Umbilical Cord Care 101: Safe Practices, Myths & Signs of Infection

The Umbilical cord is a vital lifeline that connects the fetus to the placenta. It usually contains two arteries and one vein encased in Wharton’s jelly, a protective gelatinous substance. It plays an important role in the development of the fetus. It brings oxygen and all the needed nutrients to the fetus and takes out CO2 and other residues from it.

After the baby is born and is able to address its needs in a more direct manner (such as breathing and drinking milk), the body treats the umbilical cord as waste. Although the umbilical cord is something that the baby’s body tries to get dispense of, until it is attached to the baby’s body, it needs to be cared for. In this article, we will discuss the necessary care that is needed for proper management of the umbilical cord after birth, including immediate postnatal care, routine care instructions for parents, common complications, red flags that warrant medical attention, and some common misconceptions on this matter.

Immediate postnatal care:

Right after birth, the umbilical cord must be clamped and cut, leaving a stump that requires careful management to prevent infection (omphalitis) and promote natural healing. According to Nelson's textbook of pediatrics, “Delayed cord clamping (30–60 seconds post-delivery) is now recommended for term and preterm infants, improving neonatal circulation and increasing neonatal red blood cell volume.” The stump should be kept clean and dry, with routine antiseptic applications, such as chlorhexidine, suggested in settings with high neonatal infection rates. Immediate care is done by experienced obstetricians, and parents should not be worried about this matter.

Routine Care for the umbilical cord:

Parents should keep the umbilical cord clean using a clean, damp cloth. Alcohol wipes might be suggested by pediatricians, but are not generally recommended. It is also necessary for the umbilical cord to be kept dry, as moisture may help the bacteria grow and cause infection. Applying other substances, such as traditional remedies and powders, is generally not recommended. Nelson's textbook of pediatrics advises parents to “Inspect daily for signs of infection, such as redness, swelling, or foul odor,” as they could be an early sign of infection. For minor concerns, parents may use warm water for cleaning the area and then patting it dry gently. Elevating the diaper away from the stump can also be used to prevent irritation. If the routine cares fail or parents are more than mildly concerned, seeking medical advice is necessary.

Common Misconceptions:

Many parents encounter misinformation about umbilical cord care, which may lead to some improper practices. Some of these common myths are:

The use of alcohol is always necessary: While alcohol was historically recommended, many guidelines now prioritize keeping the stump dry and clean without routine alcohol application.

Forcing the stump off speeds up healing: Parents should be advised never to pull or force the stump off, as this can lead to bleeding and infection.

Traditional remedies are safe: Applying powders, oils, or herbal treatments can introduce pathogens and increase the risk of omphalitis.

A foul smell always indicates infection: While odor can be a sign of infection, it may also occur as the stump naturally separates. Parents should be instructed to look for accompanying signs like redness, swelling, or discharge.

Natural separation of the cord and when to be concerned:

According to Nelson's textbook of pediatrics, “The cord stump typically dries and falls off within 1–3 weeks. Delayed separation beyond this period may indicate an underlying condition, such as leukocyte adhesion deficiency.” Delayed separation of the cord stump (more than 3 weeks) may need a proper assessment by a pediatrician. But even before the 3-week period ends, parents should consult a physician if there is excessive bleeding or if there are signs of infection. Normal bleeding is considered a small amount of spotting or smudges of blood on the diaper or clothing around the time the stump detaches. Anything heavier is considered not normal and might need further assessment.

Common complications of the umbilical cord

Bleeding: As we mentioned before, minor bleeding occurs when the stump detaches. Persistent bleeding may require evaluation for coagulation disorders.

Umbilical Granuloma: according to Nelson, umbilical granuloma is “A small, moist, pink overgrowth of tissue at the stump site. Silver nitrate application or cryotherapy effectively resolves most cases.”

Umbilical Hernia:  textbook mentions it is “Common in neonates, especially preterm infants. Most hernias resolve spontaneously by age five, but surgical repair may be required in persistent cases.”

Umbilical cord infection or Omphalitis: it is one of the most severe complications of the umbilical cord, especially when left untreated. Nelson describes omphalitis as “A severe infection characterized by erythema, swelling, and purulent discharge.” Prompt antibiotic treatment is essential to prevent systemic involvement. In more severe cases, admission to the hospital might be necessary. “Mortality rates for untreated omphalitis can be significant, emphasizing the need for rapid intervention”.

Authored by:
Dr. Alireza Sarmadi
Family Physician

References:

Nelson Textbook of Pediatrics, 21^st ed. Chapters 113.3 and 125

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