Considering this, it makes sense to sterilize any unorthodox
preparation for the umbilical stump. But why not just leave
it alone?!?
Umbilical
cord
care: a pilot study comparing topical human milk,
povidone-iodine, and dry care.
Vural G, Kisa S.
J Obstet Gynecol Neonatal Nurs. 2006 Jan-Feb;35(1):123-8.
CONCLUSION: The cultural practice of applying human milk to the
umbilical cord stump appears to have no adverse effects and is
associated with shorter cord separation times than are seen with
the use of antiseptics.
"The findings of this literature review indicate that the current standard of umbilical cord care may be based on historic practices and traditions rather than scientific investigation and justification. There appears to be little support for continued alcohol use. Yet, insufficient evidence is available to support an immediate change in the standard of care from topical antimicrobial treatment of the umbilical cord to natural healing. Further research is recommended to evaluate natural healing and to establish evidence-based recommendations for practice."
"Although it is unclear which antimicrobial is the most beneficial for cord care treatment, many researchers recommend their use as a result of their studies. Others argue that the role of decreasing bacterial colonization has an uncertain relationship with the development of infection. If topical antimicrobials are going to be used in the prophylactic treatment of infection in newborns, it is important to realize the potential for adverse local and systemic reactions."
"In fact the research that demonstrated this was done during a transition into a newly built nursery and was able to present findings that indicated that the cross-contamination was coming from the infants themselves.[12] Another study was also able to relate an increase in colonization with an increase in length of maternal or neonatal hospital stay.[11]"
'They recommend the use of antiseptic treatment for umbilical cords because cross-infection happened principally when no antiseptic was used on cords.[26]"
"Of the current cleansing agents, a one-time application of triple dye seems to have the fewest adverse reactions and is associated with a significant decrease in staphylococcal colonization."
"Alcohol, on the other hand, seems to offer more adverse effects than benefits. Several studies demonstrated it as inferior with regard to decreasing colonization. Some studies could not even demonstrate a significant difference in alcohol and water or no treatment. Alcohol was also significantly proven to prolong cord separation time. In light of alcohol's limited effect on decreasing colonization, and its deleterious effect of prolonging cord separation time, it is not recommended as a routine treatment for umbilical cord care."
As a homebirth midwife, my conclusion from reading this article
was that most umbilical cord infections come from being in the
hospital.
Untreated Umbilical Cord Stumps Must Be Monitored Closely - another good reason for postpartum home visits! [medscape registration is free]
Jan 21, 2003 - Discontinuation of bacteriocidal care of the
umbilical cord may increase the risk of omphalitis, according to a
report in the January issue of Pediatrics. Researchers therefore
recommend that umbilical cord stumps that are not treated with
antibacterial agents be closely monitored for infection.
[from Pediatrics 2003;111:15-20.]
Care
of
the Umbilical Cord - A review of the evidence (from World
Health Organization - WHO)
It's always bothered me that the typical umbilical cord clamps are rigid and relatively large and firmly attached to the baby for at least the first day of life. What fun is it for a baby to be belly-to-belly with mom when there's this nasty clamp sticking into the tummy? I've seen babies who weren't latching on well because the clamp was pinching, twisting, pulling or poking some part of their body. That's not the easiest way to get breastfeeding off to a good start!
Fortunately, there's an easy solution to this problem . . . the Averbach Cord Bander, invented by Dr. Louis
Averbach; it leaves only a tiny rubber band securely "clamping"
baby's umbilical cord. It's a bonus that they're
environmentally more responsible as the disposable rubber band is
very tiny compared to the bulky plastic disposable clamps.
(Those reusable, metal clamps were most reusable of all, but they
are no longer available, and they were still very poky to new
babies!)
Design engineers have been working on a better cord closure that is supportive of breastfeeding, requires no specialized equipment, and is easy to use. There have been a number of iterations of these modern cord rings, which are single-use. The AGA Cord Ring and Sterifeed Cord Ring seem to have disappeared. But we still have two winning replacement options: Umbi-Rings and Cetro Cord Rings. Both come in sterile, single-use packets, and even a very tired nursery nurse will be able to get the hang of it the first time. Cord tie (also called cord tape) is also soft and flexible, but may come off as the cord dries and shrinks; this isn't really a problem but can be worrying to new parents.)
Right now, it is primarily homebirth midwives who use the
Averbach cord bander instead of the common, plastic clamp. I would
love to see other providers and hospitals make this simple change
to support breastfeeding. Most maternity care providers seem
unaware of the availability of the Averbach cord bander, so it's
up to expectant parents to lobby for positive change here. You can
purchase your own Sterifeed Cord Ring for about $5, including
shipping. Or, if you have the resources to try to help other
mothers and babies, you could buy your own Averbach Bander for
your baby and then give it as a gift to your birth
attendant. Alternatively, you could pass it around among
your friends and families, sterilizing it in between uses, of
course.. [NOTE - The Averbach cord bander is significantly
more cost effective as well - the instrument itself costs $85, but
each little rubber band costs only eight cents, compared with
sixty-five cents per plastic cord clamp. The cost of the
instrument is recovered after only 132 births! All the
subsequent births actually save the hospital money, in addition to
helping mom and baby get off to a better start with
breastfeeding. As of April, 2018, I don't see the Averbach
Cord Bander on Cascade's website, so the above cost analysis is
invalid. But this Canadian birth supply house carries
a similar instrument: Birth
Supplies Canada Inc. / Cord Bander.]
Doulas are ideal ambassadors for humanization of clamping
devices. Most homebirth midwives use breastfeeding-friendly cord
closures because we provide comprehensive mother/baby care and see
how obnoxious standard clamps are. It also helps that we prepare
our own equipment sterile packs and so have total control over
this. OBs are divorced from breastfeeding as well as their
equipment preparation.
yourwaterbirth.com has the Umbilical
Cord Ring - sterile
BirthWithLove.com carries the Cetro
cord ring and has Instructions for Use.
NOTE - According to Cascade's web page, the rubber bands are made of latex. Sigh. What's a midwife to do?
Well, what other field uses very small rubber bands. Ah!
Orthodontics. A web search turns up lots and lots of
latex-free orthodontic elastics. I'll be doing some research
as to ideal size, but so far I really like these Creatures
of
the Sea orthodontic elastics. :-)
The
Averbach
Cord Bander is available from Cascade HealthCare Products,
which is the only manufacturer and distributor. HURRAY for
Cascade for continuing to make this great instrument available to
caring birth attendants everywhere.
As of April, 2018, I don't see the Averbach Cord Bander on
Cascade's website. You might call them to check. But
this Canadian birth supply house does: Birth
Supplies Canada Inc. / Cord Bander
It is a hemostat with a little wire attached the allows the
placement of a simple rubber band on the cord stump. Similar to a
rubber band used in dental braces. It is so small that it allows
no return blood flow into the stump and there is not the hassle of
a large metal or plastic clamp.
With the Averbach, is there any bleeding routinely? I have been using the cord clamp at first because it closes the stump off so well and then taking that off at about and hour (during the newborn exam) and replacing it with cord tie.
Parents are so scared of a little blood from the stump. I need to
know that the bands don't allow much spotting.
Many of us clamp first with a hazeltine or kelly and then use the averbach later after everything has settled down and parents are ready to dress the baby. So often an hour or more has passed before we use the cord-bander.
I'll bet there was an extra strong 'snap" when the band slipped off, or else a little bit of a jerk on the cord. (and possibly a friable cord?).
The only trouble I had with the cordbander was once when it when
down too far to almost the skin edge. Since then I keep a kelly
nearby to stop it from going too far. Also, it seems to help if
the cord bander is wet -- as if the rubber slips off more easily
without quite as much snap. You might want to dip it into alcohol
or sterile water just before use.
It really depends on the width of the cord. On those really skinny ones the band does allow a very small seeping of blood for the first couple of hours, but on those normal big home birth baby cords I don't see any seeping at all.
Since the bander is part of a clamp/forceps, the cord is pretty well crimped and the band usually settles nicely into the groove the forceps makes. I can think of two things to do to eliminate any blood at all....1) double band, or 2) use a plastic clamp first and replace with a band at the newborn check-up or at the 24 hour visit.
I used to tie off the cords with cord tie, and saw much more
blood seeping with that method than I do with the bands. I think I
paid around $50 for my bander from Cascade a couple of years ago.
But you don't have to buy a cordbander (averbach). You can use two hemostats. Slip a couple inches of cord tape (or dental floss etc) through the rubber band. Slip the band over a kelly. Open the kelly and clamp the cord. Use the second kelly to grasp the tape/string and pull the band off of the first kelly and over the cord. Practice on something first... Pretty easy.
I hope my description is clear.. if not, there is an illustration
in Myles Textbook For Midwives, pg 315 seventh edition.
It's easy to do with two kelly clamps and a piece of umbilical tape through the band (to use to pull the band off the kelly.) Or you can put the band around one kelly - put the kelly (with band) -- on the cord. Shorten the cord. Use a second kelly to pull the cord through the band and to slide the band off the first kelly and onto the cord. (I did this once, when the flipper mechanism on the averbach broke . Worked fine). You don't really need the averbach, but it' s just a bit simpler..
You can practice on an old placenta, piece of the cord, or even a piece of yarn.
If you do buy an averbach -- or other bander gizmo - then you would need only one.. I don't know anyone who HAS more than one, anyway.
Are you thinking of needing a second in case you need to run to
another birth with no time to sterilize? The bander is not a
cutting instrument so you could probably be safe with scrubbing
really well and soaking in alcohol or Zirconium Chloride.. But
often we will clamp the cord rather long with a hazeltine, and
then shorten it up and apply the band when it's time to dress the
baby.. This may be an hour or so after birth.. So plenty of time
to boil, or bake the averbach if you felt the need.
The averbach is designed to be a one-step clamper/bander.
You put the rubber band on the averbach and clamp the cord just as if you were using kelly's (placing a second clamp if you with on the mothers side). After cutting the cord near the averbach clamp, you use that flipper-thingy to slide the band from the averbach onto the cord.
But sometimes we end up cutting the cord and then shortening it
later.. Perhaps mom wants to nurse baby and the cord is too short
-- and she doesn't want to wait till placenta comes.. We might
just clamp with a kelly or hazeltine, leaving the cord quite long,
and then use the averbach later to shorten the cord and band it.
yeah. The tiny rubber band is nearly invisible -- it shrinks as
the cord shrinks and eventually falls off with the cord stump. You
shouldn't attempt to remove it. I think you'll be impressed
if/when you switch to bands!
We put a band on the cord bander after it has been cleaned and
boiled, but before baking it in the tube pouch. So, when the cord
bander is removed from it's pouch, the band is already on it. It's
possible that the rubber band could fly off before you got it put
on correctly, though that's not happened to us yet, so we carry a
few extra and would probably dip it in betadine before putting it
on the cord. We like the bander so much better than the plastic
clamps or the cord tape.
The picture in the catalog looks like someone somehow got a teeny
tiny rubber band over the clamps itself as well as the little wire
doohickey - just how does one go about this?
You close the averbach and slip the band over both the clamp part and the wire doohicky. It's not as hard as it seems, though you will probably shoot a few bands across the room before you get the hang of it!
One trick is to slip the band over the point of a kelly clamp and
then use the kelly to slip the band on the averbach. I wish I
could show you; it is very simple once you see it done!
And do you "load" it like that before or after you sterilize it?
either way. boiling doesn't seem to harm the bands, but I don't
know about autoclaving or cold sterilizing. You can place the band
on the sterile averbach and then dip it in alcohol if you are
wish. (though if we think about it; the teeshirt, diaper, and
baby's clothing will not be sterile. If the scissors are sterile,
it's doubtful whether the band needs to be more than clean.)
Before... only I'm not sure if it makes a diff how you sterilize.
I autoclave and there is no problem w/ it.
we bake the bands right on the bander. They do fine.
It does not melt on the bander and yes I always sterilize it with
my instruments. I clean and instralube all and then place
them in a steri pouch and bake them in the oven at 225 degrees for
one hour. I place the pouches on a cookie sheet and also
have a bowl of water in there as well. Never have any probs
with the cord melting as longs as temp is steady at 225 and I do
not bake over 90 min.
I put a band on the tip of the bander before I wrap and bake
it. I've only had one band disintegrate on me and that
happened when I overbaked the instruments. The band looked
really dark and it broke when I tried to stretch it over the
bander itself. Just replaced it with another nonsterile
one. I doubt that it makes much, if any, difference. I
just bake them so I can write on my little note to the peds that
"a sterile band was applied to the baby's cord and does NOT need
to be removed."
I have put them on the averbach and boiled them together. Seemed
to work OK ---- but I worried the heat would weaken the band.
I don't sterilize them.
I figure the utensil cutting cord MUST be sterile, but after that
the entire cord is going to come in contact with many unsterile
objects (including the baby's own skin!!!) . The baby is
about to be wrapped in clothing or a tee-shirt and the tee
shirt isn't sterilized so why should I worry about the band (which
only touches the sides of the cord -- not the end, and not the
skin margin?)
The bands have never melted on mine, but I quit sterilizing them
because if it is too long before you use it the band gets
stretched out.
Then, do you clamp the cord near the base with this clamp, then
cut it, and slip the teeny tiny rubber band over the stump with
the little wire doohickey and hope that it's on right?
just pretend the loaded averbach is a kelly clamp. Clamp the cord
with the averbach, cut it as usual and (lo and behold!) there is a
rubber band right there to "tie" the cord! Just slip it off the
averbach and on to the cord stump.
(can't imagine one can adjust it much once it's on...). Always
cut the cord a little longer than what seems to be necessary. The
only remedy for adjusting is to re-clamp w/ your hemostat, cut the
rubber band w/ a blunt blunt scissor. I would have some
alternative around in case the procedure fails. Maybe carry an
extra stainless or plastic clamp for emergency. It might take a
little getting use to. It seems to be easier and so much more
comfortable for those sweet little ones. I load the devise w/ the
wire pulled back over the hemo. w/ the angle curved downward and
wire over top. You can do it both ways only I found this works
best for me. Then I carefully pull the band over the tip oh maybe
2/3 - 3/4" up the hemostat. When I first got it lost several bands
- rocketing across the kitchen (my little boy loved it, thought I
was playing!), due to getting the hang of how to affix them little
critters. Don't let that dismay you... you'll get it. Be tenacious
and you'll find it a snap soon. I like mine bunches!
I have one of these and I find it very helpful. First, take a
piece of rope and practice clamping it, pulling the arm holding
the band over the end of the rope, and then releasing. Easy
cheesy, right? And to sterilize, I use sterilization pouches with
one band loaded onto the instrument, and one or two extra bands in
the pouch just in case the first one breaks. That way I have
another sterilized as spare. The parents like it because the baby
won't be rubbing against that big plastic cord clamp that's
usually used.
Many of us clamp first with a hazeltine or kelly and then use the averbach later after everything has settled down and parents are ready to dress the baby. So often an hour or more has passed before we use the cord-bander.
I'll bet there was an extra strong 'snap" when the band slipped off, or else a little bit of a jerk on the cord. (and possibly a friable cord?).
The only trouble I had with the cordbander was once when it when
down too far to almost the skin edge. Since then I keep a kelly
nearby to stop it from going too far. Also, it seems to help if
the cord bander is wet -- as if the rubber slips off more easily
without quite as much snap. you might want to dip it into alcohol
or sterile water just before use.
Cascade now offers single-use
packets
of cord tape, ideal for parents to provide for a birth
attendant who routinely uses one of the inferior cord
clamps. 800-443-9942, item #0362 for $5.00
I have my moms and babies do a pretty astringent herb bath about two hours after birth, pound of sea salt, yarrow, comfrey, garlic, lavender, calendula, plaintain, and they soak for a half hour, heals mom beautifully and baby's cord falls off usually in three days.
My moms take their babies in water all the time. Pat the cord dry
afterwards, don't put alcohol or peroxide, or goldenseal on it. It
will get goopy but not gross or smelly. Alcohol and peroxide
actually make that thing stay on longer I swear!
When I worked at the hospital a few years ago, we always removed
the plastic clamps at 24 hours, not replacing it with anything.
We are talking about removing the clamp at 1 hour. I like to do
this so the baby does not have to lay on it and the mother doesn't
have to diaper around it and yes since we do alcohol on the stump
it helps get the alcohol down into the cracks.
I'm nervous about removing bands at one hour because I once saw
the results of a cord tie slipping an hour or two after birth - -
and there was blood ALL OVER, spurting out of the cord! Very
scary! I was just a kid -- the teenage apprentice who was left
with the baby. I don't know what type of knot the midwife used or
any details. I've always been afraid that removing a tie/clamp too
soon after birth might cause a repeat experience. I used to take
the clamps off after two days -- but deeply love the rubber bands!
Care
of
the Umbilical Cord - A review of the evidence (from World
Health Organization - WHO)
Alcohol
versus
natural drying for newborn cord care.
Dore S, Buchan D, Coulas S, Hamber L, Stewart M, Cowan D, Jamieson
L.
J Obstet Gynecol Neonatal Nurs. 1998 Nov-Dec;27(6):621-7.
"CONCLUSIONS: (a) Evidence does not support continued use of
alcohol for newborn cord care; (b) health care providers should
explain the normal process of cord separation, including
appearance and possible odor; and (c) health care providers should
continue to develop evidence to support or eliminate historic
practices."
Cleaning
solutions
and bacterial colonization in promoting healing and early
separation of the umbilical cord in healthy newborns.
Medves JM, O'Brien BA.
Can J Public Health. 1997 Nov-Dec;88(6):380-2.
The efficacy of alcohol or water in promoting umbilical cord
separation was compared in a randomized controlled trial. Rates of
skin colonization between groups were also evaluated on three
occasions. Time to cord separation, rates of colonization, and
species of organisms that colonized were compared between groups.
Of 148 participants, 136 (92%) completed the protocol. Cords
that were cleaned with sterile water separated more quickly than
those cleaned with alcohol (t = 3.15, p = 0.002).
Between-group differences in colonization rates were not found (F
= 1.59, df = 2, p = 0.205). Umbilical or other infections did
not occur. Bacterial colonization of the umbilical area and
surrounding skin occurs over time in healthy term neonates.
Cleaning with alcohol will increase the length of time from birth
to cord separation but will not prevent colonization of the
umbilical area.
There was an article in a recent JOGNN (Journal of Obsteric,
Gynecologic and Neonatal Nursing) about not needing to put
anything on the cord. (Dore, S., Buchan, D., Coulas, S. et al.
(1998). Alcohol
versus
natural drying for newborn cord care. JOGNN 27(6):621-7.)
Our hospital is just phasing out the alcohol routine.
I have found that triple dye on the cord delays the healing
process - these cord stumps do not fall off until 7-10 days, while
just routine cleansing of the area (no ETOH either), the stump is
usually off or ready to fall off by my 72 hour PP Visit.
Much faster and cleaner healing.
How long does it take the cord to fall off? I have found that
cords not cut before about an hour, fall off within 3 days.
I just learned alcohol on cord has a longer fall off time then
using nothing!-I will still use goldenseal though......Its hard to
do nothing.
Alcohol has been shown to delay cord separation when compared to
just keeping cord clean and dry... there was NO difference in the
rate of cord infections..... hmmmmm so really no reason to use
alcohol for those who believe in evidence based care.
Since our last discussion of cord care, I do nothing but have
parents alcohol about once/day. The cords drop off much faster
(usually within a week), but get more stinky before they go...
We use nothing at all!
I have started recommending using nothing on the cord as research
shows cords fall off faster this way. Another study just came out
in Canada confirming this.
Having practiced for 15 years and always telling moms to use alcohol/sterile cotton balls every diaper change, etc. I was intrigued by the "do nothing to cord at all" approach, read all comments with interest and put it into practice. We have had about 90 or so babies this year and to date all cords have fallen off in record time (we use either plastic clamps or metal clamp pins and remove at 24 hours) and only one mom said cord looked a little gooey on day 2, so used golden seal powder on it...Great results all around and pleased by knowledge learned.
I really believe in the good qualities of this stuff, but have
found that some people develop a contact dermatitis from it. That
has made me leery of using it for cord care. How long have you
done this & have you ever noticed any problems - apparently
not . .
I have never had a cord bleed and when used in combination with golden seal POWDER, the cords fall of quickly and cleanly. A capsule or two is included in the birthing kit. I had my families use alcohol for years then made a change to dressing the cord with Golden Seal powder. Most cords are off with little residual bleeding within 2-4 days. Alcohol is 70% alcohol and 30% water. When the alcohol evaporates you are left with a wet cord. Smells and becomes sticky. No odor with GS.
I use capsules, three doses/cap. Or bulk using a straw cut at one
end at an angle and used to scoop up a small amount and sprinkled
onto the cord, covered with a gauze square and only used once per
day.
For the last year or so we have been using Aztec Healing Clay on
all our cords, no alcohol or hydrogen peroxide at all. I have been
very impressed by how rapidly these cords are falling off. No
smell at all. We used the golden seal powder a few years ago, but
I am much happier with the Aztec Healing Clay. I think the lack of
moisture and the drawing power of the clay make for quickly dried
up cords.
We use golden seal powder on the cord during the newborn exam,
and the parents follow suit with every diaper change. Golden seal
is a wonderful herbal anti-viral, anti-bacterial and drying
agent...cords usually fall off in 4 - 6 days.
We use goldenseal on the cord at the newborn exam, and instruct
the mom to use alcohol twice a day. At each postpartum checkup, we
apply more goldenseal, if mom doesn't object to the smell. It
seems to work real well at drying the cord up, and we don't have a
problem with gooey cords. If not goldenseal, I use ground
rosemary, which smells much better. We also have the moms take
herbal baths for three days, which, by itself, does a great job
with the cord. Herbals baths include shepherd's purse and uva
ursi, comfrey and sea salt and myrrh.
I use goldenseal powder applied 3 to 4 times per day. The cords
usually fall off in 2 or 3 days and are totally healed by day 10.
I do not keep my moms from bathing the baby, just apply the
goldenseal after the bath.
Yes, golden seal! It is in powder form so the cord never gets oozy - the g.s. just soaks it up and forms a nice hard crust. Some people swear that the cord will fall off in three days, but that hasn't been my experience. (5-10 days) It is also a yellow dye - will stain clothes and if it spills on the baby will look like jaundice and freak out the pediatrician (again speaking from personal experience).
Parents can use alcohol if it makes them feel better[Grin]. Most common among the midwives here is a goldenseal and myrrh powder (some use only one or the other). A few recommend calendula tincture. A couple use hydrogen peroxide; or BFI powder. Rarely, sea salt.
Everyone claims their own formula is wonderful and makes cords
dry and fall up "really fast" -- usually in 3 to 5 days. That's
what I see with nothing at all on the cords too[Grin]
The woman who puts together our birthing kits first introduced this product to me, she packages it up in small 1 oz size jars and puts them in the kits. I have since heard that it can be found at health food stores.
One of my partners makes it into a paste (using a little water) and uses it on her children's insect bites, splinters, cuts and scrapes, and it can be used as a drawing agent for cysts and boils. For the cords we instruct the mothers to sprinkle it on the stump several times a day.....it seems like magic the way it dries those cords up overnight!!!
It's sold under several names (including French Beauty mud!). I
think it's just bentonite clay and can be ordered by that
name...... We use it quite a bit in my family on rashes, insect
stings etc -- or dissolved in the bath tub -- and it's WONDERFUL
for chicken pox (which we recently experienced!). My only (slight)
concern is to question the sterility of the substance... we're
always told about tetanus bacterium in soil. Hope this is NOT
something which might live in clay as well -- Does anyone know?
(Perhaps the clay is baked? or perhaps it "could" be baked.
We use Tea Tree Oil for cord care.
I've used witch hazel on cords with better results (and less
squawking from the baby) than alcohol. Cord comes away in 3-5 days
and heals cleanly.
For cord care, I use this wonderful stuff called B.F.I. powder. It is "antiseptic first aid powder". Very drying, and very mild. Kind of hard to find in some places, so all my relatives look for it for me. I give a little envelope full to the parents at their birth. Works well & quickly!
An umbilical granuloma is a small piece of bright red, moist flesh that remains in the umbilicus after cord separation when normal healing should have occurred. It is a small piece of scar tissue, usually on a stalk, that did not become normally covered with skin cells. It contains no nerves and has no feeling. Depending upon when they are more flat or berry-like, these things are either cauterized with silver nitrate, tied off with a suture and allowed to wither and drop off, or just plucked off with a clamp and cauterized.
Talk to your Pedi. about the pros & cons and what would be
best for your particular situation.
A Newborn
with an Umbilical Mass - a great photo and article from the
American
Family
Physician
CURATIVE EFFECT OF COMMON SALT ON UMBILICAL GRANULOMA
M. R. Derakhshan
Department of Pediatrics, Hamadan University of Medical Sciences
and Health Services, Hamadan, I.R. Iran
from Iran Medex
CURATIVE EFFECT OF COMMON SALT ON UMBILICAL GRANULOMA
M. R. Derakhshan
Department of Pediatrics, Hamadan University of Medical Sciences
and Health Services, Hamadan, I.R. Iran
ABSTRACT Umbilical granuloma (UG) is a common lesion in the first
few weeks of life. Its traditional therapy is topical application
of silver nitrate stick. In this article the curative effect of
common salt on UG is reported. The parents of fifty-eight infants
with UG, were given instruction to treat their infant at home. The
treatment consisted of application of common salt on the lesion
twice a day, washed half hour later and repeated for three days.
Fifty-two out of 58 cases had perfect cure after the three-day
course of treatment. Relapses or complications were none. Six of
the patients were lost to follow up. It is concluded that
treatment of UG with common salt is simple, cost-effective,
curative and safe.
Irn J Med Sci 1998; 23(3&4):132-133
Keywords ? Umbilical granuloma ? common salt ? silver nitrate
In 1972 Schmitt,10 in a very short note, described the shrinking
effect of common salt on umbilical granuloma (UG). This
observation has rarely made an appearance in subsequent medical
literature, perhaps because in developed countries more advanced
methods, such as electrical and cryocauterization are readily
accessible, thus, obviating alternative methods of therapy.11
Cauterization with silver nitrate, which is the conventional
method of treatment,7,9 involves the use of the special silver
nitrate stick which is not always available in remote areas in
developing countries. This study addresses the successful
treatment of UG with common salt.
Fifty-eight cases of UG were enrolled into this study. The parents
(mostly mothers) were asked to treat their babies at home by
applying a pinch of common salt over the lesion for half an hour.
Thereafter, the lesion would be cleansed using a cotton ball
soaked in boiled water. The procedure was repeated twice a day for
three consecutive days.
In three cases, the procedure was only carried out for one day,
and no evidence of UG was apparent on the third day.
Thirty-nine of the patients were visited again within 31 days
after completion of the therapy. Healing was complete in all
patients. The parents of 10 cases were communicated by telephone.
They also reported complete cure of the lesion.
The most common observation described by parents was the discharge
of a cherry black secretion from the lesion on the first day of
therapy, after which, frank shrinkage and gradual healing of the
lesion was apparent, so that many of the parents did not feel it
necessary to complete the recommended three day course of
treatment.
No relapse or any complication was observed in 41 patients who
were followed for a period of 14-20 months. Totally, six patients
were missed in follow up.
Schmitt recommended the use of salt after cleansing the umbilicus
with alcohol. The author's experience showed that instillation of
alcohol prior to application of salt caused irritation and
erythema of the surrounding normal skin and can be omitted in the
management.
UG should be differentiated from other less common conditions.
These mostly include patent urachus, omphalomesenteric duct and
umbilical polyps. These conditions are relatively rare and few
cases have been reported in medical literature in recent
decades.1-3,5,8
Differentiation of these rare lesions from UG should not deter the
physician from treating a doubtful case as UG, since failing to
obtain the expected result might serve as a guide to the right
diagnosis.1,2,6 Applications of silver nitrate twice weekly for
one month clears up most UGs.6,7,9 Needless to say, therapy with
silver nitrate should be performed by the physician, which is time
consuming and may involve several visits, and is not free of
complication.4
The curative mechanism of salt when used in the treatment of UG is
thought to be through its desiccant effect and other biologic
properties; the high concentration of sodium ion in the area draws
water out of the cells and results in shrinkage and necrosis of
the wet granulomatous tissue. However, this effect is not so
powerful as to cause damage to the normal surrounding
cornified tissue when applied for a short treatment duration.
Acknowledgement
I would like to thank Dr. M.Emadi and Dr. J. Sohailifar for
referring some of the patients and also their encouraging and use
of this method for treatment of their own patients.
References
1 Alessandrini P, Derlon S: [Congenital umbilica fistulas. A
report of 12 cases]. Pediatric 1992;47:67-71.
2 Boothroyd AE, Cudmore RE: Ultrasound of the discharging
umbilicus. Pediatr Radiol 1996;26:362-4.
3 Campbell J, BeAsley SW, McMullin N, et al: Clinical diagnosis of
umbilical swelling and discharges in children. Med J Aust
1986;145:450-3.
4 Chamberlin JM, Gorman RL, Young GM: Silver nitrate burns
following treatment for umbilical granuloma. Pediatr Emerg Care
1992;8:29-30.
5 Genieser NB, Becker MH, Grosfeld J, et al: Draining Umbilicus in
Infants. NY State J Med 1974;74:1821-3.
6 Guzzeta PC, Anderson KD, Eichelberger MR, et al: In: Avery GB,
Fletcher MA, MacDonald MJ, eds. Neonatology. 4th ed. Philadelphia:
JB Lippincott, 1994:944.
7 Kliegman RM: The Umbilicus. In: Behrman RE, Kleigman RM, Arvin
AM, editors. Nelson Textbook of Pediatrics. 15th ed. Philadelphia:
WB Saunders, 1996:506.
8 McCallum DI, Hall GFM. Umbilical granulomata with particular
reference to talc granuloma. Br J Derm 1970;83:151-6.
9 Rescorla FJ, Rink RC. Disorders of the umbilicus. In: Burg FD,
Ingelfinger JR, Wald ER, Polin RA, eds. Gellis & Kagan's
Current Pediatric Therapy. 15th ed. Philadelphia: WB Saunders,
1996:774.
10 Schmitt BD: Tip of the Month. Consultant 1972; 12:91.
11 Steck WD: Diseases of the umbilicus. In: Demis DJ, ed. Clinical
Dermatology. 18th ed. Philadelphia: JB Lippincott, 1991;(4)28-7:4.
12 Steck WD: Diseases of the umbilicus. In: Moschella SL, Hurley
HJ, eds. Dermatology. 3rd ed. Philadelphia: WB Saunders,
1992:2230.
Salt for umbilical granuloma from the Welsh NHS.
Is silver
nitrate the best agent for management of umbilical granulomas?
from Best Bets. No, try salt or alcohol!
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