The umbilical cord is the link between the mother and the child. The ligation and disconnection of the umbilical cord marks that the child has started his own life journey as an independent individual.
Umbilical cord stump is also often the child’s first open wound, In the past, when medical care was underdeveloped, Many children are born at home, Due to problems such as nonstandard umbilical cord treatment, The incidence of umbilical infection is very high, and even tetanus infection occurs, causing many new lives to break halberds in the cradle. With the progress of medical treatment, there are fewer and fewer family births, and umbilical cord treatment is becoming more and more standardized. Such tragedies are less and less. However, umbilical care still gives some parents a headache. How should we care for the baby’s navel?
Prevention of infection: cleaning and drying
Infection is the most common problem in the umbilicus, The most common symptoms of infection are redness, exudation, touching and crying. The reason why umbilicus is susceptible to infection, Mainly because of the existence of the wound after ligation, And the umbilical cord has the umbilical artery and the umbilical vein, Although the blood flow is gone after birth, the lumen structure can still exist for 10-20 days. This provides a good way for the invasion of bacteria. Bacterial invasion and infection can cause slight omphalitis, or umbilical cellulitis, peritonitis, portal phlebitis and even septicemia leading to death. In order to reduce the risk of infection, on the one hand, umbilical ligation should be standardized, and on the other hand, umbilical care should be strengthened.
After the umbilical stump was ligated, Due to the loss of blood flow, it will gradually dry up and then fall off. Before falling off, it is very important to keep the umbilicus clean and dry. Cleaning can reduce the sticking of bacteria. Drying can reduce the reproduction of bacteria on the one hand and accelerate the falling off of the stump on the other. Cleaning and drying are the principles recommended by WHO [1] and the American Academy of Pediatrics [2].
There are several key points in keeping clean and dry:
- Let the umbilicus not stick to water as much as possible, and use wiping bath instead of bathing. Try not to wrap diapers on your navel to avoid being soaked by urine. Routine disinfection is not required, and this recommendation evidence is not so sufficient. For the sake of caution, it is recommended to use disinfectants according to local practices in areas with high risk of bacterial infection, that is, developing countries.
WHO’s recommendation is based on evidence at that time that no difference in umbilical cord infection rate was found between topical disinfectants and umbilical cord dry care and placebo. WHO’s caution is wise.
WHO’s caution is wise.
According to a 2006 Lancet article, according to a large sample randomized controlled study carried out in Nepal, the infection rate and mortality rate of topical use of another disinfectant, washitai, are lower than those of simply keeping dry and washing with soap and water [3].
A meta-analysis in the British Medical Journal in 2013 reached a similar conclusion. In developing countries, disinfection of umbilicus with 4% washing and pyridine can significantly reduce infection rate and mortality rate [4], so it is not surprising that WHO will change the recommended principles one day.
The key to avoiding umbilical infection is prevention, but once signs of infection are found in the child’s umbilicus, a doctor should be consulted.
Hemorrhage of umbilicus
In addition to infection, Occasionally there is bleeding in the umbilicus, Bleeding before the stump falls off is mostly caused by dawdling clothes or diapers to stimulate the umbilical stump. Sometimes it is because the stump ligation is not tight enough, and a small part is caused by abnormal coagulation function or local infection in children. Some children will bleed a little when the stump falls off, and a small amount of bleeding can be stopped by gauze compression. If the bleeding does not stop, they should also seek medical treatment as soon as possible.
Treatment of stump falling off
Most of the umbilical stump falls off within 1-2 weeks after birth, and some are later. If it does not fall off within 2 months, the doctor should check it, some because the ligation is not tight enough.
After falling off, some children’s umbilical fossa will have a small wound surface, most of which can heal in more than 10 days. Before complete healing, there may be a small amount of liquid secretion, which can be washed with cotton swabs dipped in iodophor. If the wound surface does not heal but some granular red granulation, it also needs to be treated by a doctor.
But there are also some children who continue to have secretions in their umbilical fossa:
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If purulent secretions may be caused by infection, seek medical treatment.
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If there is gas or fecal water flowing out, it may be umbilicus-intestinal fistula caused by yolk tube residue, and navel and intestine communicate.
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If it is clear liquid flowing out, it may be urine, because the urachal catheter is not closed, causing the navel to communicate with the bladder.
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There are also some because there are small umbilical antlers (also called umbilical polyps) in the umbilical fossa, because the mucous membrane on its surface has secretory function and will continuously produce liquid.
The latter three situations are all need surgical treatment. Because now many hospitals no longer use the traditional line ligation of umbilical stump, but with a very small plastic ring ligation, some children’s umbilical fossa is relatively deep, sometimes the plastic ring still remains in the umbilical fossa after the stump falls off, also can cause foreign body reaction to produce secretions, need doctors to examine carefully.
Umbilical hernia
Shortly after the umbilical cord fell off, some parents found that their children’s navel protruded as soon as they cried. It was round and deflated when they were pinched. The inside was still rumbling and looked scary. This was umbilical hernia.
Umbilical hernia incidence rate is very high, but fortunately the harm is very small, very few will have stuck intestines, in addition to the appearance of a little ugly, does not cause what influence on children. And umbilical hernia self-healing opportunities are very big, to about 1.5 years old most can self-heal, so rarely need surgery, even surgery also generally have to wait until after 4 years old to do again.
However, there are also some exceptions. If the umbilical ring defect is especially large (> 2 cm), or the defect continues to increase after one or two years old, the possibility of self-healing is small, so it should be operated earlier. Although it is rarely stuck, if the protruding mass is found to harden, the child should also be on guard against pain and crying.
Misunderstanding
As for navel, there are still some misunderstandings among the people, which should be avoided.
Some old people heard the rumbling of the child’s stomach and thought it was the wind in the navel. They thought it was only good to prick the child with a needle. In fact, this was the normal sound of bowel sounds and the sound of gas and liquid flowing in the intestines.
Some parents think that the navel is an important part and cannot be cleaned, otherwise they will get sick. In fact, the navel is complete and safe, and it is also the most commonly used surgical part for minimally invasive surgery. It can be cleaned safely. If it is not cleaned for a long time, dirt will remain, which may induce omphalitis and other problems.
Author: Pei Honggang
The article was reprinted by Clove Garden authorized by the author.