.

• Your child develops a rash, pimples, or blisters around the navel.

• Your child seems ill or has any other symptoms that concern you.

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

• Ask your child’s healthcare provider how you should take the temperature.

• Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

• Armpit temperature of 99°F (37. 2°C) or higher, or as directed by the provider

Everything You Need to Know About Umbilical Granulomas

When you leave the hospital with your newborn baby, you’re usually armed with tips for helping the stump of your baby’s umbilical cord heal. What starts as a pale, wet-looking lump inside your baby’s belly button eventually begins to dry up and harden, turning into a dark and shriveled knot before falling off completely.

Once your baby’s stump finally falls off, it reveals a super cute little belly button—and, often, a small raw spot where the last bit of cord was attached (kind of like when a scab falls off). This is totally normal and should heal up pretty quickly.

In some cases, though, not only does this spot seem to never heal, it actually grows into a small lump of tissue inside your baby’s belly button. If this happens, your baby probably has an umbilical granuloma. While it’s completely harmless and painless for your baby, it usually has to be treated by a doctor to avoid infection.

Umbilical Cord Care 101

For the most part, you don’t have to do much to aid in the umbilical cord healing process other than keep the area around the stump clean and dry. Your pediatrician will examine your baby’s umbilical cord at each newborn well visits, checking for infection.  

In the meantime, you will probably be advised not to give your baby a full bath or submerge their belly button in water. Stick to sponge baths until your baby’s cord has fallen off completely:

• In a small tub or in your sink, gently cleanse your baby’s skin with warm, soapy water and a washcloth.
• Carefully wipe the area around your baby’s belly button with the washcloth, avoiding getting the umbilical cord stump overly wet.
• Pat your baby dry, including their belly button. If the top of your baby’s diaper rubs up against the belly button, fold the top part of the diaper down to leave the area exposed and free of friction.

The umbilical cord should fall off on its own between one and three weeks after birth; if the cord is still attached after three weeks, you should let your pediatrician know. Sometimes, it falls off sooner—as long as it wasn’t removed on purpose, that’s totally fine. 

When Does a Granuloma Form?

According to the American Pediatric Surgical Association (APSA), about 1 in every 500 newborns will end up with an umbilical granuloma.

A granuloma is a clump of tissue somewhere in or on the body that forms as a result of inflammation or infection. They can be associated with certain medical conditions, but when they form in the belly button after a newborn’s umbilical cord has fallen off, it’s due to the development of scar tissue during the healing process. (Some adults develop granulomas in the belly button after navel piercings.)

After your baby’s cord falls off, it’s normal for there to be a small red spot or even a red lump of tissue left behind…at first. But if, after two weeks, your baby’s belly button isn’t fully healed or you notice new growth of tissue, you should contact your doctor for next steps.

What Does It Look Like?

The granuloma itself will look like a small, moist, pink or red ball. It may be covered with a thin yellow or white film, drain light-colored fluid, or look pink or inflamed around its perimeter. 

Can It Hurt My Baby?

An umbilical granuloma is not painful or dangerous, and it’s not a cancerous growth. The only reason doctors treat umbilical granulomas is to prevent further growth that could become restrictive or lead to future problems, and to prevent any kind of umbilical infection.

How Is It Treated?

In most cases, your child’s pediatrician will treat your baby’s granuloma with a chemical called silver nitrate. When a tiny amount is applied to the granuloma, it burns or cauterizes the tissue, forcing it to stop growing and, eventually, shrink; this doesn’t hurt your baby, because there are no nerve endings in the granuloma tissue.

If this doesn’t work, there are other treatment options:

1. Your pediatrician can remove the granuloma by applying a small amount of liquid nitrogen to the growth to freeze it off.
2. Your pediatrician can tie suture thread around the base of the granuloma to deprive the tissue of blood flow. This will force it to dry up. 

Neither one of these procedures are painful for your baby. In some rare cases, surgery may be required to remove the granuloma, but the vast majority of these growths are treated with simple procedures at your pediatrician’s office.

Can I Do Anything to Prevent It?

No. No one knows why some newborns develop granulomas and others don’t. There are no genetic or environmental causes, and we don’t have any evidence proving that granulomas are more likely to form when proper umbilical cord care isn’t performed after birth. It may be more common in babies when the cord takes longer than average to fall off, but again, we don’t know for sure.

Other Umbilical Cord Problems

You should always be on the lookout for signs of infection in your newborn’s belly button. According to the American Academy of Pediatrics (AAP), an umbilical infection may:

• produce a foul-smelling discharge
• ooze yellow fluid or pus
• cause fever and/or irritability
• make the surrounding area look bright red, inflamed, or streaked with red
• cause your newborn distress when you touch it

Another common umbilical cord problem is an umbilical hernia. Per the APSA, about 20% of babies have an umbilical hernia, a condition where the muscles around the belly button aren’t fully connected. This leaves a little bit of room for internal tissue to bulge out through the belly button and is often most noticeable when a baby is crying. Like a granuloma, hernias are not painful for your baby.

Although umbilical hernias sound scary, the AAP says most heal on their own without intervention by the time a child is 18 months old.  If not, an outpatient surgery may be required when the child is older to close the gap. (This usually isn’t done until a child is closer to 5 years old.)

When to Call Your Doctor

While most umbilical cord issues aren’t harmful or painful for your baby, you should let your doctor know if your baby’s umbilical cord isn’t healing the way it’s supposed to. This might include not falling off in the first month of life, leaving behind a growth of tissue for more than two weeks, or appearing infected at any time. 

A Word From Verywell

While it may be nerve-wracking to think about your child having an umbilical granuloma, you can find ease knowing that it isn’t painful or harmful to your baby, and most can be easily removed by a doctor. In no time, your child’s belly button will be ready for warm baths and plenty of tickles.

Umbilical Cord Symptoms

Is this your child’s symptom?

• Umbilical cord or navel questions about newborns
• The navel is also called the belly button or umbilicus

Symptoms

• Umbilicus (navel) has a cloudy discharge or even some dried pus on the surface
• Bleeding occurs from cord’s point of separation
• Separation of cord is delayed past 3 weeks

Omphalitis: Serious Complication

• Definition. Bacterial infection of the umbilical stump with spread to the skin around it. It’s a medical emergency.
• How Often. 1 out of 200 newborns.
• Symptoms. Redness spreads around the navel. The area may be tender, swollen and have a foul odor.

Umbilical Granuloma: Minor Complication

• Definition. Small round growth in center of navel after the cord falls off. It’s red. Covered with clear mucus. Not dry like normal skin.
• How Often. 1 out of 500 newborns.
• Outcome. Usually grows in size if not treated. Can become an entry point for umbilical infections.
• Treatment. Easily treated in the doctor’s office by putting on a chemical called silver nitrate.

Dry Cord Care or Alcohol Cord Care

• The AAP and ACOG both advise dry cord care (natural drying). (Guidelines for Perinatal Care, 2012). It has become common practice in US hospitals.
• The book advises against using alcohol for routine umbilical cord care.
• Alcohol cord care is advised in less developed countries with high infection rates.

When to Call for Umbilical Cord Symptoms

Call Doctor or Seek Care Now

• Age less than 1 month old and looks or acts abnormal in any way
• Bleeding won’t stop after 10 minutes of direct pressure applied twice
• Spot of blood more than 2 inches (5 cm) across
• Red streak runs from the navel
• Red skin spreads from around the navel
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Small bleeding lasts more than 3 days
• Pimples, blisters or sores near navel
• Lots of drainage (such as urine, mucus, pus) from the navel
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• After using care advice for 3 days, navel is not dry and clean
• Small piece of red tissue inside the navel
• Cord stays attached more than 6 weeks
• You have other questions or concerns

Self Care at Home

• Normal cord care
• Normal navel care after cord falls off
• Minor infection of cord or navel
• Normal bleeding from cord or navel
• Normal delayed separation of the cord after 3 weeks

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice

Treatment for Normal Umbilical Cord

1. What You Should Know About Normal Umbilical Cords:
   • Normal cords don’t need any special treatment.
   • Just keep them dry (called dry cord care or natural drying).
   • Reason: Cords need to dry up, before they will fall off.
   • As they dry up, cords normally change color. They go from a shiny yellowish hue, to brown or gray.
   • The cord will normally fall off between 1 and 3 weeks.
   • Here is some care advice that should help.
2. Normal Dry Cord Care:
   • Check the skin around the base of the cord once a day.
   • Usually the area is dry and clean. No treatment is needed.
   • If there are any secretions, clean them away. Use a wet cotton swab. Then dry carefully.
   • You will need to push down on the skin around the cord to get at this area. You may also need to bend the cord a little to get underneath it.
   • Caution: Don’t put alcohol or other germ killer on the cord. Reason: Dry cords fall off sooner. (Exception: instructed by your doctor to use alcohol).
3. Bathing:
   • Keep the cord dry. Avoid tub baths.
   • Use sponge baths until the cord falls off.
4. Fold Diaper Down:
   • Keep the area dry to help healing.
   • To provide air contact, keep the diaper folded down below the cord.
   • Another option for disposable diapers is to cut off a wedge with a scissors. Then seal the edge with tape.
5. Poop on Cord:
   • Getting some poop on the cord or navel is not serious.
   • If it occurs, clean the area with soap and water.
   • This should prevent any infections.
6. Call Your Doctor If:
   • Develops a red streak or redness around belly button
   • Fever occurs
   • Your baby starts to look or act abnormal
   • You think your child needs to be seen

Treatment for Normal Navel After Cord Falls Off

1. What You Should Know About Navels After the Cord Falls Off:
   • The cord can’t fall off too early.
   • The average cord falls off between 10 and 14 days. Normal range is 7 to 21 days. Even if it falls off before 7 days, you can follow this advice.
   • After the cord has fallen off, the navel will gradually heal.
   • It’s normal for the center to look red at the point of separation.
   • It’s not normal if the redness spreads on to the belly.
   • It’s normal for the navel to ooze some secretions.
   • Sometimes the navel forms a scab. Let it heal up and fall off on its own.
   • The navel has a small risk of becoming infected.
   • Here is some care advice that should help.
2. Normal Navel Care:
   • Keep the navel (belly button) clean and dry.
   • If there are any secretions, clean them away. Use a wet cotton swab. Then dry carefully.
   • Do this gently to prevent any bleeding.
   • Caution: Don’t use any rubbing alcohol. Reason: can interfere with healing.
3. Bathing:
   • After the cord falls off, continue sponge baths for a few more days.
   • Help the belly button area dry up.
   • Then, tub baths will be fine.
4. Fold Diaper Down:
   • Keep the navel dry to help healing.
   • To provide air contact, keep the diaper folded down below the navel.

5. What to Expect: The belly button should be healed and dry by 7 days.

6. Call Your Doctor If:
   • Develops a red streak or redness around belly button
   • Fever occurs
   • Cloudy discharge occurs
   • Your baby starts to look or act abnormal
   • You think your child needs to be seen

Treatment for Minor Infection of Cord or Navel

1. What You Should Know About a Minor Infection of Cord or Navel:
   • The belly button will ooze secretions for several days.
   • Normal secretions are clear or blood tinged mucus.
   • A cloudy discharge is usually a mild infection.
   • This can be from normal skin bacteria.
   • A small amount of pus may be present.
   • Here is some care advice that should help.
2. Clean the Navel:
   • Clean the navel (belly button) 2 times a day.
   • Use a wet cotton swab or cloth.
   • Clean away any dried secretions or pus.
   • Do this gently to prevent any bleeding.
   • Caution: Don’t use any rubbing alcohol. Reason: Can interfere with healing.
3. Antibiotic Ointment for Pus:
   • If any pus is present, use an antibiotic ointment (such as Polysporin).
   • No prescription is needed.
   • Put a tiny amount on the belly button.
   • Do this 2 times per day after the area has been cleaned.
   • Do this for 2 days. After that, use the antibiotic ointment only if you see more pus.
4. Bathing:
   • Do not use tub baths until the cord falls off. The navel should be well healed.
5. Fold Diaper Down:
   • Keep the belly button dry to help healing.
   • To provide air contact, keep the diaper folded down. Keep it below the cord and belly button.
6. What to Expect:
   • With treatment, the cloudy discharge and pus should be gone in 2 to 3 days.
   • The navel should become dry and healed by 7 days.
7. Call Your Doctor If:
   • Develops a red streak or redness around the belly button
   • Fever occurs
   • Cloudy discharge not gone after 3 days of using this care advice
   • Your baby starts to look or act abnormal
   • You think your child needs to be seen

Treatment for Normal Bleeding Around Cord

1. What You Should Know About Mild Bleeding Around the Cord:
   • A few drops of blood are normal when the cord falls off or catches on something.
   • The diaper rubbing against the belly button may make it start up again.
   • Here is some care advice that should help.
2. Bleeding:
   • To stop bleeding, put direct pressure on the navel for 10 minutes. Use a clean cloth.
   • Clean the area beforehand, rather than afterwards.
   • Reason: This helps prevent bleeding from starting back up.
3. Diaper:
   • Prevent the diaper from rubbing on the belly button.
   • Do this by folding the diaper down away from the belly button.
   • You can also cut a wedge out of the diaper.
4. What to Expect:
   • The bleeding may come back a few times.
   • It should only be a small smear of blood.
   • The bleeding site should heal up by 2 days.
5. Call Your Doctor If:
   • Bleeding gets worse
   • Few drops of blood lasts more than 3 days
   • Your baby starts to look or act abnormal
   • You think your child needs to be seen

Treatment for Normal Delayed Separation of the Cord Beyond 3 Weeks

1. What You Should Know Cords Falling Off:
   • Most cords fall off between 10 and 14 days. Normal range is 7 to 21 days.
   • All cords slowly fall off on their own.
   • Continue to be patient.
   • Here is some care advice that should help.
2. Stop Alcohol:
   • If you have been using rubbing alcohol to the cord, stop doing so.
   • Rubbing alcohol can kill the good bacteria that help the cord fall off.
3. Diaper:
   • Help the cord dry up faster by keeping the diaper folded below it.
   • Another approach is to cut out a wedge of the diaper (if disposable).
   • Air contact helps the cord stay dry.
4. Call Your Doctor If:
   • Cord starts to look infected
   • Fever occurs
   • Cord is still on for more than 6 weeks
   • Your baby starts to look sick or act abnormal
   • You think your child needs to be seen

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 04/05/2021

Last Revised: 03/11/2021

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

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Seborrheic Dermatitis

Seborrheic dermatitis is a common inflammatory disease of the skin characterized by scaly lesions usually on the scalp, hairline, and face.Seborrheic dermatitis appears as red, inflamed skin covered by greasy or dry scales that may be white, yellowish, or gray.

Related Journals of Seborrheic Dermatitis
Vitiligo & Dermatomyositis, Clinical Pediatrics & Dermatology, Archives of Medicine, Dermatologic Clinics,     Mycoses, JDDG – Journal of the German Society of Dermatology, Clinical, Cosmetic and Investigational Dermatology.

My baby has an umbilical granuloma. How can it be treated?

If the area around your newborn’s umbilical stump doesn’t heal properly, your GP or health visitor may recommend treating it with salt. This is an effective and safe treatment that you can do at home.

With the proper care, your baby’s umbilical stump is likely to drop off on its own within about a week. It will leave behind a small wound that should gradually heal over the next seven days to ten days.

However, in some cases the wound can take longer than ten days to heal. If you notice a soft pink or red lump that leaks clear or yellow fluid, or feels damp, then your baby may have an umbilical granuloma. A granuloma is an overgrowth of scar tissue.

If you think your baby may have an umbilical granuloma, speak to your health visitor. If there isn’t any sign of infection then she may give you advice on how to care for the granuloma at home, using salt treatment.

Putting salt on a wound sounds rather strange. But it’s a safe treatment that usually works well at healing umbilical stumps.

Don’t use salt treatment or any other home treatment on your baby’s umbilical stump before seeking professional advice, though. Your health visitor will want to take a good look at your baby’s umbilical stump, to see how it’s healing.

Take care of the cord stump

See what a healthy umbilical cord stump looks like, and how to care for your baby’s cord in the early days.More baby videos
If your health visitor recommends treating the wound with salt, you may want to wait until your baby is asleep. Here’s what to do:

• Wash and clean your hands or use plastic gloves.
• Clean the area with cotton wool soaked in warm water.
• Apply a small pinch of table or cooking salt on to the umbilical granuloma. If you are unsure how much to use, ask your health visitor to show you how much is required.
• Cover the area with a clean piece of gauze and hold in place for 10 to 30 minutes.
• Clean the area using a clean gauze dressing soaked in cooled boiled water.
• Continue the treatment twice a day for at least two days.

In two or three days you should notice that the granuloma reduces in size and starts to heal.

If the granuloma shows signs of infection, such as redness of the surrounding skin, discharge, or a bad smell, or if your baby has a fever, see your GP.

Your health visitor will examine your baby’s umbilical stump after a week. If it has not responded to the salt, your baby may be referred to hospital for cauterisation treatment. This is where the tissue is sealed by applying a chemical compound called silver nitrate to it.

Although this sounds frightening, cauterisation is a simple procedure. Your baby won’t feel it at all, as there are no nerve endings in his umbilical cord.

See how your baby’s umbilical stump looks as it heals and becomes your baby’s tummy button.

Last reviewed: July 2018

Umbilical granuloma: Symptoms, causes, and treatment

An umbilical granuloma is one of the most common umbilical abnormalities in newborns. The granuloma looks like a ball of moist, red tissue on the bellybutton.

They most frequently occur in newborns once the stump of umbilical cord has fallen off.

The umbilical cord connects the baby to the placenta during pregnancy. Containing arteries and veins, it carries nutrients, oxygen, and waste between the mother and baby.

After birth, the umbilical cord is cut, separating the baby from the placenta. A small stump of the cord is left on the navel, and it usually falls off within 1 to 2 weeks.

A doctor or midwife will provide guidance about caring for the healing navel before the baby is discharged from the hospital or birthing center.

Share on PinterestA doctor will inspect a newborn for umbilical granuloma during regular checkups.

An umbilical granuloma is a moist, red lump of tissue on the navel. Additional symptoms may include:

• oozing
• the presence of sticky mucus
• mild irritation of the skin around the navel

Umbilical granulomas are usually not a cause for concern, and they do not cause pain or discomfort.

However, they occasionally become infected. Symptoms of an infection may include:

• a fever
• pain or discomfort when the navel or surrounding tissue is touched
• increased swelling
• warmth or redness in the area
• red streaks leading from the navel
• pus draining from the granuloma

A doctor will examine a newborn’s navel during each checkup, especially after the stump of umbilical cord has fallen off.

A parent or caregiver should report any unusual symptoms at these visits. If they suspect an infection, they should contact a doctor right away.

The medical community is uncertain what causes umbilical granulomas. They are not related to the quality of care a baby receives or any other health conditions.

However, these granulomas may be more likely to develop if it takes longer than 2 weeks for the umbilical cord to fall off.

It is rare but possible for an adult to develop an umbilical granuloma. They most commonly form after navel piercings.

As a piercing heals, granulation tissue will form around the area. This tissue is new and rich in small blood vessels. When too much granulation tissue is produced, a granuloma can form.

Doctors recommend the same treatments when these granulomas form in adults and newborns. However, if the granuloma does not go away with treatment, a piercing should be removed to encourage complete healing.

Share on PinterestSurgical thread may be used to cut off the blood supply to the granuloma so that it falls off by itself.

A doctor may suggest watching and waiting to see if a granuloma goes away without treatment. They examine it at regular checkups and make sure that it is healing.

If the granuloma does not go away over time, the following options are available:

• Silver nitrate: Applying this topical solution can cause a granuloma to dry out, shrink, and disappear. This may require several visits. Silver nitrate is the most common treatment in newborns.
• Liquid nitrogen: This will cause the tissue to freeze and fall off.
• Surgical thread: A doctor may tie off the base of the granuloma with surgical thread. This cuts off blood supply to the tissue, and it will eventually fall off.
• Surgical removal: In a final resort, the doctor can gently remove the tissue using a scalpel or knife.

Removing an umbilical granuloma does not cause discomfort or pain.

At follow-up visits, a doctor will determine if the granuloma is healing appropriately or if additional treatment is required.

Follow a doctor’s instructions when caring for an infant with a granuloma.

Some instructions may include:

• Changing diapers frequently. Keeping the diaper area clean and free of moisture will promote healing and help to prevent infection.
• Positioning the diaper below the bellybutton. Roll the top of the diaper down at the front, so that it sits under the navel. This will help to keep the area clean.
• Giving the baby sponge baths. A baby’s skin is more likely to dry following sponge baths, rather than soaks in the tub. When the navel area is dry, a granuloma is likely to heal more quickly.

Umbilical granulomas are common abnormalities in newborns. In most cases, treatment will provide a complete recovery without complications.

Speak to a doctor if a granuloma shows any signs of infection, or if it does not heal over time.

Umbilical Granuloma

It is easy to fall into a potentially callous mindset in the Emergency Department – “If it isn’t an emergency, then it can wait to see the Primary.”  While that may be a valid statement, it won’t win you any bed-side manner awards.  It also mandates the ability to determine what presentations are not due to underlying emergent issues, which can be tricky in kids (hence the common theme of remaining vigilant).

Additionally, if the family brings their kid at 3am, they likely think it is at least important enough to warrant your potential concern.  Fortunately, many times the “important” issue revolves around a typical oddity of being a young child (like periodic breathing).  Being comfortable with some minor issues, particularly neonatal issues (currently, there are 26 categorized neonatal Morsels), can make you more comfortable with dealing with the potential emergent conditions that exist within seemingly innocuous presentations.   Umbilical Granuloma is a good example.

• In utero, the umbilical cord is one of the most important structures. After birth, it becomes useless.
  • All of the structures associated with it should be obliterated or recede.
  • When they don’t, problems can occur.
• Umbilical Cord Stump may remain attached from 3 to 45 days.
  • Mean duration was ~2 weeks.
  • Delayed cord separation is associated with some immune problems.
• The care for the umbilical stump vary from institution to institution.
  • Some recommend no care.
  • Some recommend soaps or alcohol application.
  • All fear umbilical stump infection (omphalitis)!

• Most common cause of Umbilical Masses.
• Form within the 1st week after cord separation.
• They:
  • are moist and pink
  • range in size from 1 mm to 10 mm.
  • can be associated with some sanguinous or even greenish discharge.
• Most often treated, successfully, with Silver Nitrate application.
  • Silver nitrate is not without its complications.
  • Some advocate for application of salt crystals instead.

• Silver Nitrate  can act as an antiseptic, an astringent, or a caustic agent (depends on the concentration)
• While it can help resolve an Umbilical Granuloma, it can also burn the tissue around it!
  • Contact with normal tissue should be avoided.
  • The Umbilical Granuloma should be dried before application to limit the potential spread of the silver nitrate by the discharge from the Umbilical Granuloma.
• When dealing with a persistent Umbilical Granuloma:
  • don’t just keep adding silver nitrate.
  • If the Umbilical Granuloma persists after 2 applications, consider other potential issues.

• Omphalitis
  • The issue we all worry about.
  • Can complicate the other issues as well.
  • This is an emergency!
• Omphalomesenteric Remnants
  • The Omphalomesnteric Duct (OMD), also known as the vitelline duct, is present in early gestation.
  • The OMD connects the yolk sac with the developing GI tract.
  • It should involute at week 8 or 9 of gestation.
  • Remnants occur in ~2% of the population.
    • May persist as tissue attached to ileum = Meckel’s Diverticulum
      • May present with painless rectal bleeding.
      • Most common of these anomalies.
    • May persist as a cyst beneath the umbilicus = OMD Cyst
    • May persist as a patent Fistula between the GI tract an umbilicus.
      • Present as persistent drainage, often with fecal material!
    • May persist as a Polyp at the umbilicus = Umbilical Polyp
      • Present as a Very Red mass within the umbilicus.
      • Can contain gastric or intestinal tissue.
      • Do not resolve with silver nitrate.
      • Often confused with Umbilical Granuloma!
• Urachal Remnants
  • Fistula – present with clear drainage or drainage of urine from the umbilicus.
  • Cyst – present with painful mass between the suprapubic region and the umbilicus.
  • Both can become infected.

• Look for signs of infection (obviously). If infected, do sepsis work up and consult surgery!
• If it appears as if you are dealing with a simple Umbilical Granuloma, gently and carefully apply silver nitrate and arrange follow-up.
• Refer to Surgery:
  • If the Umbilical Granuloma / mass did not respond to silver nitrate.
  • If it is unusually RED.
  • If there is significant drainage.
  • If there is a mass associated.

Kondrich J1, Woo T, Ginsburg HB, Levine DA. Evisceration of small bowel after cauterization of an umbilical mass. Pediatrics. 2012 Dec;130(6):e1708-10. PMID: 23166332. [PubMed] [Read by QxMD]

The omphalomesenteric duct (OMD), a temporary structure essential to fetal development, normally involutes completely by week 8 or 9 of gestation. On occasion, the OMD persists, the clinical presentations of which vary widely. We describe a case of a 6-week-old male with a patent OMD remnant that was initially treated as an umbilical granuloma, which then potentially allowed for prolapse of the small bowel through the umbilical ring. The patient […]

Nagar H. Umbilical granuloma: a new approach to an old problem. Pediatr Surg Int. 2001 Sep;17(7):513-4. PMID: 11666047. [PubMed] [Read by QxMD]

Umbilical granuloma (UG) is the most common umbilical abnormality in neonates, causing inflammation and drainage. Most fail to epithelialize and persist for more than 2 months. The common treatment is application of a 75% silver nitrate stick, usually repeated two to three times over a number of clinic visits. Burns have been reported following spillage onto the surrounding tissues. During a 10-year period, 302 neonates were treated for UG using […]

Chamberlain JM1, Gorman RL, Young GM. Silver nitrate burns following treatment for umbilical granuloma. Pediatr Emerg Care. 1992 Feb;8(1):29-30. PMID: 1603685. [PubMed] [Read by QxMD]

Three infants treated for umbilical granuloma with silver nitrate suffered chemical burns to the periumbilical area which prompted visits to the emergency department. Treatment was conservative, and the outcome was good in all cases. We recommend caution when applying silver nitrate to the umbilicus, careful drying of the umbilical exudate to prevent spillage, and discussion with parents that burns may occur but apparently are not serious. The po […]

Novack Ah2, Mueller B, Ochs H. Umbilical cord separation in the normal newborn. Am J Dis Child. 1988 Feb;142(2):220-3. PMID: 3341328. [PubMed] [Read by QxMD]

During a 13-month period, 363 infants were followed up through the first six weeks to determine the effect of perinatal factors (birth weight, gestational age, type of delivery, and pregnancy and neonatal complications) on umbilical cord separation. Also, breast-feedings and umbilical cord care were studied. Except for cesarean section deliveries, study infants were similar to all infants (N = 1474) admitted to the same nursery during the study p […]

Sean M. Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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Care of the umbilical cord, prevention and treatment of omphalitis

The umbilical cord, which connects the baby and the placenta in utero, consists of blood vessels and connective tissue covered with a membrane, which is washed by amniotic fluid. After birth, the umbilical cord is cut and the baby is physically separated from the mother. Within 1-2 weeks of life, the umbilical cord dries up (mummifies), the surface at the place of attachment of the umbilical cord epithelizes and the dry residue of the umbilical cord falls off. Until the umbilical cord has fallen off and the umbilical wound has not epithelized, there is a high probability of penetration of the infectious pathogen through the umbilical vessels into the child’s blood. However, the umbilical cord cannot be sterile, since in the process of normal childbirth and immediately after birth, the baby’s skin, including the umbilical cord, is colonized mainly by opportunistic microorganisms, such as coagulase-negative staphylococci and diphtheroids, as well as conditionally pathogenic bacteria such as E. coli and streptococci.

Umbilical cord transection and cord care are procedures that have been known for a very long time, their technology varies depending on the established practice and cultural characteristics. In many developing countries, the umbilical cord is cut with non-sterile instruments (razors or scissors), after which a variety of substances, such as coal, fat, cow dung or dried bananas, are still used to process the umbilical cord to accelerate mummification and falloff. Such cord care is a source of bacterial infection, including neonatal tetanus, which still occurs in developing countries and contributes significantly to neonatal mortality.The high mortality rate of newborns in developing countries from umbilical sepsis and a decrease in neonatal mortality in countries where the rules of asepsis and antiseptics have long been used for any manipulations on the umbilical cord, including in our country, prove that the prevention of omphalitis is based on cord transection and care behind the umbilical residue with a sterile instrument and clean hands. Nevertheless, there is still no consensus regarding the prevention of infectious pathology associated with the penetration of microorganisms through the vessels of the umbilical cord.Most often, alcohol, silver nitrate solution, iodine preparations, chlorhexidine, aniline dyes (gentian violet, acriflavine, brilliant green solution, etc.) are used for this purpose. Some countries recommend the topical use of antimicrobials, including bacitracin, neomycin, nitrofurans, or tetracycline, in the form of moisture-absorbing powders in order to accelerate the mummification of the umbilical cord, in the form of an aqueous and alcoholic solution or ointment. There is also the practice of caring for the umbilical cord without the use of antibacterial or disinfectants; the umbilical cord is kept dry and clean.It was previously recommended to bathe the baby immediately after birth with the addition of disinfectant solutions such as hexachlorophene, as this procedure can reduce skin colonization, however, hexachlorophene is absorbed through the skin and may have neurotoxic effects, so its use in neonatological practice is not currently recommended.

I. Technique of cutting the umbilical cord and processing the umbilical cord in the delivery room

The newborn is taken into a sterile diaper.A sterile individual kit is used for the initial treatment of the newborn.

It is recommended to clamp and cross the umbilical cord 1 min after birth.

It is considered safe to clamp the umbilical cord between 1 and 3 minutes after birth.

Early cord clamping (immediately after delivery) can lead to low hemoglobin levels and late anemia. At the same time, too late clamping of the umbilical cord often leads to the development of hypervolemia and polycythemia, which can be the cause of respiratory disorders, hyperbilirubinemia.

1. Compression and cutting of the umbilical cord (IA):

– The midwife of the maternity ward wearing sterile gloves will perform the transection of the umbilical cord.

– Apply one Kocher clamp to the umbilical cord at a distance of 10 cm from the umbilical ring.

– Place the second Kocher clamp on the umbilical cord as close as possible to the external genitalia of the woman in labor.

– Apply the third Kocher clamp 2 cm outward from the first.

– Wipe the section of the umbilical cord between the first and third Kocher clamps with a gauze ball moistened with 95% ethanol solution, cross with sterile scissors.

2. Processing of the umbilical cord:

Currently, the most reliable and safe is a disposable plastic clamp, which is applied to the umbilical cord.

A midwife of the maternity ward in the delivery room performs a plastic clamp on the umbilical cord after the first attachment of the baby to the breast.

Before the application of the plastic staple (or ligature), the personnel carry out hygienic treatment of the hands. The place where the clamp is applied is treated with 70% ethyl alcohol.

3. Technique of applying the plastic clamp:

– Change gloves.

– Carry out hygienic treatment of hands.

– Put on sterile gloves.

– Squeeze blood from the umbilical ring to the periphery with a sterile gauze pad.

– Treat the area of ​​the umbilical cord with a 70% solution of ethyl alcohol with a sterile gauze napkin.

– Place a plastic clamp on the umbilical cord at a distance of 2-3 cm, but not less than 1 cm from the umbilical ring.Applying the forceps too close to the skin can cause the umbilical ring to sag.

– After applying the clamp, cut off the umbilical cord tissue above the clamp, wipe off the blood with a sterile gauze pad.

– If the clamp needs to be removed, use special sterile forceps.

Not recommended: Applying a gauze bandage and reprocessing the umbilical cord immediately after the clamp is applied.

4. Care of the umbilical cord (IA) The umbilical cord undergoes natural mummification and independent separation within 2 weeks.The final epithelialization of the umbilical wound occurs within 3-4 weeks after birth.

During daily examination of the umbilical cord, it is necessary to pay attention to the stage of the natural separation of the umbilical cord:

– the umbilical cord dries up, decreases in volume;

– becomes denser;

– becomes dark brown;

– separated from the child’s body;

– the bottom of the umbilical wound is covered with epithelium.

Recommended:

– A sterile environment is not required to care for the umbilical cord.

– It is enough to keep the umbilical cord residue dry and clean, to protect it from contamination with urine, feces, as well as from injury – exclude tight swaddling or the use of disposable diapers with tight fixation.

– In case of contamination (urine, feces), the umbilical cord residue and the skin around the umbilical ring should be washed with water and the liquid soap used in the compartment and dried with a clean gauze cloth.

The timing of discharge from the obstetric hospital is determined by the state of health of the mother and child.From an epidemiological point of view, including in order to reduce the frequency of purulent-inflammatory diseases of the umbilical wound, early discharge on the 3-4th day after childbirth is justified, including before the umbilical cord falls off. In other words, the discharge of a newborn home does not depend on the time when the umbilical cord remains.

Before discharge, the neonatologist advises the mother / parents on the care of the newborn, including skin and umbilical cord care, with a corresponding note in the newborn’s medical records.

Not recommended:

– to use bandages and additional tying of the umbilical cord to accelerate the fall of the umbilical cord;

– to treat the umbilical cord residue with any antiseptics (solutions of aniline dyes, alcohol, potassium permanganate solution, etc.), since the local use of antiseptics not only does not reduce the frequency of infections, but also helps to delay the spontaneous fall of the umbilical cord residue.

– Forcible removal (cutting off) of the umbilical cord is not recommended, since such a procedure can cause severe complications (bleeding, injury to the intestinal wall with an undiagnosed umbilical cord hernia, infection).The effectiveness of this procedure has not been proven, and the potential danger is obvious. Forcible removal of the umbilical cord remains should be recognized as an unreasonable invasive intervention, potentially dangerous for the life of the newborn.

II. Diagnostics and treatment of omphalitis (IB) Omphalitis is an inflammatory process of the bottom of the umbilical wound, skin and subcutaneous tissue around the navel, umbilical vessels.

Classification according to ICD X: R-38

Children who have been diagnosed with omphalitis, regardless of the form, should be transferred from the obstetric hospital to the department of pathology of newborns and premature babies, and in severe cases of necrotic form of omphalitis – in the department surgery of newborns.

Etiology: the most common pathogens are bacteria –

gram-positive ( S. aureus ) and gram-negative ( E. coli, P. mirabilis, P. vulgaris, M. morganii), P. aeruginosa , etc.

Clinical forms:

– simple omphalitis;

– phlegmonous omphalitis (diffuse-purulent);

– necrotizing omphalitis.

Simple omphalitis:

The most favorable prognostic form is the most common simple form (weeping navel) (Fig. 1):

– local hyperemia;

– edema of the umbilical (umbilical) ring;

– infiltration of subcutaneous fatty tissue around the umbilical ring;

– long-term non-healing umbilical wound, from which there is serous or serous-purulent discharge;

– periodically the umbilical wound is covered with a crust of an unpleasant odor from the umbilical cord or discharge from the umbilical wound;

– excessive growth of granulating tissue is possible, which leads to the formation of fungus;

– the general condition of the child does not suffer.

Phlegmonous omphalitis (diffuse-purulent) (Fig. 2): in addition to the above symptoms, the following are noted:

– the spread of the inflammatory process to the surrounding tissues;

– hyperemia and infiltration of the skin in the navel;

– an umbilical wound in the form of an ulcer, covered with fibrinous overlays, surrounded by a dense skin ridge;

– discharge of pus from the umbilical wound when pressing on the umbilical region;

– phlegmon of the anterior abdominal wall;

– deterioration of the general condition, an increase in intoxication, an increase in body temperature.

Necrotic omphalitis is observed in weakened children with the addition of an anaerobic infection (Fig. 3):

– necrosis of the skin and subcutaneous tissue (The necrotic process can cover all layers of the anterior abdominal wall and cause peritonitis);

– the mummification of the umbilical cord remains suspended, it becomes wet, takes on a dirty brown tint and an unpleasant putrid odor;

– a severe complication of phlegmonous and necrotic forms of omphalitis is an ascending infection – thrombosis of the umbilical, portal veins, portal hypertension, liver abscesses and sepsis.

Tactics for the treatment of simple, phlegmonous and necrotic forms of omphalitis

1. In order to control the detection, operational (daily) registration of pyoinflammatory diseases, including anti-epidemic measures in the prescribed manner, the attending physician promptly brings information to the head of the department and the hospital epidemiologist (assistant epidemiologist) about the case (s) in the newborn (s) of phlegmonous and / or necrotic forms of omphalitis.

2. Ultrasound examination of internal organs (with suspicion of phlegmonous or necrotic form of omphalitis).

3. The following laboratory tests are prescribed:

– clinical blood test;

– blood culture with determination of the sensitivity of microflora to antibiotics;

– sowing a detachable umbilical wound to identify bacterial pathogens;

– determination of markers of the systemic inflammatory response (procalciotonin, C-reactive protein).

4. Additionally with phlegmonous form of omphalitis:

– consultation of a pediatric surgeon to confirm the diagnosis;

– hospitalization in the children’s surgical department is required;

– surgical intervention required;

– antibiotic therapy is prescribed, taking into account the sensitivity to drugs, immunosubstitution therapy with immunoglobulin preparations for intravenous infusion according to the instructions for the drug.

5.Additionally, for necrotic omphalitis:

– consultation with a pediatric surgeon to confirm the diagnosis;

– hospitalization in the children’s surgical department is required;

– surgical intervention required;

– antibacterial therapy is prescribed taking into account the sensitivity to drugs, detoxification therapy, immunosubstitution therapy with immunoglobulin preparations for intravenous infusion according to the instructions for the drug.

6.Antibacterial therapy for phlegmonous and necrotizing omphalitis until the results of culture and sensitivity of microflora are obtained, parenteral (intravenous or intramuscular) administration of drugs from the group of penicillins in combination with aminoglycosides is recommended, doses, method and frequency of administration are determined by the instructions for the drug.

In case of ineffectiveness of treatment within 3 days , the antibiotic therapy is changed to cephalosporins of the second generation (cefuroxime), doses, method and frequency of administration are determined by the instructions for the drug.

When identifying methicillin-resistant Staphylococcus aureus (MRSA), drugs from the group of glycopeptides (vancomycin) are prescribed, doses, method and frequency of administration are determined by the instructions for the drug.

7. Local treatment.

– If only redness of the umbilical ring is noted, without edema and spread of erythema to the skin around the umbilical ring, treatment is not required.

– In complicated forms of omphalitis (phlegmonous and necrotic), the scope of conservative therapy and indications for surgery is determined by the surgeon.

III. Prevention (IA) 1. Compliance with the rules of asepsis and antiseptics when working with newborns.

2. Compliance with the technique of crossing the umbilical cord, processing the umbilical cord in the delivery room, provided for by this protocol.

3. “Dry method” of the umbilical residue.

4. Providing a hospital epidemiologist (assistant epidemiologist), deputy chief physician of the hospital together with the heads of structural units for active detection of nosocomial infections by prospective observation, which consists in the following: diseases;

– receiving daily information from all functional units of the maternity hospital (department) about cases of infectious diseases among newborns and women in childbirth, violations of the sanitary and epidemiological regime, the results of bacteriological studies;

– investigation of the causes of their occurrence and information of the management for taking urgent measures.

5. Registration and registration of newborn diseases caused by opportunistic microorganisms is carried out in accordance with the ICD-10 codes.

6. Implementation of the principles of infection control with regular audits of infectious and inflammatory diseases in obstetric institutions and neonatological hospitals.

7. Consulting the mother (parents) on the care of the newborn’s skin, umbilical cord in conditions of joint stay and after discharge from the maternity hospital, with a note in the history of the child’s development.

Literature

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14. Shaffer T.E., Baldwin J.N., Rheins M.S. Staphylococcal infections in newborn infants: I. Study of an epidemic among infants and nursing mothers // Pediatrics.- 1956. – Vol. 18. – P. 750-761.

15. Baldwin J.N., Rheins M.S., Sylvester R.F. Staphylococcal infections in newborn infants: III. Colonization of newborn infants by staphylococcus pyogenes // Am. J. Dis. Child. – 1957. – Vol. 94. – P. 107-116.

16. Corner B.D., Crowther S.T., Eades S.M. Control of staphylococcal infection in a maternity hospital: Clinical survey of the prophylactic use of hexachlorophane // Br. Med. J. – 1960. – Vol. 1. – P.1927-1929.

17. Gillespie W.A., Simpson K., Tozer R. Staphylococcal infection in a maternity hospital: Epidemiology and control // Lancet. – 1958. – Vol. II. – P. 1075-1084.

18. Gluck L., Simon H. J., Yaffe S. J. Effective control of staphylococci in nurseries // Am. J. Dis. Child. – 1961. – Vol. 102. – P. 737-739.

19. Gluck L., Wood H. Effect of an antiseptic skin-care regimen in reducing staphylococcal colonization in newborn infants // N.Engl. J. Med. – 1961. – Vol. 265. – P. 1177-1181.

20. Hardyment A.F., Wilson R.A., Cockcroft W. Observations on the bacteriology and epidemiology of nursery infections // Pediatrics. – 1960. – Vol. 25 .– P. 907-918.

21. Hurst V. Transmission of hospital staphylococci among newborn infants: I. Observations on the contamination of a new nursery // Pediatrics. – 1960. – Vol. 25. – P. 11-20.

22. Jellard J. Umbilical cord as reservoir of infection in a maternity hospital // Br.Med. J. – 1957. – Vol. 1. – P. 925-928.

23. Simon H.J., Yaffe S.J., Gluck L. Effective control of staphylococci in a nursery // N. Engl. J. Med. – 1961. – Vol. 265. – P. 1171-1176.

24. Williams C.P.S., Oliver T.K. Nursery routines and staphylococcal colonization of the newborn // Pediatrics. – 1969. – Vol. 44 .– P. 640-646.

25. Mendenhall A.K., Eichenfield L.F. Back to basics: Caring for the newborn’s skin // Contemp. Pediatr.- 2000. – Vol. 17. – P. 98-114.

26. Czarlinsky D.K., Hall R.T., Barnes W.G. Staphylococcal colonization in a newborn nursery, 1971-1976 // Am. J. Epidemiol. – 1979. – Vol. 109. – P. 218-225.

27. Pildes R.S., Ramamurthy R. S., Vidyasagar D. Effect of triple dye on staphylococcal colonization in the newborn infant // J. Pediatr. – 1973. – Vol. 82. – P. 987-990.

28. Barrett F.F., Mason E.O., Fleming D. Brief clinical and laboratory observations: The effect of three cord-care regimens on bacterial colonization of normal newborn infants // J.Pediatr. – 1979. – Vol. 94. – P. 796-800.

29. DeLoache W.R., Cantrell H.F., Reubish G.K. Prophylactic treatment of umbilical stump: Comparison of techniques // South. Med. J. – 1976. – Vol. 69. – P. 627-628.

30. Perry D.S. The umbilical cord: Transcultural care and customs // J Nurse Midwifery. – 1982. – Vol. 27. – P. 25-30.

31. Cloherty J.P., Eichenwald E.C., Stark A.R. Manual of Neonatal Care. 6th ed. – Lippincott Williams and Wilkins, 2008.- P. 297-298.

32. Seidel H . M ., Rosenstein B.J., Pathak A., McKay W.H. Primary Care of the Newborn. 4th ed. – 2006. – P. 391-393.

33. Novack A.H., Mueller B., Ochs H. Umbilical cord separation in the normal newborn // Am. J. Dis. Child. – 1988. – Vol. 142. – P. 220-223.

34. Medves J.M., O ‘ Brien B.A.C. Cleaning solutions and bacterial colonization in promoting healing and early separation of the umbilical cord in healthy newborns // Can.J. Public Health. – 1997. – Vol. 88. – P. 380-382.

35. Howard R. The appropriate use of topical antimicrobials and antiseptics in children // Pediatr. Ann. – 2001. – Vol. 30. – P. 219-224.

36. Spray A., Siegfried E. Dermatologic toxicology in children // Pediatr. Ann. – 2001. – Vol. 30. – P. 197-202

37. Paes B., Jones C.C. An audit of the effect of two cord-care regimens on bacterial colonization in newborn infants // Qual.Rev. Bull. – 1987. – Vol. 13. – P. 109-113.

38. Gladstone I.M., Clapper L., Thorp J.W. Randomized study of six umbilical cord care regimens: Comparing length of attachment, microbial control, and satisfaction // Clin. Pediatr. – 1988. – Vol. 27. – P. 127-129.

39. Verber I.G., Pagan F.S. What cord care: If any? // Arch. Dis. Child. – 1993. – Vol. 68. – P. 594-596.

40. Darmstadt G.L., Dinulos J.G. Neonatal skin care // Pediatr.Clin. North Am. – 2000. – Vol. 47. – P. 757-782.

41. Stark V., Harrisson S.P. Staphylococcus aureus colonization of the newborn in a Darlington hospital // J. Hosp. Infect. – 1992. – Vol. 21. – P. 205-211.

42. Watkinson M., Dyas A. Staphylococcus aureus still colonizes the untreated neonatal umbilicus // J. Hosp. Infect. – 1992. – Vol. 21. – P. 131-135.

43. Andrich M.P., Golden S.M. Umbilical cord care: A study of bacitracin ointment vs.triple dye // Clin. Pediatr. – 1984. – Vol. 23. – P. 342-344.

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45 McConnell T. P., Lee C. W., Couillard M. et al. Trends in Umbilical Cord Care: Scientific Evidence for Practice NBIN. – 2004. – Vol. 4, No. 4. – P. 211-222. © 2004 W.B. Saunders.

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48. Sanitary and epidemiological rules and regulations.SanPiN 2.1.3.2630 – 10

49. Resolution of the Chief State Sanitary Doctor of the Russian Federation of May 18, 2010 No. 58, IV, pp.76-95.

Fungus navel in newborns – causes, symptoms, diagnosis and treatment

Fungus of the navel in newborns is an excessive growth of granulations in the umbilical wound, which has a mushroom shape. The cause of the disease is long-term healing of the umbilical residue with improper care, the development of simple or phlegmonous omphalitis.It looks like a pale pink or grayish rounded formation up to 1.0 cm in diameter, dense to the touch. Uncomplicated fungus proceeds without pain or discomfort. For diagnosis, a visual examination is sufficient. There are 2 treatment options: conservative (cauterization of granulations with silver nitrate solution) or surgical removal of excess connective tissue.

General

Navel fungus is a common neonatal problem that affects 1 in 500 babies, and is equally common in boys and girls.The name comes from the Latin word “fungus” (mushroom), which is due to the characteristic appearance of the formation of granulation tissue. The disease itself does not pose a risk to the health of newborns, but an atypical skin defect, which is sometimes mistaken for a tumor, causes concern for parents.

Fungus of the navel in newborns

Causes

Growth of granulations occurs as a result of a prolonged healing process of the umbilical wound caused by improper skin care of newborns or inflammation of the navel.Omphalitis ranks first among the purulent-inflammatory processes in children of the first month of life, but it does not always end with the development of fungus. A risk factor is a large body weight, a wide umbilical ring.

Granulations grow in newborns with a slow wound healing process, which is caused by non-compliance with medical recommendations, late referral to a pediatrician, when omphalitis has become widespread and passed into a phlegmonous form. There are studies confirming that navel fungus is more common in post-term children or in infants with congenital abnormalities and reduced reactivity of the body.

Pathogenesis

The formation of the navel fungus is based on the physiological process that occurs during the healing of wounds and ulcers. After the acute inflammation subsides, the edema subsides, and the umbilical wound is cleared of exudate. During this period, granulations begin to form in newborns – young connective tissue, which has a granular surface and contains a large number of capillaries. Gradually, it thickens, becomes smooth and uniform.

Normally, granulations completely fill the wound and are subsequently replaced by a scar that remains inside the navel for life.With a sluggish subacute inflammation or a decrease in the regenerative abilities of the skin in newborns, an excess of granulations containing leukocytes, fibroblasts and an increased number of vessels begins to form. The formation grows outward and is not covered with epithelium. This is how the fungus is formed.

Symptoms

Fungus is distinguished by specific visual signs by which parents can easily recognize it. At 2-3 weeks of life, an excess granulation tissue of a grayish or pale pink color, dense in consistency, grows inside the umbilical wound in newborns.In shape, it resembles a mushroom: the main part of the tumor-like mass resembles a hemisphere, which rests on a thin stem or has a wide base. Fungus sizes vary from a few millimeters to 1 cm.

Growth does not cause discomfort in newborns. In its normal state, fungus is painless and does not manifest itself in any way. If the formation reaches a large size, the child shows anxiety when swaddling or carelessly handling the umbilical wound. Uncomplicated forms of the disease proceed without general symptoms, do not disturb the state of health and represent only an aesthetic problem.

When fungus is complicated by microbial inflammation, redness and swelling of the skin around the navel, maceration of the granulation surface are observed. A cloudy liquid with an unpleasant odor is released from the wound. The baby becomes restless and often cries, eats worse, does not gain weight well. When turning over and changing the diaper, the newborn cries out loudly, as touching causes pain.

Complications

Granulation tissue is very thin and delicate, therefore, with constant trauma (diaper, overalls), bacteria enter it and the inflammatory process begins.Fungus can be complicated by extensive phlegmonous inflammation, which affects not only the navel, but also the surrounding tissues. In the absence of timely treatment, the disease turns into a necrotic form.

Active bacterial inflammation of the navel tissues is fraught with the spread of the pathological process to the umbilical vessels with the occurrence of phlebitis and arteritis. In this case, microorganisms enter the bloodstream and can be carried throughout the body. As a consequence, in newborns with reduced immune responses, there is a risk of manifestation of umbilical sepsis.

Diagnostics

The child is examined by a pediatrician. Fungus of the navel has pathognomonic clinical manifestations, therefore, the results of a physical examination of newborns are sufficient to make a diagnosis. Additional methods are indicated for a complicated course of the disease and the addition of a purulent infection. In such cases, the following is performed:

• bacterial sowing of the discharge from the wound;
• general analysis of blood and urine;
• Ultrasound of the soft tissues of the anterior abdominal wall.

Treatment of navel fungus in newborns

Conservative therapy

Small fungus can be successfully treated with medication. To destroy excess granulation, the doctor cauterizes the umbilical wound with silver nitrate. After manipulation, it is necessary to treat the navel daily with antiseptic solutions (chlorhexidine, hydrogen peroxide). It is recommended to lubricate the wound with brilliant green to prevent the ingress of microorganisms and accelerate healing.

With the development of phlegmonous inflammation in the fungus, systemic antibiotic therapy is carried out in newborns, with reduced immune reactivity, immunoglobulins may be administered.For local treatment of purulent wounds, ointments with antimicrobial components (synthomycin emulsion, levomekol) are used, which are applied to fungus from 2 to 3 times a day.

Surgical treatment

In modern pediatrics, surgical intervention is used in the presence of large-diameter granulation growths in newborns or in case of severe purulent complications. The fungus is removed with a scalpel, after which the wound is opened, treated with antiseptics and wound healing medicines.Necrotizing inflammation requires extensive excision within healthy tissue.

Forecast and prevention

Fungus is not a life-threatening disease, the prognosis for newborns is favorable. After the removal of the overgrown granulations and the healing of the navel, the cosmetic defect does not remain. Complicated forms with inflammation of the phlegmonous type, in which bacterial pathogens may enter the bloodstream, are of concern. The success of treatment in this case depends on the timeliness of the visit to the doctor.

The basis of prevention is the proper care of the umbilical residue in the neonatal period: it is important to avoid contamination of the wound with urine or feces, wash and dry the navel area daily, do not cover it with a diaper to give air access, accelerating healing. Preventive measures include early detection and treatment of catarrhal omphalitis to eliminate the risk of granulation formation.

90,000 Fungus navel in newborns – causes, symptoms, diagnosis and treatment

Fungus of the navel in newborns is an excessive growth of granulations in the umbilical wound, which has a mushroom shape.The cause of the disease is long-term healing of the umbilical residue with improper care, the development of simple or phlegmonous omphalitis. It looks like a pale pink or grayish rounded formation up to 1.0 cm in diameter, dense to the touch. Uncomplicated fungus proceeds without pain or discomfort. For diagnosis, a visual examination is sufficient. There are 2 treatment options: conservative (cauterization of granulations with silver nitrate solution) or surgical removal of excess connective tissue.

General

Navel fungus is a common neonatal problem that affects 1 in 500 babies, and is equally common in boys and girls. The name comes from the Latin word “fungus” (mushroom), which is due to the characteristic appearance of the formation of granulation tissue. The disease itself does not pose a risk to the health of newborns, but an atypical skin defect, which is sometimes mistaken for a tumor, causes concern for parents.

Fungus of the navel in newborns

Causes

Growth of granulations occurs as a result of a prolonged healing process of the umbilical wound caused by improper skin care of newborns or inflammation of the navel. Omphalitis ranks first among the purulent-inflammatory processes in children of the first month of life, but it does not always end with the development of fungus. A risk factor is a large body weight, a wide umbilical ring.

Granulations grow in newborns with a slow wound healing process, which is caused by non-compliance with medical recommendations, late referral to a pediatrician, when omphalitis has become widespread and passed into a phlegmonous form.There are studies confirming that navel fungus is more common in post-term children or in infants with congenital abnormalities and reduced reactivity of the body.

Pathogenesis

The formation of the navel fungus is based on the physiological process that occurs during the healing of wounds and ulcers. After the acute inflammation subsides, the edema subsides, and the umbilical wound is cleared of exudate. During this period, granulations begin to form in newborns – young connective tissue, which has a granular surface and contains a large number of capillaries.Gradually, it thickens, becomes smooth and uniform.

Normally, granulations completely fill the wound and are subsequently replaced by a scar that remains inside the navel for life. With a sluggish subacute inflammation or a decrease in the regenerative abilities of the skin in newborns, an excess of granulations containing leukocytes, fibroblasts and an increased number of vessels begins to form. The formation grows outward and is not covered with epithelium. This is how the fungus is formed.

Symptoms

Fungus is distinguished by specific visual signs by which parents can easily recognize it.At 2-3 weeks of life, an excess granulation tissue of a grayish or pale pink color, dense in consistency, grows inside the umbilical wound in newborns. In shape, it resembles a mushroom: the main part of the tumor-like mass resembles a hemisphere, which rests on a thin stem or has a wide base. Fungus sizes vary from a few millimeters to 1 cm.

Growth does not cause discomfort in newborns. In its normal state, fungus is painless and does not manifest itself in any way.If the formation reaches a large size, the child shows anxiety when swaddling or carelessly handling the umbilical wound. Uncomplicated forms of the disease proceed without general symptoms, do not disturb the state of health and represent only an aesthetic problem.

When fungus is complicated by microbial inflammation, redness and swelling of the skin around the navel, maceration of the granulation surface are observed. A cloudy liquid with an unpleasant odor is released from the wound. The baby becomes restless and often cries, eats worse, does not gain weight well.When turning over and changing the diaper, the newborn cries out loudly, as touching causes pain.

Complications

Granulation tissue is very thin and delicate, therefore, with constant trauma (diaper, overalls), bacteria enter it and the inflammatory process begins. Fungus can be complicated by extensive phlegmonous inflammation, which affects not only the navel, but also the surrounding tissues. In the absence of timely treatment, the disease turns into a necrotic form.

Active bacterial inflammation of the navel tissues is fraught with the spread of the pathological process to the umbilical vessels with the occurrence of phlebitis and arteritis. In this case, microorganisms enter the bloodstream and can be carried throughout the body. As a consequence, in newborns with reduced immune responses, there is a risk of manifestation of umbilical sepsis.

Diagnostics

The child is examined by a pediatrician. Fungus of the navel has pathognomonic clinical manifestations, therefore, the results of a physical examination of newborns are sufficient to make a diagnosis.Additional methods are indicated for a complicated course of the disease and the addition of a purulent infection. In such cases, the following is performed:

• bacterial sowing of the discharge from the wound;
• general analysis of blood and urine;
• Ultrasound of the soft tissues of the anterior abdominal wall.

Treatment of navel fungus in newborns

Conservative therapy

Small fungus can be successfully treated with medication. To destroy excess granulation, the doctor cauterizes the umbilical wound with silver nitrate.After manipulation, it is necessary to treat the navel daily with antiseptic solutions (chlorhexidine, hydrogen peroxide). It is recommended to lubricate the wound with brilliant green to prevent the ingress of microorganisms and accelerate healing.

With the development of phlegmonous inflammation in the fungus, systemic antibiotic therapy is carried out in newborns, with reduced immune reactivity, immunoglobulins may be administered. For local treatment of purulent wounds, ointments with antimicrobial components (synthomycin emulsion, levomekol) are used, which are applied to fungus from 2 to 3 times a day.

Surgical treatment

In modern pediatrics, surgical intervention is used in the presence of large-diameter granulation growths in newborns or in case of severe purulent complications. The fungus is removed with a scalpel, after which the wound is opened, treated with antiseptics and wound healing medicines. Necrotizing inflammation requires extensive excision within healthy tissue.

Forecast and prevention

Fungus is not a life-threatening disease, the prognosis for newborns is favorable.After the removal of the overgrown granulations and the healing of the navel, the cosmetic defect does not remain. Complicated forms with inflammation of the phlegmonous type, in which bacterial pathogens may enter the bloodstream, are of concern. The success of treatment in this case depends on the timeliness of the visit to the doctor.

The basis of prevention is the proper care of the umbilical residue in the neonatal period: it is important to avoid contamination of the wound with urine or feces, wash and dry the navel area daily, do not cover it with a diaper to give air access, accelerating healing.Preventive measures include early detection and treatment of catarrhal omphalitis to eliminate the risk of granulation formation.

90,000 Fungus navel in newborns – causes, symptoms, diagnosis and treatment

Fungus of the navel in newborns is an excessive growth of granulations in the umbilical wound, which has a mushroom shape. The cause of the disease is long-term healing of the umbilical residue with improper care, the development of simple or phlegmonous omphalitis.It looks like a pale pink or grayish rounded formation up to 1.0 cm in diameter, dense to the touch. Uncomplicated fungus proceeds without pain or discomfort. For diagnosis, a visual examination is sufficient. There are 2 treatment options: conservative (cauterization of granulations with silver nitrate solution) or surgical removal of excess connective tissue.

General

Navel fungus is a common neonatal problem that affects 1 in 500 babies, and is equally common in boys and girls.The name comes from the Latin word “fungus” (mushroom), which is due to the characteristic appearance of the formation of granulation tissue. The disease itself does not pose a risk to the health of newborns, but an atypical skin defect, which is sometimes mistaken for a tumor, causes concern for parents.

Fungus of the navel in newborns

Causes

Growth of granulations occurs as a result of a prolonged healing process of the umbilical wound caused by improper skin care of newborns or inflammation of the navel.Omphalitis ranks first among the purulent-inflammatory processes in children of the first month of life, but it does not always end with the development of fungus. A risk factor is a large body weight, a wide umbilical ring.

Granulations grow in newborns with a slow wound healing process, which is caused by non-compliance with medical recommendations, late referral to a pediatrician, when omphalitis has become widespread and passed into a phlegmonous form. There are studies confirming that navel fungus is more common in post-term children or in infants with congenital abnormalities and reduced reactivity of the body.

Pathogenesis

The formation of the navel fungus is based on the physiological process that occurs during the healing of wounds and ulcers. After the acute inflammation subsides, the edema subsides, and the umbilical wound is cleared of exudate. During this period, granulations begin to form in newborns – young connective tissue, which has a granular surface and contains a large number of capillaries. Gradually, it thickens, becomes smooth and uniform.

Normally, granulations completely fill the wound and are subsequently replaced by a scar that remains inside the navel for life.With a sluggish subacute inflammation or a decrease in the regenerative abilities of the skin in newborns, an excess of granulations containing leukocytes, fibroblasts and an increased number of vessels begins to form. The formation grows outward and is not covered with epithelium. This is how the fungus is formed.

Symptoms

Fungus is distinguished by specific visual signs by which parents can easily recognize it. At 2-3 weeks of life, an excess granulation tissue of a grayish or pale pink color, dense in consistency, grows inside the umbilical wound in newborns.In shape, it resembles a mushroom: the main part of the tumor-like mass resembles a hemisphere, which rests on a thin stem or has a wide base. Fungus sizes vary from a few millimeters to 1 cm.

Growth does not cause discomfort in newborns. In its normal state, fungus is painless and does not manifest itself in any way. If the formation reaches a large size, the child shows anxiety when swaddling or carelessly handling the umbilical wound. Uncomplicated forms of the disease proceed without general symptoms, do not disturb the state of health and represent only an aesthetic problem.

When fungus is complicated by microbial inflammation, redness and swelling of the skin around the navel, maceration of the granulation surface are observed. A cloudy liquid with an unpleasant odor is released from the wound. The baby becomes restless and often cries, eats worse, does not gain weight well. When turning over and changing the diaper, the newborn cries out loudly, as touching causes pain.

Complications

Granulation tissue is very thin and delicate, therefore, with constant trauma (diaper, overalls), bacteria enter it and the inflammatory process begins. Fungus can be complicated by extensive phlegmonous inflammation, which affects not only the navel, but also the surrounding tissues. In the absence of timely treatment, the disease turns into a necrotic form.

Active bacterial inflammation of the navel tissues is fraught with the spread of the pathological process to the umbilical vessels with the occurrence of phlebitis and arteritis. In this case, microorganisms enter the bloodstream and can be carried throughout the body. As a consequence, in newborns with reduced immune responses, there is a risk of manifestation of umbilical sepsis.

Diagnostics

The child is examined by a pediatrician. Fungus of the navel has pathognomonic clinical manifestations, therefore, the results of a physical examination of newborns are sufficient to make a diagnosis. Additional methods are indicated for a complicated course of the disease and the addition of a purulent infection. In such cases, the following is performed:

• bacterial sowing of the discharge from the wound;
• general analysis of blood and urine;
• Ultrasound of the soft tissues of the anterior abdominal wall.

Treatment of navel fungus in newborns

Conservative therapy

Small fungus can be successfully treated with medication. To destroy excess granulation, the doctor cauterizes the umbilical wound with silver nitrate. After manipulation, it is necessary to treat the navel daily with antiseptic solutions (chlorhexidine, hydrogen peroxide). It is recommended to lubricate the wound with brilliant green to prevent the ingress of microorganisms and accelerate healing.

With the development of phlegmonous inflammation in the fungus, systemic antibiotic therapy is carried out in newborns, with reduced immune reactivity, immunoglobulins may be administered.For local treatment of purulent wounds, ointments with antimicrobial components (synthomycin emulsion, levomekol) are used, which are applied to fungus from 2 to 3 times a day.

Surgical treatment

In modern pediatrics, surgical intervention is used in the presence of large-diameter granulation growths in newborns or in case of severe purulent complications. The fungus is removed with a scalpel, after which the wound is opened, treated with antiseptics and wound healing medicines.Necrotizing inflammation requires extensive excision within healthy tissue.

Forecast and prevention

Fungus is not a life-threatening disease, the prognosis for newborns is favorable. After the removal of the overgrown granulations and the healing of the navel, the cosmetic defect does not remain. Complicated forms with inflammation of the phlegmonous type, in which bacterial pathogens may enter the bloodstream, are of concern. The success of treatment in this case depends on the timeliness of the visit to the doctor.

The basis of prevention is the proper care of the umbilical residue in the neonatal period: it is important to avoid contamination of the wound with urine or feces, wash and dry the navel area daily, do not cover it with a diaper to give air access, accelerating healing. Preventive measures include early detection and treatment of catarrhal omphalitis to eliminate the risk of granulation formation.

90,000 Umbilical treatment. Umbilical cord falling off.

Everyone knows that the umbilical cord connects the fetus to the placenta, which is placed in the uterus, and that the embryo receives nutrition through this umbilical cord, which enters its body through the navel.

At the moment of birth, the umbilical cord pulsates, because arteries and veins pass through it, blood continues to flow into it through the placenta, then it stops pulsing, and then it is cut and a special clamp is applied, which is called the “Bar clamp” and remains there until then until the remainder of the umbilical cord falls off.

Indeed, this stump dries up and falls off on the 5th or 6th day after birth, and the umbilical fossa will begin to heal, although it may become wet for several days. At the same time, the blood vessels that were in the umbilical cord, and now have lost all physiological necessity for the newborn’s body, begin to clog, narrow and retract into the center of the navel.

In a very young child, the navel is formed by a kind of small fibrous ring, inside which the little finger pad can fit; in the future, this ring will gradually narrow and close, giving the navel the same shape that it has in an adult.

Now 2 small problems may arise.

The navel really heals only on the 12-15th day of a child’s life. Until then, you need to take care of it, wipe it with an alcohol solution or disinfectant solution and constantly cover it with a sterile dressing, fixing it with an elastic mesh bandage.If the navel continues to get wet, this usually means that granular tissue is formed there, which the doctor cauterizes with 5% nitrate solution silver to speed up healing.

Even if the navel does not stop getting wet, you should not postpone the first bath for more than 15 days of life, because without this it is impossible to properly observe the baby’s hygiene.

It often happens that the umbilical ring closes rather slowly, and a small, about 1 cm in diameter, umbilical hernia occurs. The ring can close completely only by the end of the first year of a child’s life. Sometimes, even after reaching this age, the navel remains convex and finally retracts after a few years, when the abdominal muscles get stronger.This small hernia, as you can see for yourself on any beach, is quite common in babies, but rarely seen in older people.

If the diameter of the umbilical hernia remains much more than 1 cm and after the child is one year old, you should consult a surgeon.

Within 1 or 2 months of life, you can apply a simple method of treating a hernia, which consists in stitching a coin that clearly exceeds the umbilical ring into the tissue and securing it with an elastic bandage.This will prevent parts of the intestine from staying inside the umbilical ring, preventing it from closing, which, recall, occurs naturally.

I quite often happened to observe in 3 month old children an umbilical hernia, which completely disappeared by 6-8 months. Therefore, it is very rarely necessary to offer surgical treatment for this.

ago – 18. Sleep. Awakening. How does your baby move? How to stack it?

further – 20.Eye, nail, scalp care.

Abdominal surgery for children (Isakov Yu.F.)

Abdominal surgery for children

taking into account the sensitivity to the sown flora of
), a surgical intervention
is carried out. After injecting with a solution of
antibiotics infiltrated 90,733 tissue sites in the circumference of the zone

necrosis produce multiple per

cuts to and along the entire surface affected by
, including the border with healthy

howling.

Forecast for phlegmonous and necrotizing

90,002 forms in many of them are determined by
neglect of the disease and 90,733 intensity of the applied therapy. With
complications such as
peritonitis, sepsis, liver abscesses,
the prognosis is serious, lethality is pain
.

• Muscle aplasia

anterior abdominal wall

This is a serious malformation, the first

whose description refers to 1833.
Since 1901, this defect has been described by canon
Prune Belly syndrome (“plum belly”),
characterized by muscle aplasia
of the anterior abdominal stenosis in combination with
obstructive uropathies that arose
during the period embryogenesis, cryptorchidism –
m about m in boys (Welch KI, 1969).

Syndrome occurs predominantly

but in boys (95%), it is not
hereditary. Known observation

triplets, of which only one pe has

patients were diagnosed with aplasia of the muscle of 90,733 abdomen.K.I. has the largest number of nab
people. Welch (1969):
own 38 and collected in letter
round 184.

There are different views on

reasons contributing to the development of the defect.
The authors, who believe that
violation of the anlage of the nerve trunks in front of
her abdominal stenna is primary, explain the dilatation of
and atony of the urinary tract by the absence of holes
of minimal intra-abdominal pressure. J. Jon-
ston (1972), S. Arap et al.(1978) consider
that aplasia or dysplasia of the abdominal muscles
is primary, and explain it teratogenic who

by action on myotomes in the period 6-10th not

delays of intrauterine life, as a result of which 90,733 the formation of the entire tissue of the anterior abdominal wall is disrupted 90,733 and

urinary tract. This theory is confirmed by 90,733 macro- and microscopic studies of
, which proved that the spinal cord, nerves
of the small pelvis and muscles of the abdominal wall in pain 90,733 with Prune Belly syndrome are formed
correctly.

R.F. Rendolf (1977) considers the delay

of the development of ventral myotomes promotes 90,733 dilatation of the bladder and upper
sections of the urinary system, and R. Re-
don, D. Smith, F. Shepfard (1979) 90,733 express an opinion about the polyetiology of aplasia of
abdominal muscles, which develops secondary to
the background of a sharp increase in the abdomen of the fetus.
Among other reasons, fetal ascites
is called due to underdevelopment of the lymphatic system
, ascites of unknown etiology, Beckwith-Wiedemann syndrome
, polyynous kidneys, and
the structure of the urethra.The origin of

Prune Belly, in the opinion of these authors, 90,733 lies a sharp increase in the volume of the abdomen in the embryo
nal period with subsequent regression

still in the period of intrauterine life – in
as a result, an overstretched anterior abdomen

The

wall is thinned, its muscles
are underdeveloped, the skin is stretched, wrinkled

that is going to be in stock.

It should be noted that back in 1903 there were

put forward a theory according to which obstruction of the urethra
in embryogenesis leads to

in the bladder and lying above

divisions of the urinary system, which in 90,733 in turn contributes to overstretching

of the abdominal wall, thinning of its muscle
parts and interferes with the normal process

descent of the testicles.

Proponents of this theory believe that only

but an insufficiently detailed and targeted 90,733 study was the reason that
was not found in all children with Prune Belly about
urethral structure.

From concomitant malformations

more often there are defects of the locomotor system
of the gut apparatus, intestinal atresia,
malformations of the face, chest,
of the central nervous system.

Immediately after birth turns to

yourself attention a carved increase in w and
vota and its spreading

46

Non-infectious diseases of the umbilical cord, umbilical wound and skin Flashcards

Prickly heat.
Represents a small, punctate, red rash on the trunk, neck and inner surfaces of the extremities. Appears due to perspiration retention in the excretory tubules of the sweat glands when the child overheats or insufficient skin care. The elements of the rash can become infected. Treatment consists in eliminating the cause of increased sweating, conducting hygienic baths with potassium permanganate.

Diaper rash.
The occurrence of diaper rash is associated with defects in care – infrequent swaddling, irregular hygienic baths and washing, reuse of diapers.In children with exudative-catarrhal diathesis or when infected with fungal flora, there is a tendency to rapidly emerging and persistent diaper rash.
Diaper rash is more often located in the area of ​​the buttocks, genitals, and also in the skin folds (Fig. 28 on color incl. ). There are three degrees of diaper rash: I – moderate redness of the skin; II – bright redness with large erosion; III – bright redness and oozing as a result of merged erosion. Diaper rash with a violation of the integrity of the skin can quickly become infected.

Treatment. It provides for swaddling the baby before each feeding, air baths, UFO. In case of skin hyperemia, it is lubricated with boiled vegetable oil, fatty solution of vitamin A, baby cream, disinfecting and skin-protecting powders are used. Petroleum jelly, which irritates the skin, should not be used. The simultaneous use of powders and oils on the same areas of the skin is not allowed. In case of erosion, the skin is treated with 5% potassium permanganate solution, 0.5% resorcinol solution, 1.25% silver nitrate solution, talkers.We recommend hygienic baths with a solution of potassium permanganate (1: 10000), a 1% solution of tannin, a decoction of oak or chamomile bark.

Skleredema and sclerema.
This is a woody density edema of the skin and subcutaneous tissue. More often observed in premature babies with hypothermia. With scleredema, foci of compaction appear on the lower leg, feet, above the pubis and on the genitals, and other parts of the body can also be captured. Unlike the sclera, the lesions do not tend to generalize. The skin over the lesion is tense, cold to the touch, has a cyanotic hue, and does not fold into a fold.When pressed with a finger, a depression remains, which disappears very slowly. Good care and warmth of the baby will lead to the disappearance of the lumps after a few weeks.

The sclerem is characterized by the appearance of diffuse induration, more often in the area of ​​the leg muscles and on the face, then spreads to the trunk, buttocks and limbs. Deepening when pressing on the skin is not formed. The affected areas seem to be atrophied, the face is mask-like, movements in the limbs are limited. The body temperature is lowered.Children are lethargic, drowsy, poor breastfeeding.